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Abstract Details
Immunetolerant Hepatitis B: Maybe a misnomer but still hard to treat
Martin P1. Hepatology. 2019 Apr 9. doi: 10.1002/hep.30654. [Epub ahead of print]
Author information
1 Division of Gastroenterology and Hepatology, Miller School of Medicine, University of Miami, Miami, FL, 33136.
Abstract
An unresolved issue in the management of chronic hepatitis B (HBV) infection has been the role of antiviral therapy in the large number of younger patients infected at an early age with active viral replication and HBeAg positivity without biochemical abnormalities, felt to reflect an immune tolerant (IT)) state without progressive liver injury. The recent AASLD Guidance document defines the IT phase as absence of biochemical dysfunction (ALT < 35 U/l in men, < 25 U/L in women), presence of HBeAg, elevated HBV DNA > 1 million IU/L and minimal inflammation with an absence of fibrosis 1 The authors however also suggest that if ALT levels are borderline normal or mildly elevated evaluation of hepatic fibrosis and inflammation especially in patients > 40 years with childhood acquired HBV infection be undertaken by liver biopsy or elastography to determine need for antiviral therapy.