中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 40 Issue 5
May  2024
Turn off MathJax
Article Contents

Low-level viremia in chronic hepatitis B patients treated with first-line treatment with nucleos(t)ide analogues and its treatment strategies

DOI: 10.12449/JCH240506
More Information
  • Corresponding author: LU Xiaobo, xjykdluxiaobo@126.com (ORCID: 0000-0001-5532-7551)
  • Received Date: 2024-02-29
  • Accepted Date: 2024-03-30
  • Published Date: 2024-05-25
  • Highly effective oral antiviral therapy with low drug resistance can strongly inhibit HBV replication; however, some patients may still have low-level viremia (LLV) after receiving entecavir, tenofovir disoproxil fumarate, tenofovir alafenamide, or tenofovir amibufenamide for 48 weeks or more. Multiple studies in China and globally show that LLV after antiviral therapy is closely associated with the progression of chronic hepatitis B liver fibrosis, the risk of decompensated liver cirrhosis and hepatocellular carcinoma, and the reduction in long-term survival rate. Therefore, this article reviews the development, risk factors, and clinical harm of LLV after first-line treatment with nucleos(t)ide analogues, as well as different treatment regimens, in order to provide a reference for the treatment of LLV in chronic hepatitis B patients in the future.

     

  • loading
  • [1]
    SHI Y, ZHENG M. Hepatitis B virus persistence and reactivation[J]. BMJ, 2020, 370: m2200. DOI: 10.1136/bmj.m2200.
    [2]
    YU X, PFEFFERKORN M, van BÖMMEL F, et al. Clinical applications of circulating HBV RNA as a potential surrogate biomarker for intrahepatic cccDNA transcriptional activity[J]. Gut, 2024, 73( 4): 563- 566. DOI: 10.1136/gutjnl-2023-331217.
    [3]
    Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B(2022 version)[J]. Chin J Infect Dis, 2023, 41( 1): 3- 28. DOI: 10.3760/cma.j.cn311365-20230220-00050.

    中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2022年版)[J]. 中华传染病杂志, 2023, 41( 1): 3- 28. DOI: 10.3760/cma.j.cn311365-20230220-00050.
    [4]
    KIM JH, SINN DH, KANG W, et al. Low-level viremia and the increased risk of hepatocellular carcinoma in patients receiving entecavir treatment[J]. Hepatology, 2017, 66( 2): 335- 343. DOI: 10.1002/hep.28916.
    [5]
    TERRAULT NA, LOK ASF, MCMAHON BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance[J]. Hepatology, 2018, 67( 4): 1560- 1599. DOI: 10.1002/hep.29800.
    [6]
    LU FM, FENG B, ZHENG SJ, et al. Current status of the research on low-level viremia in chronic hepatitis B patients receiving nucleos(t) ide analogues[J]. J Clin Hepatol, 2021, 37( 6): 1268- 1274. DOI: 10.3969/j.issn.1001-5256.2021.06.007.

    鲁凤民, 封波, 郑素军, 等. 核苷(酸)类似物经治的慢性乙型肝炎患者低病毒血症的研究现状[J]. 临床肝胆病杂志, 2021, 37( 6): 1268- 1274. DOI: 10.3969/j.issn.1001-5256.2021.06.007.
    [7]
    ZHANG Q, PENG H, LIU XQ, et al. Chronic hepatitis B infection with low level viremia correlates with the progression of the liver disease[J]. J Clin Transl Hepatol, 2021, 9( 6): 850- 859. DOI: 10.14218/JCTH.2021.00046.
    [8]
    SUN FR, LIU ZF, WANG BY. Correlation between low-level viremia and hepatitis B-related hepatocellular carcinoma and recurrence: A retrospective study[J]. BMC Cancer, 2021, 21( 1): 1103. DOI: 10.1186/s12885-021-08483-3.
    [9]
    WANG XH, LIU XL, WANG P, et al. Antiviral therapy reduces mortality in hepatocellular carcinoma patients with low-level hepatitis B viremia[J]. J Hepatocell Carcinoma, 2021, 8: 1253- 1267. DOI: 10.2147/JHC.S330301.
    [10]
    SUN YM, WU XN, ZHOU JL, et al. Persistent low level of hepatitis B virus promotes fibrosis progression during therapy[J]. Clin Gastroenterol Hepatol, 2020, 18( 11): 2582- 2591. e 6. DOI: 10.1016/j.cgh.2020.03.001.
    [11]
    CHEN H, FU JJ, LI L, et al. Risk factors of low-level viremia in chronic hepatitis B patients receiving Entecavir monotherapy: A retrospective cohort study[J]. J Gastroenterol Hepatol, 2024, 39( 1): 180- 184. DOI: 10.1111/jgh.16357.
    [12]
    WANG LJ, GU ZQ, XU ZM, et al. A possible mechanism for low-level viremia occurrence in nucleos(t)ide analog-treated chronic hepatitis B patients[J]. Chin J Hepatol, 2021, 29( 12): 1151- 1155. DOI: 10.3760/cma.j.cn501113-20211124-00578.

