Relationship Between Low-level Viremia And Hepatic Inflammation And Fibrosis In Patients With Chronic Hepatitis B And Hepatitis B Cirrhosis

Objective:To investigate the relationship between low-level viremia(LLV)and the progression of liver inflammation and fibrosis in patients with chronic hepatitis B(CHB)and hepatitis B cirrhosis(LC).Methods:A total of 417 CHB and LC patients who attended the Liver Disease Clinic of the Affiliated Hospital of Medical College Qingdao University for≥1 year of oral nucleos(t)ide antiviral therapy and had HBV DNA<2000 IU/ml were selected to assess the proportion of low-level viremia(LLV)before November 30,2021.According to whether HBV DNA was≥10 IU/ml in the study subjects.Further,according to the HBV DNA level of the study subjects,they were divided into low-level viremia group(LLV,10 IU/ml≤HBV DNA<2000 IU/ml)and complete virological response group(CVR,HBV DNA<10 IU/ml).The differences in general data,virology data,biochemistry data and liver fibrosis indicators before and after antiviral therapy were compared between the two groups,and the influencing factors of LLV occurrence were analyzed.Meanwhile,the degree of changes in liver inflammation and fibrosis parameters before and after antiviral therapy was compared two groups.And the relationship between LLV and the progression of liver inflammation and fibrosis was analyzed.Results:1.After≥1 year of oral nucleos(t)ide antiviral therapy in CHB patients and LC patients,LLV accounted for 41.5%of patients with HBV DNA<2000 IU/ml,and 10IU/ml≤HBV DNA<1000 IU/ml was predominant,accounting for 94.8%.2.Family history of cirrhosis or liver cancer(HCC)before antiviral therapy and HBe Ag positivity were risk factors for the development of LLV,with ORs of 2.929 and3.099,respectively.Meanwhile,high levels of HBV DNA(>1.0×10~8 IU/m L)before antiviral therapy were a risk factor for the development of LLV,with an OR of 10.790.However,AST>40 U/Lbefore antiviral therapy could reduce the risk of LLV,with an OR of 0.355.HBe Ag positivity after antiviral therapy was also a risk factor for the development of LLV,with an OR of 4.394.The treatment course of antiviral therapy is an important factor in reducing the occurrence of LLV,and the treatment course of antiviral therapy is prolonged and patients have reduced risk of developing LLV.3.ΔAST andΔAFP changed significantly in patients in the CVR group compared with patients in the LLV group,and the occurrence of LLV was negatively correlated withΔAST andΔAFP(T=-0.114,-0.192,P=0.018,<0.001),and liver inflammation was significantly relieved in patients with CVR obtained after antiviral therapy,indicating that the occurrence of LLV lead to a lower control of liver inflammation in patients treated with antiviral therapy.ΔAPRI andΔFIB-4 changed significantly in the CVR group compared with patients in the LLV group,and the occurrence of LLV was negatively correlated withΔAPRI andΔFIB-4(T=-0.210,-0.202,P=0.02,0.003),and liver fibrosis was significantly improved in CVR patients obtained after antiviral therapy,indicating that the occurrence of LLV resulted in a reduced degree of liver fibrosis remission in patients treated with antiviral therapy.Conclusions:1.After CHB and LC patients received≥1 year of antiviral therapy with NAs,LLV accounted for 41.5%and LLV accounted for a relatively high proportion of patients with HBV DNA<2000 IU/ml.The incidence of LLV requires our attention,and highly sensitive HBV DNA detection modalities are used to monitor HBV DNA for CHB and LC patients to improve the early diagnosis rate of LLV.2.In this study,family history of LC or HCC,HBe Ag positivity,high levels of HBV DNA and low levels of AST before antiviral therapy were all risk factors for the development of LLV.HBe Ag failure to turn negative after more than 1 year of antiviral therapy is also a risk factor for the development of LLV,and prolonged antiviral therapy is an important factor to reduce the risk of LLV development.3.The occurrence of LLV leads to a slowing of liver inflammation and fibrosis remission in patients treated with antiviral therapy,and the occurrence of LLV affects the efficacy of antiviral therapy in CHB and LC patients.