Keywords
HBV; Chronic Hepatitis B; Low-Level Viremia(LLV); Mechanisms of LLV; Sequential Combined Therapy; Clinical Cure; Case Report
Abstract
Background: At this stage, CHB is mainly pursuing functional cure, which is defined as the completion of a limited course of treatment with persistent undetectable serum HBsAg and HBV DNA, HBeAg negativity (with or without HBsAg seroconversion), persistence of residual cccDNA, regression of hepatic inflammation, improvement of hepatic histopathology, and a significant reduction in the prevalence of end-stage liver disease, i.e., the end of treatment, and a significant reduction in the incidence of end-stage liver disease. An important modality for achieving clinical cure is currently combination therapy. However, in recent years, studies have found that some HBV-infected patients with LLV even after long term antiviral therapy, i.e., HBV-DNA levels are higher than the lower limit of detection but lower than 2000 IU / ml. Many experts believe that weak host immunity and the abundance of deoxynucleotides in the body leading to the competitive inhibition of the NUC is the main reasons. For chronic HBV patients who still have LLV even after more than 1 year of antiviral therapy, the treatment regimen should be modified when appropriate. In this article, we report a case of chronic HBV with LLV during antiviral therapy, and the study of the mechanism of LLV will help us to optimize the antiviral therapy and reduce the incidence of adverse effects such as cirrhosis and hepatocellular carcinoma.
Case Summary: Patients with chronic hepatitis B infection who develop LLV on sequential combination therapy and ultimately achieve clinical cure. The patient had been infected with the hepatitis B virus for 18 years and had recurrent liver function abnormalities for 7 years, and began receiving treatment 7 years ago, and was now suffering from liver function abnormalities, positive surface antigen and core antibodies, and was initially diagnosed with chronic viral hepatitis B. During the sequential combination therapy of Nas and PEG-IFN, the patient developed LLV. During the course of Nas and PEG-IFN sequential combination therapy, the patient developed LLV, and after adjusting the treatment regimen, the surface antigen and HBVDNA became negative, and clinical cure was achieved.
Conclusion: Some HBV-infected patients develop LLV during long-term antiviral therapy, which may be related to the competitive inhibition of NUC due to weak host immunity and abundant deoxynucleotides in the body, and the treatment regimen should be modified at an appropriate time for chronic HBV patients who suffer from LLV even after more than one year of antiviral therapy.
Citation
Wang L, Lv J (2024) Mechanisms and Treatment of Patients with Chronic Hepatitis B Presenting with Low-Level Viremia (LLV): A Case Report. SM J Infect Dis 7: 4.