【摘 要】
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Background and Aims: Currently, insufficient clinical data are available to address whether low-level viremia (LLV) ob-served during antiviral treatment will adversely affect the clinical outcome or whether treatment strategies should be altered if LLV oc
【机 构】
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Department of Infectious Diseases,Institute for Viral Hepatitis,The Key Laboratory of Molecular Biol
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Background and Aims: Currently, insufficient clinical data are available to address whether low-level viremia (LLV) ob-served during antiviral treatment will adversely affect the clinical outcome or whether treatment strategies should be altered if LLV occurs. This study compared the clinical out-comes of patients with a maintained virological response (MVR) and patients who experienced LLV and their treat-ment strategies. Methods: A retrospective cohort of 674 patients with chronic hepatitis B virus (HBV) infection who received antiviral treatment for more than 12 months was analyzed for the development of end-stage liver disease and treatment strategies during the follow-up period. End-stage liver disease included decompensated liver cirrhosis and hepatocellular carcinoma (HCC). Results: During a median 42-month follow-up, end-stage liver disease developed more frequently in patients who experienced LLV than in those who experienced MVR (7.73％ and 15.85％ vs. 0.77％ and 5.52％ at 5 and 10 years, respectively; p=0.000). The trend was consistent after propensity score matching. In the high-risk group of four HCC risk models, LLV patients had a higher risk of HCC development (p<0.05). By Cox proportional hazard model analysis, LLV was an independent risk factor for end-stage liver disease and HCC (hazard ratio [HR]=6.280, con-fidence interval [CI]=2.081–18.951, p=0.001; HR=5.108, CI=1.392–18.737, respectively; p=0.014). Patients achieved a lower rate of end-stage liver disease by adjusting treat-ment compared to continuing the original treatment once LLV occurred (p<0.05). Conclusions: LLV is an independent risk factor for end-stage liver disease and HCC, and treatment adjustments can be considered.
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