Background With the increased sensitivity of nucleic acid detection, HBV DNA in serum of some hepatitis B virus (HBV) patients is undetectable by conventional PCR, but can still be detected using highly sensitive real-time PCR. The academic community divided these patients into low-level viremia (LLV) patients and very low-level viremia (VLLV) patients. For LLV, both at home and abroad have been reported, while for VLLV, there are few international discussions.
Objective To determine the proportion of VLLV patients with hepatitis B virus infection detected to be negative by routine PCR, and analyze the clinical characteristics and associated factors of VLLV, so as to provide evidence for the prevention of VLLV in clinical work.
Methods A total of 998 patients with HBV infection whose HBV DNA was lower than 40 IU/mL were selected from the Fifth Medical Center of Chinese PLA General Hospital from October 2020 to March 2021. The sera viral load of the patients was detected by high sensitivity HBV DNA technology. According to the detection results, the patients were divided into VLLV group (5-40 IU/mL) and HBV DNA negative group (< 5 IU/mL). Blood routine, biochemical, HBV markers and imaging examination were compared between the two groups. The influencing factors of VLLV were analyzed by logistic regression. In addition, the VLLV group was divided into HBV DNA≥20 IU/mL group and HBV DNA < 20 IU/mL group, and the differences of clinical data between the two groups were analyzed.
Results VLLV status was detected in 10.02% (100/998) of HBV infected patients. There was no significant difference in age and gender between VLLV group and HBV DNA negative group (P>0.05). The quantitative HBsAg (MIQR: 2 781.00 2 540.00-4 785.00 vs 604.00 67.51-870.00, P＜0.001), AFP (2.68 1.74-3.80 vs 2.30 1.66-3.32, P=0.020) and positive rate of HBeAg (39.13% vs 23.22%, P=0.001) of the VLLV group were significantly higher than those of the HBV DNA negative group. The proportion of chronic liver damage in the VLLV group was significantly higher than that in the HBV DNA negative group (70.00% vs 59.51%, P=0.042). VLLV was related to disease stage, drug use, quantification of HBsAg, AST, ALT, etc (P<0.05). Among them, quantification of HBsAg (OR=7.684, 95% CI: 3.289-17.950) was independently related to VLLV. Subgroup analysis showed that viral load was not significantly associated with disease stage, drug use, drug duration, HBsAg quantification, AST, ALT, etc. (P > 0.05).
Conclusion Patients with high HBsAg quantification have a higher probability of VLLV, and monitoring of such patients should be strengthened in clinical practice.
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