中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 41 Issue 6
Jun.  2025
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2025  >  41(6): 1056-1061

Influence of antiviral treatment adjustment on the prognosis of chronic hepatitis B patients with low-level viremia

DOI: 10.12449/JCH250609
  • 1.

    Peking University 302 Clinical Medical School，Beijing 100039，China

  • 2.

    Senior Department of Hepatology，The Fifth Medical Center of PLA General Hospital，Beijing 100039，China

Research funding:

General Project of National Natural Science Foundation of China (82470632);

National Key Research and Development Program of China (2023YFC2306800)

More Information
  • Corresponding author: JI Dong， jidg302@126.com （ORCID： 0000-0001-8214-462X）
  • Received Date: 2024-11-11
  • Accepted Date: 2024-12-26
  • Published Date: 2025-06-25
    Abstract
  •   Objective  To investigate the incidence rate of primary liver cancer （PLC） and the progression of liver fibrosis in chronic hepatitis B （CHB） patients with low-level viremia （LLV） （HBV DNA<2 000 IU/mL but ≥20 IU/mL） after treatment adjustment， and to provide more robust evidence for clinical practice.  Methods  A retrospective analysis was performed for the clinical data of LLV patients who initially received nucleos（t）ide analogue （NAs） for at least 48 weeks at the Fifth Medical Center of PLA General Hospital from August 2007 to April 2017 and subsequently underwent NAs adjustment due to LLV， and according to the virologic response after 48 weeks of treatment adjustment， the patients were divided into LLV group and complete virological response （CVR） group （HBV DNA<20 IU/mL）. The patients were followed up once every 3‍ ‍—‍ ‍6 months till the primary endpoint event of PLC or October 2024. The incidence rate of PLC and the progression of liver fibrosis were observed， and the progression of liver fibrosis was defined as an increase of ≥1 grade in fibrosis-4 （FIB-4） index. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups； the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to calculate the cumulative incidence rate of PLC， and the Log-rank test was used for comparison between groups； the Cox regression analysis was used to investigate the risk factors for PLC， and the Logistic regression analysis was used to investigate the influencing factors for the progression of liver fibrosis.  Results  A total of 307 patients were enrolled， with a mean age of 50.0 years， and the male patients accounted for 80.5%. After 48 weeks of treatment with the adjusted NAs regimen， 254 patients （82.7%） achieved CVR， and 53 patients （17.3%） still had LLV. For the LLV group， the incidence rate of PLC was 30.2% and the rate of liver fibrosis progression was 22.6%， while for the CVR group， the incidence rate of PLC was only 13.4%， and the rate of liver fibrosis progression was 7.5%. The multivariate regression analyses showed that LLV was an independent risk factor for the onset of PLC （hazard ratio=2.623， 95% confidence interval ［CI］： 1.315‍ ‍—‍ ‍5.234， P=0.006） and the progression of liver fibrosis （odds ratio=3.213， 95%CI： 1.385‍ ‍—‍ ‍7.455， P=0.007）.  Conclusion  Active adjustment of treatment is needed immediately after the diagnosis of LLV to improve CVR， and if LLV persists after treatment adjustment， it is necessary to enhance the monitoring of liver fibrosis progression and PLC， so as to facilitate early diagnosis and treatment.

     

    • FullText(HTML)
  • loading
    • References(21)
  • [1]
    Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B(version 2022)[J]. Chin J Clin Infect Dis, 2022, 15( 6): 401- 427. DOI: 10.3760/cma.j.issn.1674-2397.2022.06.001.

    中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2022年版)[J]. 中华临床感染病杂志, 2022, 15( 6): 401- 427. DOI: 10.3760/cma.j.issn.1674-2397.2022.06.001.
    [2]
    ZHUANG H. Progress towards elimination of hepatitis B[J]. J Clin Hepatol, 2024, 40( 5): 857- 860. DOI: 10.12449/JCH240501.

