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Outcome of untreated low-level viremia versus antiviral therapy-induced or spontaneous undetectable HBV-DNA in compensated cirrhosis

 Daniel Q Huang  ;  Nobuharu Tamaki  ;  Hyung Woong Lee  ;  Soo Young Park  ;  Yu Rim Lee  ;  Hye Won Lee  ;  Seng Gee Lim  ;  Tae Seop Lim  ;  Masayuki Kurosaki  ;  Hiroyuki Marusawa  ;  Toshie Mashiba  ;  Masahiko Kondo  ;  Yasushi Uchida  ;  Haruhiko Kobashi  ;  Koichiro Furuta  ;  Namiki Izumi  ;  Beom Kyung Kim  ;  Dong Hyun Sinn 
 HEPATOLOGY, Vol.77(5) : 1746-1756, 2023-05 
Journal Title
Issue Date
Antiviral Agents / therapeutic use ; Carcinoma, Hepatocellular* / drug therapy ; DNA, Viral ; Hepatitis B virus / genetics ; Humans ; Liver Cirrhosis / epidemiology ; Liver Neoplasms* / drug therapy ; Viremia / drug therapy
BACKGROUND: Comparative outcomes of HBV-infected compensated cirrhosis with low-level viremia (LLV) versus maintained virological response (MVR) are unclear. We conducted a large, multiethnic, multicenter study to examine the natural history of LLV versus MVR in compensated cirrhosis.

PATIENTS AND METHODS: We enrolled patients with HBV-infected compensated cirrhosis (n=2316) from 19 hospitals in South Korea, Singapore, and Japan. We defined the LLV group as untreated patients with ≥1 detectable serum HBV-DNA (20-2000 IU/mL), Spontaneous-MVR group as untreated patients with spontaneously achieved MVR, and antiviral therapy (AVT)-MVR group as patients achieving AVT-induced MVR. Study end points were HCC or hepatic decompensation.

RESULTS: The annual HCC incidence was 2.7/100 person-years (PYs), 2.6/100 PYs, and 3.3/100 PYs for LLV (n=742), Spontaneous-MVR (n=333), and AVT-MVR (n=1241) groups, respectively ( p = 0.81 between LLV vs. Spontaneous-MVR groups and p = 0.37 between LLV vs. AVT-MVR groups). Similarly, the annual decompensation incidence was 1.6/100 PYs, 1.9/100 PYs, and 1.6/100 PYs for LLV, Spontaneous-MVR, and AVT-MVR groups, respectively ( p = 0.40 between LLV vs. Spontaneous-MVR groups and p = 0.83 between LLV vs. AVT-MVR groups). Multivariable analyses determined that HCC and decompensation risks in the LLV group were comparable to those with Spontaneous-MVR and AVT-MVR groups (all p >0.05). Propensity score matching also reproduced similar results for HCC and decompensation risks (all p >0.05 between LLV vs. Spontaneous-MVR groups and between LLV vs. AVT-MVR groups).

CONCLUSIONS: Untreated LLV in HBV-infected compensated cirrhosis is not associated with increased risk of disease progression compared with Spontaneous-MVR and AVT-MVR. These data have important implications for practice and further research. Copyright © 2023 American Association for the Study of Liver Diseases.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
Lee, Hye Won(이혜원) ORCID logo https://orcid.org/0000-0002-3552-3560
Lim, Tae Seop(임태섭) ORCID logo https://orcid.org/0000-0002-4578-8685
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