Episodic low-level viraemia does not influence prognosis in untreated compensated cirrhosis

Among untreated patients with compensated cirrhosis, episodic low-level viraemia (LLV) is not associated with a higher risk of disease progression relative to maintained virological response (MVR) status, reveals a recent study. Consequently, the benefits of antiviral therapy (AVT) for episodic LLV must be re-evaluated.

The researchers enrolled untreated patients with compensated cirrhosis with persistent serum hepatitis B virus (HBV)-DNA levels <2,000 IU/mL from three tertiary hospitals. LLV was defined as having at least one detectable serum HBV-DNA (20‒2,000 IU/mL) episode, and MVR as having persistently undetectable serum HBV-DNA (<20 IU/mL).

AVT was administered according to guidelines when serum HBV-DNA was ≥2,000 IU/mL during follow-up. The development of cirrhotic complication event (CCE) or hepatocellular carcinoma (HCC) was the primary endpoint.

A total of 567 patients were included in the analysis. Cumulative HCC risk at 3, 5, and 7 years was comparable between LLV (n=391) and MVR (n=176) groups (5.7 percent, 10.7 percent, and 17.3 percent vs 7.2 percent, 15.5 percent, and 19.4 percent, respectively; p=0.390). Likewise, CCE risk was similar between groups (7.5 percent, 12.8 percent, and 13.7 percent vs 7.8 percent, 12.3 percent, and 14.6 percent, respectively; p=0.880).

Multivariate analysis revealed that LLV, compared with MVR, showed no correlation with the risk of HCC (adjusted hazard ratio [aHR], 1.422, 95 percent confidence interval [CI], 0.694‒2.913; p=0.336) or CCE (aHR, 1.816, 95 percent CI, 0.843‒3.911; p=0.128).

On inverse probability of treatment weighting analysis, outcomes were also comparable between LLV and MVR groups in terms of HCC (HR, 0.903, 95 percent CI, 0.528‒1.546; p=0.711) and CCE risks (HR, 1.192, 95 percent CI, 0.675‒2.105; p=0.545).