| Objective: Low level viremia is a hot issue in clinic.The purpose of this study was to compare the incidence of low level viremia and complete virological response,and the time to achieve complete virological response after antiviral treatment with first-line nucleoside（acid）analogues in Yunnan province,and to further explore the correlation between complete virological response and liver hardness progression.Methods: The demographic and clinical data of all patients with chronic hepatitis B treated with first-line nucleoside（acid）analogues and followed up for more than 48 weeks were collected from January 2020 to December 2021 in the outpatient Department of Infectious Diseases of Yunnan First People’s Hospital.Patients were divided into entecavir,tenofovir disoproxil fumarate and tenofovir alafenamide fumarate groups according to the types of medication.The incidence of low level viremia,complete virologic response and the time to achieve complete virologic response were compared.According to the status of virological response,patients were divided into complete virological response group and incomplete virological response group.Multivariate Cox regression analysis was used to analyze the correlation between the patients and the progression of liver hardness.Results: A total of 354 patients with chronic hepatitis B were enrolled,and 41.1%（146/354）developed low level viremia after antiviral therapy.The incidence of low level viremia in entecavir group（36.5%,61/167）was lower than that in tenofovir disoproxil fumarate group（50.0%,71/142）,and the difference was statistically significant（P≤0.017）.There was no significant difference in the incidence of low level viremia between the entecavir group and the tenofovir alafenamide fumarate group（31.1%,14/45）or between the tenofovir disoproxil fumarate group and the tenofovir alafenamide fumarate group（P>0.017）.57.6%（204/354）patients achieved complete virologic response after antiviral treatment,among which the complete virologic response rate of entecavir group（62.8%,105/167）and tenofovir alafenamide fumarate group（68.8%,31/45）was higher than that of tenofovir disoproxil fumarate group（47.8%,68/142）,the difference was statistically significant（P<0.017）.There was no significant difference in complete virologic response rate between entecavir group and tenofovir alafenamide fumarate group（P>0.017）.Survival analysis showed that the overall median time to achieve complete virologic response was 20 months,and the median time to achieve complete virologic response was 19 months in the entecavir group,24 months in the tenofovir disoproxil fumarate group,and 8 months in the tenofovir alafenamide fumarate group,respectively.According to the survival curve,compared with the entecavir group and the tenofovir disoproxil fumarate group,The time required to achieve a complete virological response was shorter in the tenofovir alafenamide fumarate group（χ2=30.901,P<0.001）.Among 138 chronic hepatitis B patients with complete case data of liver hardness value,the value of liver hardness after antiviral therapy decreased compared with that before treatment,the difference was statistically significant [7.5（5.9-10.8）k Pa vs.6.3（5.4-7.9）k Pa,P<0.001].The proportion of liver hardness reversals in patients who achieved a complete virologic response was higher than that in patients with low level viremia,the difference being statistically significant [57.5%（50/87）vs.30.6%（15/49）,P=0.003].Multivariate Cox regression analysis showed that virologic response status was an independent factor affecting the reversal of liver hardness value（P=0.009）,and the reversal of liver hardness value in patients with complete virologic response was2.229 times higher than that in patients without complete virologic response（HR=2.229,95% CI: 1.223 ～ 4.061）;Gender,age,family history of hepatitis B,family history of cirrhosis,family history of hepatocellular carcinoma and fatty liver were not independent factors affecting the reversal of liver hardness value（P>0.05）.Conclusions: 1.After the first-line nucleoside（acid）analog antiviral treatment in patients with chronic hepatitis B in Yunnan area,the incidence of low level viremia in patients treated with entecavir was lower than that of tenofovir disoproxil fumarate,but there was no significant difference in the incidence of low level viremia between entecavir and tenofovir alafenamide fumarate or between tenofovir disoproxil fumarate and tenofovir alafenamide fumarate.2.After the first-line nucleoside（acid）analog antiviral treatment in patients with3.chronic hepatitis B in Yunnan area,Entecavir and tenofovir alafenamide fumarate antiviral treatment after complete virological response rate is higher than tenofovir disoproxil fumarate,entecavir and tenofovir alafenamide fumarate after antiviral therapy showed similar complete virological response rate,but the tenofovir alafenamide fumarate for complete virological response time is shorter.4.Early virological response after antiviral therapy is beneficial for the reversal of liver hardness. |
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