To investigate the level of hepatitis B virus (HBV) DNA in Chinese chronic hepatitis B (CHB) patients below which hepatocellular carcinoma (HCC) is unlikely to occur.

Methods  A total of 92 CHB patients diagnosed with HCC were recruited; 184 CHB patients without HCC, matched for age, sex and HBeAg status were included as controls. HBV DNA levels were performed at the time of HCC development and at the same age time points for control group.

Results  The median HBV DNA level in HCC patients was 1.7 × 106 copies/mL compared with 2.2 × 105 copies/mL in controls (P = 0.006). In HCC patients, 21 (22.8%) were HBeAg(+), with no significant difference in HBV DNA levels compared with controls. Seventy-one (77%) HCC patients were HBeAg(−) with median HBV DNA level of 3.2 × 105 copies/mL, compared with 6.0 × 104 copies/mL in controls (P = 0.006). In HBeAg(−) patients, the control group had significantly greater proportion of patients having HBV DNA levels <105 and <104 copies/mL compared with HCC patients. Fifteen per cent of all HCC patients had HBV DNA levels <103 copies/mL.

Conclusions  In HBeAg(+) patients, HBV DNA levels were high in both HCC and control patients. In HBeAg(−) patients, HCC was more likely to develop in patients with HBV DNA level >104 copies/mL. However, 15% of the patients with HCC had HBV DNA levels <103 copies/mL.