Profile Of Low Level Viremia In Patients With Chronic Hepatitis B

ObjectiveTo investigate the proportion of chronic hepatitis B(CHB)with low level viremia(LLV)(HBV DNA : 10-999IU/m L),analyse differences in clinical features and laboratory indicators between LLV group and complete virological response(CVR)(HBV DNA<10IU/m L)group,evaluate factors associated with LLV.MethodsTotal 86 CHB patients(HBV DNA < 1000IU/m L)were included from August2020 to February 2021.The general clinical features like gender,age,body mass index(BMI),cirrhosis,medication history of nucleos(t)ide analogues(NAs),duration of NAs,and the serum biochemical indicators including HBe Ag,HBe Ab,ALT,AST,ALB,TBi L,GGT,ALP,AFP were recorded.HBV DNA was quantified by Abbot Real Time HBV Test(lower limit of detection=20IU/m L).Liver Stiffness Measurements(LSMs)were performed using Fibroscan.All the results mentioned above were statistically analyzed and Logistic regression was used to analyze the influencing factors of low level viremia.Results1.Total 86 CHB patients were included,in which the males account for 70.9%,and the average age of all was(45.7±12.5).Among the patients who received antiviral therapy with NAs,35(40.7%)patients had low level viremia.Low level replication of HBV DNA was still observed in 30.6%(19/62)of first-line NAs-naive patients.2.No significant differences of gender,age,BMI,alcohol intake,diabetes and fatty liver disease were observed in LLV group and CVR group(P>0.05).3.No significant differences of cirrhosis were observed in LLV group and CVR group.The positive-HBe Ag rate was higher in LLV group than CVR group(42.9%vs.11.8%,P<0.05).All 5 CHB who received therapy with not-first-line NAs had low level viremia.Among patients received therapy with first-line NAs,whether NAs-naive was statistically significant in LLV group and CVR group(P<0.05).4.ALT level was(32.09±15.70)U/L in LLV group and(24.54±14.73)U/L in CVR group,and the difference was statistically significant(P<0.05),but significant difference was only observed in HBV DNA<10IU/m L and 100-999IU/m L group(P<0.05).ALT=23U/L was the most sensitive cut-off value for predicting HBV DNA<10IU/m L.No significant differences of AST,ALB,TBi L,GGT,ALP,AFP were observed in LLV group and CVR group(P>0.05).5.In un-adjusted analysis,The Age,positive-HBe Ag,cirrhosis,medication history of non-first-line NAs and duration of NAs were associated with LLV.In multivariable models,the positive-HBe Ag(OR=9.00,P=0.001),medication history of non-first-line NAs(OR=7.38,P=0.001)and prolonged the duration of NAs(>3years)(OR=0.21,P=0.048)were associated with LLV.ConclusionLow level viremia was observed in 30.6%-40.7% CHB patients receiving antiviral therapy with NAs,which leads to low-grade inflammation.ALT=23U/L is a sensitive indicator for predicting HBV DNA<10IU/L.Positive-HBe Ag and medication history of non-first-line NAs were independent risk factor associated with LLV.Prolonged the duration of NAs(>3years)may be helpful to achieve complete virological response.