Maintaining versus switching antiviral therapy in chronic hepatitis B patients with low-level viremia

Background The incidence of low-level viremia (LLV) in chronic hepatitis B (CHB) patients receiving first-line nucleos(t)ide analogue (NAs) therapy with negative results on conventional HBV DNA testing is unknown. Methods A total of 557 treatment-naïve CHB patients who had received first-line NAs therapy for more than 48 weeks and had negative results on conventional HBV DNA testing were enrolled. According to the results of two high-sensitivity HBV DNA tests, CHB patients were divided into two categories: maintained virological response(MVR) and LLV. Finally, LLV patients were divided into two groups: maintaining NAs therapy and switching NAs therapy. Results Among the patients whose conventional HBV DNA testing was negative , the proportions of MVR and LLV were 64.1% and 35.9% respectively. Age and treatment duration are negatively correlated with the occurrence of LLV, while HBsAg level, HBeAg positivity, and ALT level were positively associated with the occurrence of LLV. At the 48th week of follow-up, the complete virological response(CVR) of the switching NAs group and the maintaining NAs group were 81.63% and 86.36% respectively( P =0.536). In addition, there were no statistically significant differences between the two groups in the HBeAg-positive rate, HBsAg level, ALT level, APRI, and FIB-4 score over the 48-week follow-up period. Conclusion In CHB patients who had negative results of conventional HBV DNA testing, the incidence rate of LLV is still high. For LLV patients with negative results in conventional HBV DNA testing, the vast majority of patients can achieve CVR whether maintaining or switching NAs, and the efficacy of the two treatment strategies is similar. However, these findings may not be applicable to patients with higher baseline HBV DNA levels, different distributions of NAs types, or those treated in other clinical settings.