Journal of Clinical Hepatology
Antiviral treatment can suppress hepatitis B virus DNA to very low levels, but some people continue to have detectable viral DNA. This condition, known as low-level viraemia, is associated with continued liver disease and may indicate incomplete viral suppression.
Researchers studied 402 people with chronic hepatitis B who had received antiviral treatment for at least 48 weeks. Of these, 190 had a complete virological response, with HBV DNA below 20 IU/mL, while 212 had low-level viraemia, defined as HBV DNA between 20 and 2,000 IU/mL.
Median serum HBV RNA was higher in patients with low-level viraemia than in those with a complete response: 3 versus 2 log₁₀ copies/mL. HBV RNA was particularly high among patients who were positive for hepatitis B e antigen.
Higher HBV RNA was independently associated with low-level viraemia. However, within the low-level viraemia group, it was not significantly correlated with HBV DNA, liver enzymes or bilirubin.
As a standalone diagnostic marker, HBV RNA performed poorly. Its area under the receiver operating characteristic curve was 0.567, and the selected threshold detected only 30.7% of low-level viraemia cases, although specificity reached 85.8%.
HBV RNA is produced from covalently closed circular DNA, the persistent viral reservoir inside liver cells. Measuring it in blood could provide information about viral transcription without requiring a liver biopsy.
The findings suggest that HBV RNA may add biological information when evaluating patients with incomplete viral suppression, particularly those who remain HBeAg-positive. However, its weak diagnostic performance means it cannot replace HBV DNA testing or reliably identify low-level viraemia by itself.
The study was observational, and the treatment characteristics of the two groups were not fully comparable. It also did not follow patients to determine whether higher HBV RNA predicted treatment failure, cirrhosis or liver cancer. Longitudinal studies are needed to establish its clinical value.
Objective: To investigate the expression characteristics of serum HBV RNA in patients with low-level viremia (LLV) and its value in the…
