Study participants
This study was nested in a real-life prospective observational CHB cohort (Search-B cohort: NCT02167503). The study design and inclusion criteria for the Search-B cohort have been previously described.26 Patients with CHB who achieved undetectable HBV DNA levels for at least 12 months after antiviral treatment at Nanfang Hospital between September 2015 and July 2017 were enrolled in this study. Patients meeting any of the following exclusion criteria were excluded: (1) coinfection with hepatitis C virus and hepatitis D virus; (2) diagnosis of malignant tumor; (3) excessive alcohol consumption (>21 units of alcohol per week for men and >14 units of alcohol per week for women) in the previous six months; (4) receiving medications with known effects on ALT, such as Chinese traditional medicines, anti-tuberculosis drugs, lipid-lowering drugs, nonsteroidal anti-inflammatory drugs, and antibiotics; (5) diagnosis of systemic inflammatory diseases, diabetes, and autoimmune liver disease; (6) HBV DNA ≥ 20 IU/mL during follow-up; and (6) loss of follow-up.
Written informed consent for clinical data and blood sample collection was obtained from each patient during recruitment. The study protocol was approved by the Ethics Committee of Nanfang Hospital (Guangzhou, China).