What is the typical duration of Tenofovir (tenofovir disoproxil fumarate) 300mg treatment for a patient with chronic Hepatitis B (HBV) infection?

Duration of Tenofovir 300mg Treatment for Chronic Hepatitis B

For most patients with chronic hepatitis B, tenofovir 300mg treatment should be continued indefinitely (lifelong), as discontinuation typically leads to virologic relapse unless HBsAg loss occurs. 1

Treatment Duration Based on Disease Characteristics

Patients Requiring Lifelong Therapy

• All patients with decompensated cirrhosis at treatment initiation must receive lifelong antiviral therapy regardless of virologic response 1
• Patients with compensated cirrhosis (F4) or significant fibrosis (F3) at baseline should continue indefinite treatment due to persistent HCC risk and potential for severe hepatitis flares 1
• HBeAg-negative patients generally require long-term (indefinite) treatment because discontinuation without HBsAg loss leads to virologic relapse 1, 2

Potential Stopping Points (Rare)

• HBsAg loss with or without seroconversion is the only acceptable endpoint for treatment discontinuation in non-cirrhotic patients 1

  • Continue therapy for at least 12 months after confirmed HBsAg loss before considering discontinuation 2
  • Confirm HBsAg loss by repeating the test within 1-3 months to exclude laboratory error 2
  • Even after HBsAg loss, cirrhotic patients should continue indefinite therapy 2

• HBeAg-positive patients with minimal fibrosis (<F3) who achieve HBeAg seroconversion may consider discontinuation after 6-12 months of consolidation therapy, though long-term therapy is increasingly preferred due to risk of recurrent viremia and ALT flares 1

Expected Treatment Outcomes Over Time

Virologic Response Timeline

• Week 12: Monitor for primary treatment failure (HBV DNA decline <1 log₁₀ IU/mL) 1
• Week 24: Confirm continued viral suppression; 93% should have HBV DNA <400 copies/mL 1
• Year 5: 96-99% achieve HBV DNA <400 copies/mL with continued treatment 1
• Years 7-8: 98-99.6% maintain undetectable HBV DNA 3, 4

Resistance Profile

• No genotypic resistance to tenofovir has been detected through 8-10 years of treatment 1, 3, 4
• Virologic breakthrough is rare and typically due to nonadherence rather than resistance 1

Special Circumstances Requiring Extended Treatment

Immunosuppression or Chemotherapy

• Continue tenofovir prophylaxis throughout the entire duration of immunosuppressive therapy 3
• Extend treatment for at least 12 months after cessation of immunosuppression (24 months for rituximab) 3, 2

HIV Coinfection

• Treatment must be indefinite as part of combination antiretroviral therapy active against both viruses 5

Monitoring During Long-Term Treatment

• HBV DNA: Every 3-6 months during first year, then every 6-12 months 1, 3
• Liver enzymes (ALT/AST): Every 3-6 months 3
• Renal function (creatinine, CrCl): Every 3-12 months depending on risk 3
• Quantitative HBsAg: Annually to assess for potential functional cure 3
• HCC surveillance: Every 6 months for high-risk patients (cirrhosis, Asian men >40, Asian women >50, family history) 3

Critical Pitfalls to Avoid

• Do not discontinue therapy based solely on undetectable HBV DNA without HBsAg loss, as this leads to virologic relapse 1, 2
• Do not attribute virologic breakthrough to resistance first—assess adherence and drug interactions before resistance testing 3
• Do not delay or discontinue HCC surveillance even with complete viral suppression, as risk persists indefinitely 3