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Unresolved issues of immune tolerance in chronic hepatitis B

Authors
  • Lee, Hye Won1, 1, 2
  • Chan, Henry Lik-Yuen1, 1
  • 1 The Chinese University of Hong Kong,
  • 2 Yonsei University College of Medicine,
Type
Published Article
Journal
Journal of Gastroenterology
Publisher
Springer Singapore
Publication Date
Feb 03, 2020
Volume
55
Issue
4
Pages
383–389
Identifiers
DOI: 10.1007/s00535-020-01665-z
PMID: 32016713
PMCID: PMC7080668
Source
PubMed Central
Keywords
License
Unknown

Abstract

During the natural course of chronic hepatitis B virus infection, immune-tolerant phase is characterized by high viral replication, the presence of HBV e antigen (HBeAg), and normal or minimally elevated serum alanine aminotransferase. Immune-tolerant phase is usually regarded as a benign course of the disease. International guidelines recommend observation rather than treatment during immune-tolerant phase. In this article, we review unresolved issues related to the definition of true immune-tolerant phase and the benefit of antiviral treatment. Defining true immune-tolerant phase requires a careful approach and long-term follow-up. In previous studies, many patients were misclassified as being immune-tolerant phase. Noninvasive methods of assessing fibrosis are warranted for patients in the immune-tolerant phase. Yet, there has been controversy over the benefit and harm of antiviral treatment for immune-tolerant phase patients. Thus, further larger scale studies are needed to investigate the prognosis of patients in true immune-tolerant phase and their need for antiviral therapy.

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