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We explored the association between liver fibrosis and HBV DNA levels in HBeAg-positive CHB patients with normal alanine transaminase (ALT) with relatively high HBV DNA.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Six hundred and twenty-two HBeAg-positive CHB patients with normal ALT were included. Patients were divided into three categories: low (6 log<jats:sub>10<\/jats:sub> IU\/mL\u2009\u2264\u2009HBV DNA\u2009&lt;\u20097 log<jats:sub>10<\/jats:sub> IU\/mL), moderate (7 log<jats:sub>10<\/jats:sub> IU\/mL\u2009\u2264\u2009HBV DNA\u2009&lt;\u20098 log<jats:sub>10<\/jats:sub> IU\/mL), and high (HBV DNA\u2009\u2265\u20098 log<jats:sub>10<\/jats:sub> IU\/mL). APRI, FIB-4, transient elastography, or liver biopsy were used to assess liver fibrosis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The median age of patients was 33.0 years and 57.9% patients were male. 18.8%, 52.1%, and 29.1% of patients had low, moderate, and high HBV DNA levels, respectively. The APRI (0.33 vs. 0.26 vs. 0.26, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), FIB-4 (1.03 vs. 0.71 vs. 0.68, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), and LSM values (7.6\u00a0kPa vs. 5.6\u00a0kPa vs. 5.5\u00a0kPa, <jats:italic>P<\/jats:italic>\u2009=\u20090.086) were higher in low HBV DNA group than other two groups. Low HBV DNA group had higher proportions of significant fibrosis (24.8% vs. 9.9% vs. 3.3%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and cirrhosis (7.7% vs. 2.5% vs. 1.1%, <jats:italic>P<\/jats:italic>\u2009=\u20090.004) than moderate and high HBV DNA groups. Moderate (OR 3.095, <jats:italic>P<\/jats:italic>\u2009=\u20090.023) and low (OR 4.968, <jats:italic>P<\/jats:italic>\u2009=\u20090.003) HBV DNA were independent risk factors of significant fibrosis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Lower HBV DNA level was associated with more severe liver fibrosis in HBeAg-positive CHB patients with ALT.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12985-024-02368-0","type":"journal-article","created":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T19:04:19Z","timestamp":1717527859000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Lower HBV DNA level is associated with more severe liver fibrosis in HBeAg-positive chronic hepatitis B with normal alanine transaminase"],"prefix":"10.1186","volume":"21","author":[{"given":"Jian","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaoqiu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifan","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiacheng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengxia","family":"Yin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Tong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanwu","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingxiang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,6,4]]},"reference":[{"key":"2368_CR1","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1016\/S0140-6736(22)01468-4","volume":"401","author":"WJ Jeng","year":"2023","unstructured":"Jeng WJ, Papatheodoridis GV, Lok ASF, Hepatitis. 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