Analysis of the clinical characteristics of HBeAg-negative chronic HBV infection in indeterminate phase with a low viral load
Objective To analyze the clinical characteristics of HBeAg-negative chronic hepatitis B virus(HBV)infection in indeterminate phase with a low viral load.Methods One hundred and thirty-nine cases with persistent normal alanine aminotransferase(ALT)and HBeAg-negative chronic HBV infection with low viral load who visited the Department of Infectious Diseases of the Affiliated Hospital of Yan'an University from September 2013 to July 2021 were retrospectively collected.Patients were divided into low hepatitis B surface antigen(HBsAg)group(n=59)and high HBsAg group(n=80)according to the baseline hepatitis B surface antigen(HBsAg)level.The changes of various indicators at baseline and follow-up endpoints were analyzed between the two groups.The rate of HBsAg decrease ≥0.5 log10IU/ml,HBV DNA negative conversion rate,ALT persistently normal rate,and liver stiffness measurement(LSM)persistently normal rate at the end of the follow-up were compared.The t-test,or non-parametric Mann-Whitney U test,and Wilcoxon signed rank test were used for comparison of continuous data between the two groups.The x2 test,or Fisher's exact probability method,was used for comparing count data between the two groups.Results There were statistically significant differences in age,gender,and HBsAg at baseline,but there was no statistically significant difference in terms of family history of hepatitis B,follow-up time,anti-HBe,anti-HBc,HBV DNA,ALT,aspartate aminotransferase(AST),albumin(Alb),and LSM between the two groups.There were statistically significant differences in HBsAg,anti-HBc,and ALT levels before and after follow-up in the low HBsAg group,but no statistically significant differences in anti-HBe,HBV DNA,AST,Alb,and LSM levels.There were statistically significant differences in HBsAg and anti-HBc before and after follow-up in the high HBsAg group,but no statistically significant differences in anti-HBe,HBV DNA,ALT,AST,Alb,and LSM.A liver biopsy was performed in 66 patients during follow-up,and 27.27％of the patients had moderate liver damage.In the low HBsAg group,45.76％of patients had a HBsAg decrease rate of ≥0.5 log10IU/ml,10.17％of patients had HBV DNA negative conversion,88.14％of patients had a persistently normal ALT,and 96.61％of patients had a persistently normal LSM at the end of follow-up.In the high HBsAg group,3.75％of patients had a HBsAg decrease of ≥0.5 log10IU/ml,no patient had a HBV DNA negative conversion,90％of patients had a persistently normal ALT,and 98.75％of patients had a persistently normal LSM.There were statistically significant differences in the HBsAg decrease rate(45.76％vs.3.75％,x2=32.975,P＜0.001)and HBV DNA negative conversion rate(10.17％vs.0,x2=6.219,P=0.013)between the two groups at the end of follow-up,but there were no statistically significant differences in the persistently normal ALT and LSM rates.Conclusion The vast majority of patients with HBeAg-negative chronic HBV infection in the indeterminate phase with low viral load had persistent hypoviremia over the long term.Some patients have liver tissue damage and may progress to cirrhosis and liver cancer as a result of HBV DNA positivity,so antiviral treatment should be initiated in all.
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