Association between serum HBV DNA levels and liver fibrosis in chronic hepatitis B

The association between serum HBV DNA levels and liver fibrosis in patients with chronic hepatitis B (CHB) remains controversial. We investigated this association in non-cirrhotic CHB patients.

A total of 5,880 non-cirrhotic treatment-naïve CHB patients with ALT ≤2 × ULN were retrospectively included. Liver fibrosis was evaluated using FIB-4, APRI, LSM, or liver histology.

The CHB patients had a median age of 38.0 years and 57.6% were male. There was a non-linear, parabolic association between serum HBV DNA loads and non-invasive fibrosis tests (APRI, FIB-4, and LSM). Patients with moderate serum HBV DNA levels (around 6 log₁₀ IU/mL) had the highest APRI, FIB-4, and LSM values. After adjustment, the non-linear relationship between serum HBV DNA loads and non-invasive liver fibrosis indicators remained significant, especially in HBeAg-positive patients. Patients with moderate serum HBV DNA levels (around 6 log₁₀ IU/mL) had the highest proportion of significant liver fibrosis as determined by APRI, FIB-4, LSM, and liver biopsy.

A non-linear association was observed between serum HBV DNA levels and liver fibrosis in non-cirrhotic, treatment-naïve CHB patients with ALT ≤2 × ULN, with moderate HBV DNA levels (around 6 log₁₀ IU/mL) associated with a higher risk of fibrosis.