Dear @CNN ,
With such low level HBV DNA, liver disease usually absent. However, HBV DNA integration still occurs and so the risk of developing HCC is still elevated.
This is the major philosophical difference between North American (AASLD) and European (EASL) guidelines, which advise to withhold treatment in the absence of liver disease and the newer Chinese guidelines which advise to treat any person who is HBV DNA positive.
Rates of death from HBV are not declining suggesting that the NA and EU guidelines are only partially effective in the long term management of chronic HBV and not addressing the issue of death from HCC. There is also no safety data which suggests a benefit to withholding NUC therapy in a patient with no liver disease and low HBV DNA.
This fundamental issue is what divides doctors on whether to start treatment in these kinds of patients.
Best regards,