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Abstract
Background Whether patients with compensated cirrhosis and low-level viremia (LLV) of hepatitis B should receive antiviral therapy (AVT) is still controversial, and published results are inconsistent. This study aimed to investigate the association between LLV in compensated cirrhosis and prognosis in terms of hepatocellular carcinoma (HCC), decompensation and liver-related events.
Methods The PubMed, Embase, and Cochrane Library databases were searched up to March 5th, 2023. Outcomes of interest were assessed by pooled hazard ratios (HRs). The study was registered with PROSPERO (CRD42023405345).
Results Six cohort studies representing 3,155 patients were included (IDDF2024-ABS-0023 Figure 1. Flow chart). Compared with patients with undetectable HBV DNA, patients with LLV was associated with increased risk of HCC (HR: 2.06, 95% CI: 1.36-3.13; Q-statistic-P = 0.07, I2=51%) regardless of receiving antiviral therapy (AVT) or not (AVT group: HR: 3.14; 95% CI: 1.73-5.69; Q-statistic-P = 0.60, I2=0%; un-AVT group: HR: 1.73, 95% CI: 1.09-2.76; Q-statistic-P = 0.11, I2=50%.) (IDDF2024-ABS-0023 Figure 2. Forest plot for the association between LLV and HCC). The pooled results showed no statistical association between LLV and decompensation of cirrhosis (HR: 2.06, 95% CI: 0.89, 4.76; Q-statistic-P = 0.04, I2=69%) (IDDF2024-ABS-0023 Figure 3. Forest plot for the association between LLV and hepatic decompensation), and liver-related events (HR: 1.84, 95% CI: 0.92, 3.67; Q-statistic-P = 0.03, I2=72%) (IDDF2024-ABS-0023 Figure 4. Forest plot for the association between LLV and liver-related clinical events), respectively. GRADE assessment indicated moderate certainty for HCC and very low certainty for decompensation of cirrhosis and liver-related clinical events.
Flow chart
Forest plot for the association between LLV and HCC
Forest plot for the association between LLV and hepatic decompensation
Forest plot for the association between LLV and liver-related clinical events
Conclusions LLV in compensated cirrhotic patients is associated with an increased risk of HCC. This population also has a higher tendency for hepatic decompensation and liver-related events. Closer screening of HCC should be conducted in this population.