48-week prognostic analysis of very low-level viremia in patients with hepatitis B cirrhosis: a single-center retrospective study.

Abstract

Objective: Despite improvements in the accuracy of hepatitis B virus (HBV) DNA detection, some patients with chronic hepatitis B (CHB) still have very low-level viremia (VLLV; HBV DNA is detectable but less than 20 IU/mL) after achieving a complete virologic response (CVR). This study aimed to investigate the prognosis of patients with cirrhotic hepatitis B and VLLV.

Methods: A total of 267 patients with hepatitis B cirrhosis from the Third People's Hospital of Taiyuan were retrospectively enrolled. All patients took oral antiviral drugs for more than 96 weeks and were divided into the target not-detected group (TND; HBV DNA undetectable) and the VLLV group (limits of detection < HBV DNA < 20 IU/mL) by high-sensitivity testing of HBV. The incidence of cirrhosis-related complications was observed.

Results: Compared to the TND group, the baseline levels of alanine aminotransferase (ALT; 20.0 vs. 26.0 U/L, p < 0.001), aspartate aminotransferase (AST; 24.0 vs. 27.5 U/L, p < 0.001), and gamma-glutamyl transferase (GGT; 21.0 vs. 30.5 U/L, p = 0.001) were significantly higher in the VLLV group, and so were liver stiffness values (9.4 vs. 10.8 kPa, p = 0.006). No significant difference was observed in the rate of new cirrhosis-related complications between the two groups. The HCC rate was 5.4% in TND and 4.7% in the VLLV (p > 0.05). Multifactorial logistic regression showed that the main factors affecting complications at baseline were age (OR:1.063; p = 0.034), hemoglobin level (OR:0.965; p = 0.036), and platelet count (OR:0.987; p = 0.029).

Conclusion: For cirrhotic patients with VLLV, the lower the level of HBV DNA, the less severe the liver injury. There was no difference in the 48-week complication rates between the TND group. Even in the TND group, which can develop new complications, regular follow-up should be performed.