Currently, insufficient clinical data are available to address whether low-level viremia (LLV) observed during antiviral treatment will adversely affect the clinical outcome or whether treatment strategies should be altered if LLV occurs. This study compared the clinical outcomes of patients with a maintained virological response (MVR) and patients who experienced LLV and their treatment strategies.

A retrospective cohort of 674 patients with chronic hepatitis B virus (HBV) infection who received antiviral treatment for more than 12 months was analyzed for the development of end-stage liver disease and treatment strategies during the follow-up period. End-stage liver disease included decompensated liver cirrhosis and hepatocellular carcinoma (HCC).

During a median 42-month follow-up, end-stage liver disease developed more frequently in patients who experienced LLV than in those who experienced MVR (7.73% and 15.85% vs. 0.77% and 5.52% at 5 and 10 years, respectively; p=0.000). The trend was consistent after propensity score matching. In the high-risk group of four HCC risk models, LLV patients had a higher risk of HCC development (p<0.05). By Cox proportional hazard model analysis, LLV was an independent risk factor for end-stage liver disease and HCC (hazard ratio [HR]=6.280, confidence interval [CI]=2.081¨C18.951, p=0.001; HR=5.108, CI=1.392¨C18.737, respectively; p=0.014). Patients achieved a lower rate of end-stage liver disease by adjusting treatment compared to continuing the original treatment once LLV occurred (p<0.05).

LLV is an independent risk factor for end-stage liver disease and HCC, and treatment adjustments can be considered.

目前，没有足够的临床数据来说明抗病毒治疗期间观察到的低水平病毒血症 (LLV) 是否会对临床结果产生不利影响，或者如果发生 LLV，是否应该改变治疗策略。本研究比较了维持病毒学应答 (MVR) 患者和经历 LLV 的患者及其治疗策略的临床结果。

对 674 例接受抗病毒治疗超过 12 个月的慢性乙型肝炎病毒 (HBV) 感染患者的回顾性队列进行分析，以了解随访期间终末期肝病的发展和治疗策略。终末期肝病包括失代偿性肝硬化和肝细胞癌（HCC）。

在中位 42 个月的随访期间，经历 LLV 的患者比经历 MVR 的患者更频繁地发生终末期肝病（5 年和 10 年分别为 7.73% 和 15.85% vs. 0.77% 和 5.52%； p = 0.000)。倾向得分匹配后趋势一致。在四种 HCC 风险模型的高风险组中，LLV 患者发生 HCC 的风险更高（p<0.05）。通过 Cox 比例风险模型分析，LLV 是终末期肝病和 HCC 的独立危险因素（风险比 [HR]=6.280，置信区间 [CI]=2.081-18.951，p=0.001；HR=5.108， CI = 1.392-18.737，分别；p = 0.014)。与发生 LLV 后继续原始治疗相比，患者通过调整治疗获得了较低的终末期肝病发生率（p<0.05）。

LLV是终末期肝病和HCC的独立危险因素，可以考虑调整治疗。