Abstract: Objective To identify risk factors associated with hypoviremia in chronic hepatitis B patients receiving antiviral therapy. Methods A total of 108 chronic hepatitis B patients receiving antiviral treatment at our hospital were selected for this study. Based on high-sensitivity HBV DNA quantitative testing results, they were catergorized into a hypoviremia group (60 cases) and a complete virological response group (48 cases). Clinical data from both groups were collected and compared, and logistic regression analysis was employed to identify risk factors associated with hypoviremia. Results The rate of second-line initial treatment in the hypoviremia group was significantly higher than that in the complete virological response group(18.75% vs 2.63%,P<0.05), while the medication adherence rate was significantly lower (71.88% vs 91.67%, P<0.05). No statistically significant differences were observed bettwen the two groups in AST[(30.22±8.34)U/L vs (28.30±8.23)U/L],ALT[(25.35±3.49)U/L vs (27.03±4.63)U/L],TBil[(14.35±3.71)μmol/L vs (13.74±2.87)μmol/L], or HBcAb levels[(94.66±23.82)S/CO vs (95.14±26.73)S/CO] (P>0.05). However, the hypoviremia group exhibted significantly higher rates of HBeAg positivity(59.38% vs 10.53%), HBsAg levels[(3.24±0.36)IgIU/ml vs (2.87±0.32)IgIU/ml], and baseline HBV DNA levels[(7.40±1.33) vs (5.78±1.42)] compared to the complete virological response group (P<0.05). The factors of second-line initial treatment, HBeAg positivity, HBsAg levels, and baseline HBV DNA levels were negatively correlated with complete virological response(r=-0.411, -0.352, -0.413, -0.492,P<0.05), while good medication adherence is positively correlated (r=0.425,P<0.05). Logistic regression analysis identified HBeAg positivity, HBsAg levels, and baseline HBV DNA levels as significant risk factors for hypoviremia(OR=2.809,1.861,1.311,P<0.05), whereas good medication adherence emerged as a protective factor(OR=0.810,P<0.05). Conclusion Positive HBeAg, elevated HBV DNA load, and high HBsAg levels prior to antiviral treatment are significant risk factors for the develpment of hypoviremia in chronic hepatitis B patients. Ensuring good medication adherence is crucial for achieving virological responses. Early, targeted interventions should be implemented in clinical practice for CHB patients identified with these high-risk factors.

Key words: Hypoviremia, Antiviral therapy, Chronic hepatitis B, Risk factors, virological response