Virologic Response to Antiviral Therapy in Chronic Hepatitis B Patients With High Viral Load: A Real-World Cohort Study

IF 2.3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Viral Hepatitis Pub Date : 2026-08-24 DOI:10.1111/jvh.70226

Siwei Zheng, Xueyan Li, Hongli Liu, Tianhao Mao, You Ge, Wenjing Ji, Xixuan Wang, Yijun Bao, Yu Zhang, Anling Zhou, Qunzeng Danzeng, Jialuo Wang, Feng Yang, Qingfang Xiong, Yongfeng Yang

{"title":"Virologic Response to Antiviral Therapy in Chronic Hepatitis B Patients With High Viral Load: A Real-World Cohort Study","authors":"Siwei Zheng, Xueyan Li, Hongli Liu, Tianhao Mao, You Ge, Wenjing Ji, Xixuan Wang, Yijun Bao, Yu Zhang, Anling Zhou, Qunzeng Danzeng, Jialuo Wang, Feng Yang, Qingfang Xiong, Yongfeng Yang","doi":"10.1111/jvh.70226","DOIUrl":null,"url":null,"abstract":"<div>\n \n Current guidelines for chronic hepatitis B (CHB) have progressively expanded antiviral treatment indications, with age > 30 years increasingly being incorporated as an important criterion. However, real-world evidence regarding treatment outcomes in this expanded population remains limited. This study evaluated the 48-week treatment response and its independent predictors in treatment-naïve CHB patients aged > 30 years with a high baseline viral load. This retrospective study included 808 treatment-naïve CHB patients aged > 30 years with baseline HBV DNA ≥ 2000 IU/mL who received first-line nucleos(t)ide analogue (NA) monotherapy. Patients were classified into moderately high (MH; ≥ 2 × 103 to < 1 × 107 IU/mL) and extremely high (EH; ≥ 1 × 107 IU/mL) viral load groups. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were applied to adjust for baseline imbalance. At week 48, the overall virological response (VR) rate was 90.0% (727/808). Among HBeAg-positive patients at baseline, the HBeAg seroclearance and seroconversion rates were 14.0% (59/422) and 11.8% (50/422), respectively. Compared with the MH group, the EH group had significantly lower rates of VR (81.8% vs. 95.5%, p < 0.001), HBeAg seroclearance (9.4% vs. 22.6%, p < 0.001) and HBeAg seroconversion (7.2% vs. 20.5%, p < 0.001). Multivariable Cox regression analysis showed that ALT ≥ 5 × ULN was independently associated with a higher likelihood of VR, whereas HBeAg positivity and HBV DNA ≥ 1 × 107 IU/mL were independently associated with a lower likelihood of VR. These associations remained robust after PSM and IPTW adjustment. First-line NA therapy achieved a favourable 48-week VR in CHB patients aged > 30 years with a high viral load. However, HBeAg positivity and extremely high viral load were associated with suboptimal response, supporting intensified monitoring and individualised management.\n </div>","PeriodicalId":17762,"journal":{"name":"Journal of Viral Hepatitis","volume":"33 9","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Viral Hepatitis","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jvh.70226","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Current guidelines for chronic hepatitis B (CHB) have progressively expanded antiviral treatment indications, with age > 30 years increasingly being incorporated as an important criterion. However, real-world evidence regarding treatment outcomes in this expanded population remains limited. This study evaluated the 48-week treatment response and its independent predictors in treatment-naïve CHB patients aged > 30 years with a high baseline viral load. This retrospective study included 808 treatment-naïve CHB patients aged > 30 years with baseline HBV DNA ≥ 2000 IU/mL who received first-line nucleos(t)ide analogue (NA) monotherapy. Patients were classified into moderately high (MH; ≥ 2 × 10³ to < 1 × 10⁷ IU/mL) and extremely high (EH; ≥ 1 × 10⁷ IU/mL) viral load groups. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were applied to adjust for baseline imbalance. At week 48, the overall virological response (VR) rate was 90.0% (727/808). Among HBeAg-positive patients at baseline, the HBeAg seroclearance and seroconversion rates were 14.0% (59/422) and 11.8% (50/422), respectively. Compared with the MH group, the EH group had significantly lower rates of VR (81.8% vs. 95.5%, p < 0.001), HBeAg seroclearance (9.4% vs. 22.6%, p < 0.001) and HBeAg seroconversion (7.2% vs. 20.5%, p < 0.001). Multivariable Cox regression analysis showed that ALT ≥ 5 × ULN was independently associated with a higher likelihood of VR, whereas HBeAg positivity and HBV DNA ≥ 1 × 10⁷ IU/mL were independently associated with a lower likelihood of VR. These associations remained robust after PSM and IPTW adjustment. First-line NA therapy achieved a favourable 48-week VR in CHB patients aged > 30 years with a high viral load. However, HBeAg positivity and extremely high viral load were associated with suboptimal response, supporting intensified monitoring and individualised management.

查看原文本刊更多论文

高病毒载量慢性乙型肝炎患者抗病毒治疗的病毒学反应：一项真实世界队列研究

目前的慢性乙型肝炎（CHB）指南已经逐步扩大了抗病毒治疗的适应症，年龄越来越多地被纳入作为一个重要的标准。然而，关于这一扩大人群的治疗结果的真实证据仍然有限。本研究评估了年龄在bb0 ~ 30岁、基线病毒载量高的treatment-naïve慢性乙型肝炎患者的48周治疗反应及其独立预测因素。本回顾性研究纳入808例treatment-naïve CHB患者，年龄为bb0 ~ 30岁，基线HBV DNA≥2000 IU/mL，接受一线核苷(t)类似物（NA）单药治疗。将患者分为中高（MH,≥2 × 103 ~ 7 IU/mL）和极高（EH,≥1 × 107 IU/mL）病毒载量组。采用倾向得分匹配（PSM）和处理加权逆概率（IPTW）来调整基线失衡。第48周时，总病毒学应答率为90.0%（727/808）。在基线时HBeAg阳性患者中，HBeAg血清清除率和血清转化率分别为14.0%（59/422）和11.8%（50/422）。与MH组相比，EH组的VR发生率明显较低（81.8% vs. 95.5%）， p 7 IU/mL与VR的可能性较低独立相关。在调整PSM和IPTW后，这些关联仍然很强。一线NA治疗在年龄在bb0 ~ 30岁的高病毒载量CHB患者中取得了良好的48周VR。然而，HBeAg阳性和极高的病毒载量与次优反应相关，支持加强监测和个性化管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Viral Hepatitis 医学-病毒学

CiteScore

6.00

自引率

8.00%

发文量

138

审稿时长

1.5 months

期刊介绍： The Journal of Viral Hepatitis publishes reviews, original work (full papers) and short, rapid communications in the area of viral hepatitis. It solicits these articles from epidemiologists, clinicians, pathologists, virologists and specialists in transfusion medicine working in the field, thereby bringing together in a single journal the important issues in this expanding speciality. The Journal of Viral Hepatitis is a monthly journal, publishing reviews, original work (full papers) and short rapid communications in the area of viral hepatitis. It brings together in a single journal important issues in this rapidly expanding speciality including articles from: virologists; epidemiologists; clinicians; pathologists; specialists in transfusion medicine.