HBeAg-negative chronic HBV-infected individuals with normal alanine aminotransferase and an age of ≤30 years should be taken seriously when expanding anti-HBV treatment for chronic hepatitis B

ObjectiveTo validate and refine the recommendations in the recently published expert opinion on expanding anti-HBV treatment for chronic hepatitis B. MethodsAdult individuals with chronic HBV infection and normal alanine aminotransferase (ALT) who underwent liver biopsy in The Fifth Medical Center of Chinese PLA General Hospital from January 2014 to October 2020 were enrolled in this single-center retrospective study, and the proportion of individuals with moderate or severe liver injury was analyzed in the population with different HBeAg status in the ≤30 years and ＞30 years subgroups. ResultsA total of 290 individuals with chronic HBV infection were included, among whom 121 (41.7%) were HBeAg positive and 169 (58.3%) were HBeAg negative. The HBeAg-positive group and the HBeAg-negative group were further divided into subgroups according to age: in the HBeAg-positive group, 37 were aged ≤30 years and 84 were aged ＞30 years; in the HBeAg-negative group, 24 were aged ≤30 years and 145 were aged ＞30 years. There were significant differences between the four groups in age (H=151.539, P＜0.05), sex (χ2=9.959, P＜0.05), ALT (H=29.041, P＜0.05), aspartate aminotransferase (H=11.127, P＜005), albumin (H=23.538, P＜0.05), HBV DNA (H=187.982, P＜005), and HBsAg (H=132.520, P＜0.05). In both ＞30 years and ≤30 years groups, nearly 50% of the patients had a moderate or higher grade of liver injury (50.22% vs 47.54%). According to HBeAg status and age, the patients were further divided into HBeAg-positive ≤30 years group with 37 patients, HBeAg-positive ＞30 years group with 84 patients, HBeAg-negative ≤30 years group with 24 patients, and HBeAg-negative ＞30 years group with 145 patients. In the HBeAg-positive group, there was no significant difference in the proportion of patients with a moderate or higher grade of liver injury between the patients aged ＞30 years and those aged ≤30 years (42.9% vs 37.8%, P=0.605), and there was also no significant difference in such proportion between the HBeAg-negative ≤30 years group and the HBeAg-negative/positive ＞30 years groups (62.5% vs 54.5%, P=0.464). In the cohort for which a decision could not be made based on noninvasive indices (269 patients with liver stiffness measurement ＜9.0 kPa or without the data of liver stiffness measurement but with fibrosis-4 ＜325), there was no significant difference in the proportion of patients with a moderate or higher grade of liver injury between the HBeAg-negative ≤30 years group and the HBeAg-negative/positive ＞30 years groups (59.1% vs 50.7% and 59.1% vs 41.8%, P=0.468 and 0.149). ConclusionHBeAg-negative chronic HBV-infected individuals with an age of ≤30 years should be taken into consideration when expanding anti-HBV treatment for chronic hepatitis B. If conditions permit, the revised flow chart for the initiation of anti-HBV treatment based on this study can be applied to further improve the precision of individualized anti-HBV treatment.