Clinical value of serum HBV RNA in patients with chronic hepatitis B during antiviral therapy.

Background: The correlation between hepatitis B virus (HBV) RNA, HBV DNA and hepatitis B surface antigen (HBsAg) during antiviral treatment and the clinical value of HBV RNA for virological response and drug discontinuance, are still unknown. This study was to investigate the clinical significance and predicting ability of HBV RNA for hepatitis B e antigen (HBeAg) seroconversion (SR) in chronic hepatitis B (CHB) patients receiving antiviral therapy. Methods: A total of 138 patients with CHB who were newly diagnosed from January 2023 to December 2023 were enrolled in this study. Patients were divided into the SR group and the non-seroconversion (NSR) group according to HBeAg SR in baseline to the 60th week. The dynamic changes and correlations between HBV RNA, HBV DNA, HBsAg and HBeAg was analyzed between the two groups and the predictive values of them for HBeAg SR were calculated. Results: The 60th week HBeAg SR rate was 23.9% (33/138), patients treated with tenofovir alafenamide fumarate (TAF) had higher SR rate than others (P < 0.001). After antiviral therapy, the serum HBV RNA levels of SR group decreased significantly than in the NSR group. Baseline HBV RNA levels were significantly correlated with HBV DNA, HBsAg and HBeAg in both groups, but weakened after antiviral therapy. Univariate and multivariate regression analysis showed that the serum HBV RNA levels at the 12th week was an independent predictor of HBeAg SR. The area under the receiver operating characteristic curve (AUROC) of the serum HBV RNA levels at the 12th week had a higher value (AUROC = 0.8039, 95% CI [0.691-0.917]). The cut off value of HBV RNA level with 5.68 lg copies/ml at the 12th week had a sensitivity of 76.47% and a specificity of 72.55% for predicting HBeAg SR. Conclusions: Baseline HBV RNA levels in CHB patients exhibited a significantly positive correlation with HBV DNA and HBsAg levels, this correlation weakened after antiviral therapy. The serum HBV RNA level at the 12th week could serve as an early predictor for the HBeAg SR in patients with CHB. The CHB patients treated with antiviral drug TAF showed a higher HBeAg SR rate compared to ETV and TDF.