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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 6
Jun.  2021
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Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(6): 1268-1274

Current status of the research on low-level viremia in chronic hepatitis B patients receiving nucleos(t)ide analogues

DOI: 10.3969/j.issn.1001-5256.2021.06.007
  • 1.

    Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University, Beijing 100191, China

  • 2.

    Peking University Hepatology Institute, Peking University People's Hospital, Beijing 100044, China

  • 3.

    First Department of Liver Disease, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China

  • 4.

    Diagnosis and Treatment Center of Hepatic Fibrosis, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China

  • 5.

    Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China

  • 6.

    Department of Infectious Diseases & Liver Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, China

  • 7.

    Institute for Viral Hepatitis, Chongqing Medical University, Chongqing 400060, China

  • 8.

    Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, China

  • 9.

    Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China

  • 10.

    Infectious Diseases Center, Peking University First Hospital, Beijing 100034, China

  • 11.

    Department of Hepatology, The First Hospital of Jilin University, Changchun 130021, China

  • 12.

    Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China

  • Received Date: 2021-05-04
  • Accepted Date: 2021-05-12
  • Published Date: 2021-06-20
    Abstract
  • Nucleos(t)ide analogues (NAs), which are widely used as the first-line anti-hepatitis B virus (HBV) drugs in clinical practice, can effectively inhibit the replication of HBV DNA, significantly slow down disease progression in chronic hepatitis B (CHB) patients, and reduce the development of end-stage liver diseases such as liver failure and liver cancer. However, for some CHB patients receiving first-line NAs for 48 weeks or longer, serum HBV DNA is still persistently or intermittently higher than the lower detection of limit of sensitive nucleic acid detection reagents. After discussion by the authors, low-level viremia (LLV) is defined as follows: persistent LLV refers to the condition in which CHB patients, who receive entecavir, tenofovir disoproxil fumarate, or tenofovir alafenamide fumarate for ≥48 weeks, have positive for HBV DNA are positive by two consecutive detections with sensitive quantitative PCR, with an interval of 3-6 months, but < 2000 IU/ml; intermittent LLV refers to serum HBV DNA are positive intermittently by at least three consecutive detections, with an interval of 3-6 months, but HBV DNA < 2000 IU/ml. For the diagnosis of LLV, the issues of poor compliance and drug-resistant mutations should be excluded. LLV might be associated with the increased risk of progression to liver fibrosis, or hepatocellular carcinoma in patients with liver cirrhosis under NA treatment, but there are still controversies over whether the original treatment regimen with NAs should be changed after the onset of LLV. This article summarizes the incidence rate of LLV under NA treatment and the influence of LLV on prognosis and analyzes the possible mechanisms of the osnet of LLV, so as to provide a reference for the management of LLV in patients treated with NAs.

     

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