    庄辉. 消除乙型肝炎进展[J]. 临床肝胆病杂志, 2024, 40( 5): 857- 860. DOI: 10.12449/JCH240501.
    [3]
    TERRAULT NA, LOK ASF, MCMAHON BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance[J]. Hepatology, 2018, 67( 4): 1560- 1599. DOI: 10.1002/hep.29800.
    [4]
    ZHANG Q, CAI DC, HU P, et al. Low-level viremia in nucleoside analog-treated chronic hepatitis B patients[J]. Chin Med J(Engl), 2021, 134( 23): 2810- 2817. DOI: 10.1097/CM9.0000000000001793.
    [5]
    MARTINEZ MG, BOYD A, COMBE E, et al. Covalently closed circular DNA: The ultimate therapeutic target for curing HBV infections[J]. J Hepatol, 2021, 75( 3): 706- 717. DOI: 10.1016/j.jhep.2021.05.013.
    [6]
    SHI Y, ZHENG M. Hepatitis B virus persistence and reactivation[J]. BMJ, 2020, 370: m2200. DOI: 10.1136/bmj.m2200.
    [7]
    JIN Y, SHEN YL, LI T. Research progress of low-level viremia in chronic hepatitis B patients treated with nucleos(t)ide analogues[J]. Chin Hepatol, 2024, 29( 8): 896- 899. DOI: 10.3969/j.issn.1008-1704.2024.08.004.

    金燚, 沈泳利, 李佟. 核苷(酸)类似物经治的慢性乙型肝炎患者低病毒血症的研究进展[J]. 肝脏, 2024, 29( 8): 896- 899. DOI: 10.3969/j.issn.1008-1704.2024.08.004.
    [8]
    YANG J, CHOI WM, SHIM JH, et al. Low level of hepatitis B viremia compared with undetectable viremia increases the risk of hepatocellular carcinoma in patients with untreated compensated cirrhosis[J]. Am J Gastroenterol, 2023, 118( 6): 1010- 1018. DOI: 10.14309/ajg.0000000000002181.
    [9]
    KIM JH, SINN DH, KANG W, et al. Low-level viremia and the increased risk of hepatocellular carcinoma in patients receiving entecavir treatment[J]. Hepatology, 2017, 66( 2): 335- 343. DOI: 10.1002/hep.28916.
    [10]
    CHEN H, FU JJ, LI L, et al. Risk factors of low-level viremia in chronic hepatitis B patients receiving Entecavir monotherapy: A retrospective cohort study[J]. J Gastroenterol Hepatol, 2024, 39( 1): 180- 184. DOI: 10.1111/jgh.16357.
    [11]
    LI ZB, CHEN DD, JIA YF, et al. Risk factors related to low-level viraemia in chronic hepatitis B patients receiving entecavir treatment[J]. Front Cell Infect Microbiol, 2024, 14: 1413589. DOI: 10.3389/fcimb.2024.1413589.
    [12]
    Chinese Society of Liver Cancer, Chinese Anti-Cancer Association; Chinese Society of Clinical Oncology, Chinese Anti-Cancer Association; Liver Cancer Group, Chinese Society of Hepatology. Expert consensus on standardized diagnosis and treatment of primary liver cancer[J]. J Clin Hepatol, 2009, 25( 2): 83- 92.

    中国抗癌协会肝癌专业委员会, 中国抗癌协会临床肿瘤学协作专业委员会, 中华医学会肝病学分会肝癌学组. 原发性肝癌规范化诊治的专家共识[J]. 临床肝胆病杂志, 2009, 25( 2): 83- 92.
    [13]
    LYU GJ, CHEN C, HE MW, et al. Curative effect evaluation of compound Biejia Ruangan tablet on hepatic fibrosis of nonalcoholic fatty liver disease[J]. Infect Dis Inf, 2024, 37( 1): 1- 4. DOI: 10.3969/j.issn.1007-8134.2024.01.001.

