Reevaluating antiviral thresholds in HBV DNA-negative inactive HBsAg carriers: a multicenter histopathological analysis.

IF 4 3区医学 Q2 VIROLOGY

Virology Journal Pub Date : 2025-07-10 DOI:10.1186/s12985-025-02853-0

Shan Ren, Sujun Zheng, Xinyang Zhang, Junliang Fu, Rongshan Fan, Qingfa Ruan, Wenqi Huang, Haibing Gao, Xiulan Xue, Fang Yang, Yao Xie, Minghui Li, Xinyue Chen

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引用次数: 0

Abstract

Background: The definition of inactive HBsAg carriers (IHC) varies globally, particularly regarding HBV DNA thresholds. Whether HBV DNA negativity reliably predicts histological quiescence remains uncertain.

Aims: This study evaluated liver pathology in IHC patients to reassess antiviral therapy thresholds.

Methods: This multi-center, retrospective study included 231IHCs(2018-2023) stratified by HBV DNA negativity (< 20IU/mL). Liver biopsies assessed inflammation (G ≥ 2) and fibrosis (F ≥ 2); evident hepatic injury (EHI) was defined as G ≥ 2 and/or F ≥ 2. Multivariable models evaluated predictors.

Results: Among 231 IHC patients(median age:43 years old; 95.2% ≥30 years old), 35.9%(83/231) were HBV DNA negative. The median HBsAg and HBV DNA level were 132 IU/ml and 94 IU/ml, respectively. Notably, EHI prevalence was significantly higher in HBV DNA negative patients than positive ones(44.9% vs. 31%, P = 0.04), driven by fibrosis (F ≥ 2: 42.2% vs. 21.6%, P < 0.001), challenging the assumption that HBV DNA negativity ensures low histological risk. Male sex, HBV DNA negativity, and elevated liver stiffness measurement(LSM) independently predicted EHI (OR = 3.37, AUC = 0.747).

Conclusion: HBV DNA negativity does not guarantee histological quiescence in inactive HBsAg carriers aged ≥ 30 years, with 44.9% exhibiting significant liver injury. In this population, LSM > 6.4 Kpa should prompt consideration of liver biopsy and/or initiation of antiviral therapy.

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重新评估HBV dna阴性无活性HBsAg携带者的抗病毒阈值：一项多中心组织病理学分析。

背景：非活性HBsAg携带者（IHC）的定义在全球范围内有所不同，特别是在HBV DNA阈值方面。HBV DNA阴性是否可靠地预测组织学静止仍不确定。目的：本研究评估免疫组化患者的肝脏病理，以重新评估抗病毒治疗的阈值。方法：这项多中心回顾性研究纳入了231ihc患者（2018-2023），按HBV DNA阴性分层(结果：231例IHC患者(中位年龄：43岁；95.2%≥30岁),35.9%（83/231）为HBV DNA阴性。中位HBsAg和HBV DNA水平分别为132 IU/ml和94 IU/ml。值得注意的是，HBV DNA阴性患者的EHI患病率明显高于阳性患者（44.9% vs. 31%, P = 0.04），这是由纤维化引起的（F≥2:42.2% vs. 21.6%）。结论：≥30岁的非活性HBsAg携带者HBV DNA阴性不能保证组织学静止，44.9%表现为明显的肝损伤。在该人群中，LSM > 6.4 Kpa应提示考虑肝活检和/或开始抗病毒治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Virology Journal 医学-病毒学

CiteScore

7.40

自引率

2.10%

发文量

186

审稿时长

1 months

期刊介绍： Virology Journal is an open access, peer reviewed journal that considers articles on all aspects of virology, including research on the viruses of animals, plants and microbes. The journal welcomes basic research as well as pre-clinical and clinical studies of novel diagnostic tools, vaccines and anti-viral therapies. The Editorial policy of Virology Journal is to publish all research which is assessed by peer reviewers to be a coherent and sound addition to the scientific literature, and puts less emphasis on interest levels or perceived impact.