Low Level of Hepatitis B Viremia Compared With Undetectable Viremia Increases the Risk of Hepatocellular Carcinoma in Patients With Untreated Compensated Cirrhosis

Abstract

INTRODUCTION:The initiation of antiviral treatment in patients with chronic hepatitis B with compensated cirrhosis and low-level viremia (LLV; HBV DNA 15–2,000 IU/mL) remains controversial. We sought to compare the long-term outcomes of these untreated patients according to their viremic status.METHODS:Six hundred twenty-seven untreated patients with chronic hepatitis B with compensated cirrhosis were analyzed retrospectively. The risk of hepatocellular carcinoma (HCC) and liver-related clinical events, including hepatic decompensation, were compared between patients with LLV and undetectable HBV DNA. Patients who received antiviral treatment were censored during treatment initiation.RESULTS:The mean age of the patients was 54.7 years, 64.4% of whom were male. During the study period, 59 patients developed HCC (20 and 39 in the undetectable and LLV groups, respectively) with an annual incidence of 2.44/100 person-years. Multivariable analysis revealed that the LLV group was associated with a significantly higher risk of HCC (adjusted hazard ratio: 2.36, P = 0.002) than the undetectable group. In the 204 propensity score–matched cohort, the LLV group had a 2.16-fold greater risk of HCC than the undetectable group (P = 0.014). Liver-related clinical events occurred in 121 patients with an annual incidence of 5.25/100 person-years. Despite not reaching statistical significance, the LLV group tended to have a higher risk of liver-related events in the propensity score–matched cohort (hazard ratio: 1.14, P = 0.50).DISCUSSION:Compared with patients with undetectable HBV DNA, those with compensated cirrhosis and LLV had a significantly higher risk of HCC. Antiviral treatment should be advised for these patients.

Patients With Compensated Hepatitis B Virus-Related Cirrhosis and Low-Level Viremia: Treat or Not to Treat?

“…The present study by Yang et al (12) provides some additional evidence in favor of treatment. The study, which analyzed data of a historical cohort of 627 patients from a single Korean center with HBV-related compensated cirrhosis, reported a 2.4-fold increased HCC risk among patients with low-level viremia compared with those with undetectable viremia.…”

Elevated hepatitis B virus RNA levels in HBeAg‐positive patients with low‐level viraemia or previous low‐level viraemia

“…Prior studies have highlighted an increased risk of liver‐related adverse events and/or HCC in CHB patients with LLV 2,3 . However, conflicting findings exist regarding the predictive value of LLV for adverse outcomes, with some studies suggesting no significant association when patients exhibit good treatment adherence 6 .…”

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Low-level viraemia (LLV) indicates a partial control of hepatitis B virus (HBV) and is associated with a less favourable prognosis. [1][2][3] Addressing strategies to mitigate LLV and effectively manage patients with LLV undergoing first-line nucleos(t)ide analogues (NAs) holds paramount clinical significance. However, discrepancies in guideline recommendations persist due to limited clinical evidence availability.

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Impact of ALT Changes on the Risk of HCC in Hepatitis B–Compensated Cirrhotic Patients With Low Viremia

“…The long-term study with trajectory hepatitis B virus (HBV) DNA data by Yang et al (1) concluded that hepatitis B–compensated cirrhotic (HBV/LC) patients with low level of hepatitis viremia (LLV; HBV DNA: 15–2,000 IU/mL) had a >2-fold risk of hepatocellular carcinoma (HCC) than those with undetectable HBV DNA. The study involved a large enough number of patients and multiple assays during a long enough duration of follow-up.…”