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Background and Aims To accelerate hepatitis B virus (HBV) elimination, expansion of antiviral treatment (AVT) criteria for people living with chronic HBV infection (CHB) is increasingly advocated despite controversial data. We assessed the rate of liver-related events and their associated factors in treatment-naïve CHB patients who were ineligible according to the 2017 EASL guidelines.Methods We conducted a retrospective cohort study at a West London NHS Trust and analysed the 5-year clinical outcomes of hepatitis B e-antigen (HBeAg) negative CHB adult patients enrolled from 1 January 2016 to 31 December 2018. All patients were treatment naïve and ineligible for treatment as per the 2017 EASL guidelines. The primary endpoint was the proportion of patients with liver disease progression as defined by becoming newly eligible for AVT, fibrosis progression, hepatic decompensation, new hepatocellular carcinoma (HCC) or liver-related death. Kaplan-Meier (KM) survival analysis and log-rank tests were used to compare progression-free survival between groups.Results From 5,582 CHB patients, 378 HBeAg-negative, untreated and ineligible patients (228 (60.3%) in chronic infection phase and 150 (39.7%) in indeterminate phase) were analysed (52.5% male, median age 42 years [IQR 35–49]). All patients had at least one liver reassessment, and the median follow-up was 53.8 months [IQR 47.6–57.3]. 32 patients (8.5%) experienced liver disease progression (median time to event occurrence: 48 months [IQR 24–53]). One patient developed HCC, no cases of cirrhosis or hepatic decompensation occurred during follow-up. KM curves showed patients with HBV viral load ≥ 2,000 IU/mL (n=78, 20.6%) experienced more hepatic events than patients with a viral load < 2,000 IU/mL (p=0.045). Disease progression was higher (p=0.011) in patients with ALT > 40 IU/L (n= 82, 21.7%) and a tendency towards progression for indeterminate phase CHB patients (n=150, 39.7%) (p=0.084). No difference was observed between patients with (n=198, 52.4%) and without MASLD (p=0.25). Among patients with an ALT > 40 IU/L, MASLD patients experienced fewer hepatic events (p=0.028) compared to non-MASLD patients. A multivariable model adjusted for age, obesity, steatosis, diabetes, Fibroscan > 7 kPa, and ALT, only identified HBV viral load ≥ 2,000 IU/mL as an independent predictor of hepatic events [HR 2.6, 95% CI 1.2–5.8, p=0.019].Abstract P165 Figure 1Kaplan-Meier curves comparing event-free survival in patients with HBV DNA ≥ 2000 IU/mL and <2000 IU/mLDiscussion We observed a low incidence of disease progression with no liver-related mortality across our 5-year study. An HBV viral load ≥ 2000 IU/mL was the only factor independently associated with disease progression, supporting the revised 2025 EASL treatment criteria.