Systematic Reviews
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2024; 16(11): 1321-1330
Published online Nov 27, 2024. doi: 10.4254/wjh.v16.i11.1321
Low level of hepatitis B viremia is associated with increased risk of hepatocellular carcinoma in compensated cirrhotic patients
Wei-Chun Lin, Ke Lin, Ming-Kai Li, Xiao Liu, Yi-Fei Huang, Xing Wang, Bin Wu
Wei-Chun Lin, Ming-Kai Li, Yi-Fei Huang, Xing Wang, Bin Wu, Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Ke Lin, Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
Xiao Liu, Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
Co-first authors: Wei-Chun Lin and Ke Lin.
Co-corresponding authors: Xing Wang and Bin Wu.
Author contributions: Wang X and Wu B conceptualized and designed the study; Lin WC and Lin K developed the search strategy, conducted database research, and drafted the manuscript; Li MK, Liu X, and Huang YF performed data analysis and assisted with result verification; All authors have read and approved the final manuscript. Lin WC and Lin K conducted separate database research, collaboratively sifted and analyzed the data, and were jointly responsible for drafting the manuscript. Both authors have made significant and indispensable contributions to the project, qualifying them as co-first authors. As co-corresponding authors, Wang X and Wu B conceptualized and designed the study, supervised the research, and revised the manuscript. Wu B applied for and secured funding for the project. He played a crucial role in refining the study design, overseeing the entire project, and providing key revisions to the manuscript. He also ensured the quality and accuracy of the work through final approval of the manuscript. Wang X contributed to data re-analysis and reinterpretation, figure creation, and conducted a comprehensive literature review. The collaboration between Wang X and Wu B has been essential for the completion and publication of this manuscript.
Supported by the National Natural Science Foundation of China, No. 82070574.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bin Wu, PhD, Chief Physician, Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China. wubin6@mail.sysu.edu.cn
Received: March 31, 2024
Revised: September 9, 2024
Accepted: October 10, 2024
Published online: November 27, 2024
Processing time: 220 Days and 2.2 Hours
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.

AIM

To investigate the link between LLV in compensated cirrhosis and prognosis concerning hepatocellular carcinoma (HCC), decompensation, and liver-related events.

METHODS

The PubMed, EMBASE, and Cochrane Library databases were searched up to March 5, 2023. Outcomes of interest were assessed by pooled hazard ratios (HRs). The study was registered with PROSPERO (CRD42023405345).

RESULTS

Six cohort studies representing 3155 patients were included. 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 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%). 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%), and liver-related events (HR: 1.84, 95%CI: 0.92-3.67; Q-statistic-P = 0.03, I2 = 72%), respectively. Grading of Recommendations Assessment, Development and Evaluation assessment indicated moderate certainty for HCC, very low certainty for decompensation of cirrhosis and liver-related clinical events.

CONCLUSION

LLV in compensated cirrhotic patients is associated with increased risk of HCC, higher tendency for hepatic decompensation and liver-related events. Closer screening of HCC should be conducted in this population.

Keywords: Low level of hepatitis B viremia; Compensated cirrhosis; Hepatocellular carcinoma; Hepatic decompensation; Liver-related events

Core Tip: The need for antiviral therapy in patients with compensated cirrhosis and low-level hepatitis B viremia remains debated. This meta-analysis analyzed data from six cohort studies, revealing that low-level viremia in compensated cirrhosis is linked to a higher risk of hepatocellular carcinoma and an increased likelihood of cirrhosis decompensation and liver-related events. These findings support current guidelines for antiviral treatment, underscore the importance of vigilant cancer screening, and highlight the need for regular monitoring of viral levels.