Abstract: Objective The aim of this study was to investigate clinical antiviral efficacy of tenofovir amibufenamide (TMF) and entecavir (ETV) in the treatment of patients with chronic hepatitis B (CHB) and low-level viremia (LLV). Methods 79 patients with CHB were encountered in our hospital between April 2021 and April 2023, and all met enrollment criteria, e.g., receiving nucleos(t)ide analogues (NAs), including lamivudine, adefovir and ETV antiviral treatment for 4 to 22(12.1±3.6)yrs and having LLV (21 to 1999 IU/mL). Patients were divided into control (n=39) and observation (n=40) groups, receiving ETV or TMF treatment for 12 months. Serum HBV DNA loads were detected by high-sensitive real-time fluorescence quantitative PCR, serum HBsAg and HBeAg were assayed by chemiluminescence immunoassay, and routine blood and biochemical parameters were determined to obtain fibrosis-4 index (FIB-4) and estimated glomerular filtration rate (eGFR). Liver stiffness measurement (LSM) was detected by Fibroscan. Peripheral blood T lymphocyte subsets were measured by flow cytometry. Results By end of 48-week treatment, serum ALT and AST levels in the observation group were(30.2±4.0)U/L and (31.8±6.2)U/L, both not significantly different compared to [(30.9±3.6)U/L and (33.7±7.0)U/L, respectively] in the control (P>0.05), while serum HBV DNA loads was 25(14.8, 51.9)IU/mL, much lower than [223.8(87.2, 327.5)IU/mL, P<0.05] in the control; LSM, FIB-4 and eGFR were (7.0±0.8)kPa, (1.9±0.3) and (104.9±10.3)mL/min/1.73m², not significantly different as compared to [(7.1±0.9)kPa, (1.8±0.3) and (105.1±11.2)mL/min/1.73m², respectively, P>0.05] in the control; percentages of peripheral blood CD3⁺, CD4⁺, CD8⁺ cells and CD4⁺/CD8⁺ cell ratio were (66.9±6.9)%, (37.5±4.9)%, (24.0±2.5)% and (1.5±0.3), not significantly different compared to [(67.4±7.3)%, (38.8±4.6)%, (23.6±2.7)% and (1.6±0.4), respectively, P>0.05] in the control group. Conclusion TMF treatment could relatively radically inhibit HBV DNA replication in CHB patients with LLV, and long-term benefit needs further clinical investigation.

Key words: Hepatitis B, Low-level viremia, Tenofovir amibufenamide, Entecavir, Treatment