Diagnostic microbiology and infectious disease · 2026
Serum HBV RNA reflects persistent viral transcriptional activity in nucleos(t)ide analogue-treated patients despite suppressed HBV DNA.
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Gu Hongfang, Jiao Yan, Pan Yue, Li Ju, Xie Bingxin, Zhang Fan
Аннотация
BACKGROUND: Accurate assessment of viral transcriptional activity remains challenging in chronic hepatitis B (HBV) infection, especially in patients with suppressed HBV DNA. Serum HBV RNA has emerged as a potential biomarker reflecting covalently closed circular DNA (cccDNA) activity.
METHODS: A total of 336 HBV-infected patients, including chronic hepatitis B (CHB, n = 67), liver cirrhosis (LC, n = 149), and hepatocellular carcinoma (HCC, n = 120), were retrospectively enrolled. Serum HBV RNA, HBV DNA, serological markers, and liver function parameters were measured. Correlation, concordance, and multivariate analyses were performed.
RESULTS: HBV RNA was detectable in 67.16%, 74.50%, and 68.33% of CHB, LC, and HCC patients, respectively. Among HBeAg-positive patients, HBV RNA levels were significantly lower in HCC than in CHB (P < 0.05). HBV RNA correlated positively with HBV DNA and HBsAg (all P < 0.05). Notably, 61.61% of patients were HBV DNA-negative but HBV RNA-positive, with poor concordance (Kappa = 0.213). HBsAg level, DNA level and disease stage were independent predictors of HBV RNA positivity.
CONCLUSION: Serum HBV RNA reflects persistent viral transcriptional activity and provides complementary information beyond HBV DNA, supporting the potential utility of serum HBV RNA testing as a complementary laboratory marker in routine clinical monitoring of chronic HBV infection.
METHODS: A total of 336 HBV-infected patients, including chronic hepatitis B (CHB, n = 67), liver cirrhosis (LC, n = 149), and hepatocellular carcinoma (HCC, n = 120), were retrospectively enrolled. Serum HBV RNA, HBV DNA, serological markers, and liver function parameters were measured. Correlation, concordance, and multivariate analyses were performed.
RESULTS: HBV RNA was detectable in 67.16%, 74.50%, and 68.33% of CHB, LC, and HCC patients, respectively. Among HBeAg-positive patients, HBV RNA levels were significantly lower in HCC than in CHB (P < 0.05). HBV RNA correlated positively with HBV DNA and HBsAg (all P < 0.05). Notably, 61.61% of patients were HBV DNA-negative but HBV RNA-positive, with poor concordance (Kappa = 0.213). HBsAg level, DNA level and disease stage were independent predictors of HBV RNA positivity.
CONCLUSION: Serum HBV RNA reflects persistent viral transcriptional activity and provides complementary information beyond HBV DNA, supporting the potential utility of serum HBV RNA testing as a complementary laboratory marker in routine clinical monitoring of chronic HBV infection.