[Long-term therapeutic outcomes of antiviral treatment in patients with chronic hepatitis B infection with normal alanine aminotransferase, mild liver inflammation, and fibrosis].

Objective: To study the long-term prognostic outcomes of antiviral therapy in patients with chronic hepatitis B (CHB) accompanied with normal alanine aminotransferase (ALT), mild or slight inflammation, and/or liver fibrosis. Methods: A retrospective study method was used. Patients with CHB who underwent liver biopsy at Zhenjiang Third People's Hospital, affiliated with Jiangsu University, from January 2005 to July 2022 were included. Baseline data, clinical data, and clinical outcome events at the end of follow-up were collected. Cox proportional hazards regression and Kaplan-Meier survival analysis were used to assess the risk of clinical events. Results: A total of 149 CHB cases with normal ALT with mild or slight inflammation or fibrosis were included. Eighty-six cases were treated with antiviral therapy, while 63 were not. The median follow-up time was 82.00 (45.50,153.00) months. In the follow-up endpoint events, four cases (4.65%, 4/86) in the antiviral group had liver cirrhosis, while none had progressed to hepatocellular carcinoma. Five cases (7.94%, 5/63) in the non-antiviral group had liver cirrhosis, and two cases (3.17%, 2/63) had hepatocellular carcinoma. Kaplan-Meier survival analysis showed that the cumulative risk of clinical events did not significantly increase in the non-antiviral group (P>0.05). The presence of liver fibrosis with high-normal ALT levels at baseline were associated with an increased risk of clinical events (P<0.05). Cox analysis showed that baseline age, high ALT level, and presence of liver fibrosis were independent risk factors for clinical events. The two groups differed significantly in terms of the proportion of HBVDNA below the detection value and ALT normalization rate at the endpoint (P<0.05). However, there was no significant difference in the HBsAg negative conversion rate between the two groups at the end (P>0.05). Conclusion: The occurrence risk of long-term liver adverse events was not significantly improved by antiviral treatment in patients with chronic hepatitis B accompanied by normal ALT levels, mild or slight inflammation, and/or liver fibrosis. However, clinical outcomes were associated with baseline age, higher ALT levels, and liver fibrosis, suggesting that these factors are independent risk factors for the occurrence of clinical events.