Associations of HBV DNA Level with Liver-Related Parameters and Non-Invasive Liver Scores in Hepatitis B Virus Infection: A Retrospective Cross-Sectional Study in Saudi Arabia

Background and Objectives: Hepatitis B virus (HBV) infection remains a major cause of progressive liver disease worldwide. Although HBV DNA reflects viral replication, its relationships with conventional liver biochemical markers and non-invasive indices remain insufficiently studied in Saudi patients. This study evaluated the associations of HBV DNA level with conventional liver-related parameters, the Albumin–Bilirubin (ALBI) score, and the Fibrosis-4 (FIB-4) index. Materials and Methods: This retrospective cross-sectional study included patients with HBV infection evaluated at King Khalid University Hospital between January 2015 and June 2026. Laboratory data collected within 12 months of the recorded diagnosis date were used to calculate ALBI and FIB-4 scores. Relationships between HBV DNA and liver-related parameters were evaluated using Spearman correlation and group comparisons based on a predefined threshold of 2000 IU/mL. Multivariable logistic regression assessed factors associated with ALBI Grades 2–3. Results: Among 394 patients, median liver enzyme levels were generally within their reference ranges, although 55.7% of patients with available data had ALBI Grades 2–3. Among 160 patients with quantifiable HBV DNA, viral load correlated significantly with all seven evaluated liver-related parameters in the full analytical cohort, with AST showing the strongest association (ρ = 0.437, p < 0.001), although sensitivity analyses suggested these associations may partly reflect treatment-related differences in viral load distribution. Patients with HBV DNA ≥2000 IU/mL had significantly different liver-related parameters than those below this threshold. Each tenfold increase in HBV DNA was associated with 69% higher odds of ALBI Grades 2–3 (OR = 1.69; 95% CI: 1.32–2.25; p < 0.001). ALBI and FIB-4 were moderately positively correlated (ρ = 0.392, p < 0.001). Conclusions: Higher HBV DNA levels were associated with differences in liver-related parameters and poorer ALBI grade. Combining viral-load measurement with conventional markers and non-invasive indices may provide a more comprehensive assessment of hepatic involvement in HBV infection.