    吕桂基, 陈椿, 贺梦雯, 等. 复方鳖甲软肝片对非酒精性脂肪性肝病肝纤维化的疗效评价[J]. 传染病信息, 2024, 37( 1): 1- 4. DOI: 10.3969/j.issn.1007-8134.2024.01.001.
    [14]
    CHENG QQ, YANG LX, CAI TP, et al. Influencing factors for low-level viremia and their dynamic changes in patients with chronic hepatitis B treated with nucleos(t)ide analogues for the first time[J]. J Clin Hepatol, 2022, 38( 12): 2716- 2722. DOI: 10.3969/j.issn.1001-5256.2022.12.008.

    程齐齐, 杨丽霞, 蔡天盼, 等. 核苷(酸)类似物初治的慢性乙型肝炎患者发生低病毒血症的影响因素及其动态变化分析[J]. 临床肝胆病杂志, 2022, 38( 12): 2716- 2722. DOI: 10.3969/j.issn.1001-5256.2022.12.008.
    [15]
    CHEN SH, WANG CY, GUO C, et al. Establishment of a nomogram model for predicting the survival of hepatitis B virus-related hepatocellular carcinoma[J]. J Clin Hepatol, 2022, 38( 7): 1566- 1571. DOI: 10.3969/j.issn.1001-5256.2022.07.020.

    陈松海, 王春艳, 郭畅, 等. 预测HBV相关肝细胞癌生存的列线图模型的建立[J]. 临床肝胆病杂志, 2022, 38( 7): 1566- 1571. DOI: 10.3969/j.issn.1001-5256.2022.07.020.
    [16]
    ALLWEISS L, DANDRI M. The role of cccDNA in HBV maintenance[J]. Viruses, 2017, 9( 6): 156. DOI: 10.3390/v9060156.
    [17]
    WANG Y, LI YM, ZAI WJ, et al. HBV covalently closed circular DNA minichromosomes in distinct epigenetic transcriptional states differ in their vulnerability to damage[J]. Hepatology, 2022, 75( 5): 1275- 1288. DOI: 10.1002/hep.32245.
    [18]
    Coorerative Group of Basic Research and Experimental Diagnosis of Liver Disease, Chinese Society of Hepatology, Chinese Medical Association. Expert consensus on the clinical application of the markers of hepatitis B virus[J]. Chin J Hepatol, 2023, 31( 4): 389- 400. DOI: 10.3760/cma.j.cn501113-20230314-00113.

    中华医学会肝病学分会基础医学与实验诊断协作组. 乙型肝炎病毒标志物临床应用专家共识[J]. 中华肝脏病杂志, 2023, 31( 4): 389- 400. DOI: 10.3760/cma.j.cn501113-20230314-00113.
    [19]
    ZHENG RJ, LU XB. Low-level viremia in chronic hepatitis B patients treated with first-line treatment with nucleos(t)ide analogues and its treatment strategies[J]. J Clin Hepatol, 2024, 40( 5): 880- 883. DOI: 10.12449/JCH240506.

    郑嵘炅, 鲁晓擘. 一线核苷(酸)类似物经治的慢性乙型肝炎患者低病毒血症的发生及治疗策略[J]. 临床肝胆病杂志, 2024, 40( 5): 880- 883. DOI: 10.12449/JCH240506.
    [20]
    SARIN SK, KUMAR M, LAU GK, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: A 2015 update[J]. Hepatol Int, 2016, 10( 1): 1- 98. DOI: 10.1007/s12072-015-9675-4.
    [21]
    LIN CL, LIU CH, WANG CC, et al. Serum biomarkers predictive of significant fibrosis and cirrhosis in chronic hepatitis B[J]. J Clin Gastroenterol, 2015, 49( 8): 705- 713. DOI: 10.1097/MCG.0000000000000250.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(3)  / Tables(5)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (767) PDF downloads(53) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return