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Hepatitis B virus RNA levels and clinical characteristics of persistent viremia in HBsAg-positive patients undergoing nucleos(t)ide analog

Year: 2026

Type: article

Abstract: AIM: This study aimed to analyze serum HBV RNA levels in HBsAg-positive patients with persistent viremia undergoing nucleos(t)ide analog (NAs) therapy for over 48 weeks and to examine the clinical characteristics of HBV RNA-positive patients. METHODS: In this cross-sectional study, 277 patients with complete virological response (CVR) and 277 patients with persistent viral positivity (PV) were included, with confounders balanced using 1:1 propensity score matching (PSM). Serum HBV RNA levels were quantified using a PCR-fluorescent probe assay, with a lower limit of quantification of 100 copies/mL. Patients in the PV group were classified into RNA-negative (<100 copies/mL) and RNA-positive (≥100 copies/mL) subgroups based on RNA levels. RESULTS: The HBV RNA-positive rate was significantly higher in the PV group than in the CVR group (P < 0.001). Multivariable regression analysis identified ALT, AST, HBsAg level, HBeAb status, and HBV RNA status as independent predictors of HBV DNA positivity. ALT levels were significantly higher in HBV RNA-positive patients, and the prevalence of cirrhosis and splenomegaly was notably higher in the RNA-positive group (P < 0.05), suggesting more severe liver damage. HBV RNA status was positively associated with HBsAg, HBeAg, and HBV DNA positivity. CONCLUSION: HBV RNA status is an important marker of viral replication activity and liver injury, particularly in PV patients. Monitoring HBV RNA status as a non-invasive biomarker may help assess disease progression and inform patient management.

Source: Virus Research

DOI: 10.1016/j.virusres.2026.199760