Management of Immune-Tolerant Patients with Chronic HBV Infection
Tóm tắt
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. 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. 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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