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Immunotolerant HBeAg Positive Patients: To Treat or Not to Treat

  • Hepatitis B (P Martin and P Lampertico, Section Editors)
  • Published:
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Abstract

Immunotolerant hepatitis B e antigen (HBeAg) positive subjects are typically young, asymptomatic, have high serum hepatitis B virus (HBV) DNA with normal alanine aminotransferase (ALT) and no or minimal histologic changes. In addition, there is usually no or minimal disease progression if ALT remains normal. The response to currently available antiviral agents in immunotolerant subjects is poor in terms of HBeAg seroconversion. Therefore, current guidelines recommend regular follow-up for immunotolerant subjects instead of drug therapy. However, normal ALT does not always reflect an absence of significant inflammation and/or fibrosis, especially in those over age 35 and those with high “normal” ALT. Liver biopsy/fibrosis detection may help to identify patients in need of therapy. Preemptive antiviral therapy is mandatory for immunotolerant HBeAg-positive patients about to receive organ transplantation or immuno/chemotherapy. Immunotolerant HBeAg-positive pregnant women with HBV DNA > 2 × 106 IU/mL can be treated in the third trimester to prevent perinatal HBV transmission.

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Conflict of Interest

Yi-Cheng declares that he has no conflict of interest. Yun-Fan Liaw reports grants from Roche, BMS, Novartis and Gilead Sciences, outside the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 199, Tung Hwa North Road, Taipei, 105, Taiwan

    Yi-Cheng Chen & Yun-Fan Liaw

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  1. Yi-Cheng Chen
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Correspondence to Yun-Fan Liaw.

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Chen, YC., Liaw, YF. Immunotolerant HBeAg Positive Patients: To Treat or Not to Treat. Curr Hepatology Rep 13, 245–249 (2014). https://doi.org/10.1007/s11901-014-0235-5

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  • DOI: https://doi.org/10.1007/s11901-014-0235-5

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