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Management of Immune-Tolerant Patients with Chronic HBV Infection

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Abstract

Purpose of Review

Hepatitis B virus (HBV) is a leading cause of hepatocellular carcinoma (HCC). Patients in the early phase of chronic HBV infection are designated “immune-tolerant” due to highly active viral replication without significant liver damage. Although these individuals are believed to have a low HCC risk, recent data showed conflicting results, which are summarized in this review.

Recent Findings

Clonally expanded hepatocytes with HBV integration have been detected in immune-tolerant patients, implying a theoretical HCC risk. Different cohort studies have shown conflicting HCC risk due to the heterogeneity of the patient population defined by fluctuating variables such as HBV DNA and alanine aminotransferase levels. As antiviral treatment response is poor, initiating prolonged therapy in immune-tolerant patients poses a challenge.

Summary

The absence of a clear definition for “genuine” immune-tolerant patients underscores the necessity for novel and stable biomarkers to guide when to start antiviral treatment.

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Funding

The work was supported by the grants from National Taiwan University Hospital (107-N4041 and 108-N4157), the Ministry of Science and Technology, Executive Yuan, Taiwan (MOST 106–2314-B-002 -136), and Gilead Sciences (IN-TW-988–5987).

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Tai-Chung Tseng, Hung-Yao Lin & Jia-Horng Kao

  2. Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan

    Tai-Chung Tseng & Jia-Horng Kao

  3. Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan

    Tai-Chung Tseng & Jia-Horng Kao

  4. Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, 1 Chang-Te Street, Taipei, 10002, Taiwan

    Jia-Horng Kao

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  1. Tai-Chung Tseng
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Correspondence to Jia-Horng Kao.

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Conflict of Interest

T-C. T. has served on speaker’s bureaus and received grant support from Gilead Sciences. H-Y. L. and J-H. K. declare no conflicts of interests.

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Tseng, TC., Lin, HY. & Kao, JH. Management of Immune-Tolerant Patients with Chronic HBV Infection. Curr Hepatology Rep 22, 130–137 (2023). https://doi.org/10.1007/s11901-023-00604-9

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