Liver and Bile
Hepatology. 2023;77(5):1746–56
Outcome of untreated low-level viremia versus antiviral therapy-induced or spontaneous undetectable HBV DNA in compensated cirrhosis
Background: Comparative outcomes of hepatitis B virus (HBV)-infected compensated cirrhosis with low-level viremia (LLV) versus maintained virological response (MVR) are unclear. A large, multiethnic, multicenter study was conducted to examine the natural history of LLV versus MVR in compensated cirrhosis. Patients and methods: The authors enrolled patients with HBV-infected compensated cirrhosis (n = 2316) from 19 hospitals in South Korea, Singapore, and Japan. They defined the LLV group as untreated patients with ≥ 1 detectable serum HBV DNA (20–2000 IU/ml), Spontane-ous-MVR group as untreated patients with spontaneously achieved MVR, and antiviral therapy (AVT)-MVR group as patients achieving AVT-induced MVR. Study end points were hepatocellular carcinoma (HCC) or hepatic decompensation.
Results: The annual HCC incidence was 2.7 per 100 person-years (PYs), 2.6 per 100 PYs, and 3.3 per 100 PYs for LLV (n = 742), Spontaneous-MVR (n = 333), and AVT-MVR (n = 1241) groups, respectively (p = 0.81 between LLV vs. Spontaneous-MVR groups and p = 0.37 between LLV vs. AVT-MVR groups). Similarly, the annual decompensation incidence was 1.6 per 100 PYs, 1.9 per 100 PYs, and 1.6 per 100 PYs for LLV, Sponta-neous-MVR, and AVT-MVR groups, respectively (p = 0.40 between LLV vs. Spontaneous-MVR groups and p = 0.83 between LLV vs. AVT-MVR groups). Multivariable analyses determined that HCC and decompensation risks in the LLV group were comparable to those with Spontane-ous-MVR and AVT-MVR groups (all p > 0.05). Propensity score matching also reproduced similar results for HCC and decompensation risks (all p > 0.05 between LLV vs. Spontaneous-MVR groups and between LLV vs. AVT-MVR groups).
Conclusions: Untreated low-level viremia in hepatitis B virus-infected compensated cirrhosis is not associated with increased risk of disease pro-gression compared with Spontaneous-MVR and AVT-MVR. These data have important implications for practice and further research.