Distinguishing true HBV reactivation from transient viremia in patients with resolved infection

Low-level HBV DNA reappearance in resolved infections under immunosuppression is often transient, not true reactivation. A study found 18% of patients progressed to true reactivation, while nearly half cleared the virus spontaneously. Initial viral load and hematologic malignancy were key risk factors. This suggests risk stratification can guide management, potentially avoiding unnecessary antiviral treatments and improving patient safety.