    王雷婕, 顾智强, 许梓萌, 等. 核苷(酸)类药物经治慢性乙型肝炎患者低病毒血症发生的可能机制[J]. 中华肝脏病杂志, 2021, 29( 12): 1151- 1155. DOI: 10.3760/cma.j.cn501113-20211124-00578.
    [13]
    LI J, DONG XQ, CAO LH, et al. Factors associated with persistent positive in HBV DNA level in patients with chronic Hepatitis B receiving entecavir treatment[J]. Front Cell Infect Microbiol, 2023, 13: 1151899. DOI: 10.3389/fcimb.2023.1151899.
    [14]
    LU JH, ZHANG CN, HE PY, et al. Risk factors for very low-level viremia in patients with chronic hepatitis B virus infection: A single-center retrospective study[J]. Liver Res, 2022, 6( 1): 39- 44. DOI: 10.1016/j.livres.2022.02.001.
    [15]
    WANG YS, KONG Y, LIU YY, et al. Different switching therapy for chronic hepatitis B patients with low-level viraemia: A single-center retrospective study[J]. J Pract Hepatol, 2022, 25( 5): 633- 636. DOI: 10.3969/j.issn.1672-5069.2022.05.007.

    王玉珊, 孔银, 刘元元, 等. 不同转换治疗策略对经治的低病毒血症慢性乙型肝炎患者疗效的影响: 单中心回顾性研究[J]. 实用肝脏病杂志, 2022, 25( 5): 633- 636. DOI: 10.3969/j.issn.1672-5069.2022.05.007.
    [16]
    European Association for the Study of The Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection[J]. J Hepatol, 2017, 67( 2): 370- 398. DOI: 10.1016/j.jhep.2017.03.021.
    [17]
    ISHIDO S, TAMAKI N, UCHIHARA N, et al. Switching from entecavir to tenofovir alafenamide for maintaining complete virological response in chronic hepatitis B[J]. JGH Open, 2023, 7( 8): 567- 571. DOI: 10.1002/jgh3.12950.
    [18]
    LI ZB, LI L, NIU XX, et al. Switching from entecavir to tenofovir alafenamide for chronic hepatitis B patients with low-level viraemia[J]. Liver Int, 2021, 41( 6): 1254- 1264. DOI: 10.1111/liv.14786.
    [19]
    WANG YH, LIAO J, ZHANG DM, et al. Tenofovir monotherapy versus tenofovir plus entecavir combination therapy in HBeAg-positive chronic hepatitis patients with partial virological response to entecavir[J]. J Med Virol, 2020, 92( 3): 302- 308. DOI: 10.1002/jmv.25608.
    [20]
    LIU LP, WU XP, CAI TP, et al. Analysis of efficacy and factors influencing sequential combination therapy with tenofovir alafenamide fumarate after treatment with entecavir in chronic hepatitis B patients with low-level viremia[J]. Chin J Hepatol, 2023, 31( 2): 118- 125. DOI: 10.3760/cma.j.cn501113-20221019-00507.

    刘丽萍, 邬小萍, 蔡天盼, 等. 恩替卡韦经治后低病毒血症的慢性乙型肝炎患者序贯联合富马酸丙酚替诺福韦治疗的疗效及影响因素分析[J]. 中华肝脏病杂志, 2023, 31( 2): 118- 125. DOI: 10.3760/cma.j.cn501113-20221019-00507.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Article Metrics

    Article views (559) PDF downloads(124) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return