Low serum HBV DNA levels and development of hepatocellular carcinoma in patients with chronic hepatitis B: a case–control study

Summary Aim To investigate the level of hepatitis B virus (HBV) DNA in Chinese chronic hepatitis B (CHB) patients below which hepatocellular carcinoma (HCC) is unlikely to occur. Methods A total of 92 CHB patients diagnosed with HCC were recruited; 184 CHB patients without HCC, matched for age, sex and HBeAg status were included as controls. HBV DNA levels were performed at the time of HCC development and at the same age time points for control group. Results The median HBV DNA level in HCC patients was 1.7 × 10 6 copies/mL compared with 2.2 × 10 5 copies/mL in controls ( P = 0.006). In HCC patients, 21 (22.8%) were HBeAg(+), with no significant difference in HBV DNA levels compared with controls. Seventy‐one (77%) HCC patients were HBeAg(−) with median HBV DNA level of 3.2 × 10 5 copies/mL, compared with 6.0 × 10 4 copies/mL in controls ( P = 0.006). In HBeAg(−) patients, the control group had significantly greater proportion of patients having HBV DNA levels <10 5 and <10 4 copies/mL compared with HCC patients. Fifteen per cent of all HCC patients had HBV DNA levels <10 3 copies/mL. Conclusions In HBeAg(+) patients, HBV DNA levels were high in both HCC and control patients. In HBeAg(−) patients, HCC was more likely to develop in patients with HBV DNA level >10 4 copies/mL. However, 15% of the patients with HCC had HBV DNA levels <10 3 copies/mL.