HBV RNA positivity at nucleoside analogue discontinuation linked to higher relapse risk in chronic hepatitis B

This systematic review and meta-analysis examined the relationship between HBV RNA status at nucleoside analogue discontinuation and subsequent relapse risk in chronic hepatitis B. The analysis pooled data from 21 observational cohort studies involving 2,043 individuals. The primary outcomes were viral relapse and clinical relapse following treatment cessation, though the specific follow-up duration was not reported for the overall analysis.

HBV RNA-positive individuals at discontinuation showed significantly higher relapse rates compared to HBV RNA-negative patients. Viral relapse was 1.9-fold higher (p < 0.0001), and clinical relapse was 2.26-fold higher (p < 0.0001). For each log10 copies/ml increase in HBV RNA levels at discontinuation, viral relapse risk increased 1.32-fold (p < 0.0001) and clinical relapse risk increased 1.37-fold (p < 0.0001). Clinical relapse was also associated with HBeAg positivity at baseline (p = 0.006). A subgroup analysis found no significant correlation between relapse rates and follow-up periods of 2 years or longer.

Safety and tolerability data were not reported in the meta-analysis. Key limitations include the observational nature of all included studies, which precludes establishing causality, and the absence of absolute event rates for relapse outcomes. Funding sources and conflicts of interest were not reported. The findings suggest HBV RNA surveillance may have prognostic value when considering nucleoside analogue discontinuation, particularly for HBeAg-positive patients, but clinical decisions should weigh these associations against the limitations of the evidence.