Increased Risk for Liver Disease in Patients With Chronic Hepatitis B Virus Infection and Low-Level Viraemia

The relationship between hepatitis B virus low-level viraemia (HBV-LLV; HBV DNA ≤ 2000 IU/mL) and the risk of liver-related events is unclear.

To evaluate the relationship between HBV-LLV and subsequent liver-related outcomes in patients with chronic HBV.

Using Optum's deidentified Clinformatics Data Mart Database, propensity score-matched cohorts of adults (aged ≥ 18 years) with chronic HBV-LLV vs. controls without evidence of chronic HBV were identified. Cox proportional-hazards models were used to estimate the risk of compensated cirrhosis, hepatic decompensation, hepatocellular carcinoma (HCC), liver transplant, and a composite outcome of these four liver-related events among people with HBV-LLV vs. those without HBV. Incidence rates per 100 person-years and corresponding Poisson 95% CIs were calculated for each cohort.

Demographic and clinical characteristics were similar between cohorts. The risk of cirrhosis, decompensation, HCC, and the composite outcome was significantly higher for patients with HBV-LLV than for individuals without HBV. Elevated liver disease risk remained in a sensitivity analysis of a subgroup with no nucleos(t)ide analogue treatment or HBV DNA > 2000 IU/mL during follow-up. Elevated risk of cirrhosis and composite outcomes in patients with HBV-LLV was confirmed in a second US dataset (HealthVerity Marketplace).

In this analysis of US administrative claims data, individuals with HBV-LLV had a significantly increased risk of liver-related events compared with those without evidence of HBV. Additional research is needed to identify risk stratification and mitigation strategies, including earlier antiviral treatment.