{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T21:30:29Z","timestamp":1790371829567,"version":"4.1.0"},"reference-count":45,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T00:00:00Z","timestamp":1720051200000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Reviews in Medical Virology"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The question of whether patients in the immune\u2010tolerant (IT) phase of chronic hepatitis B virus (HBV) infection should undergo antiviral therapy and determine the optimal regimen remains unclear. A comprehensive search of PubMed, Embase, MEDLINE, Cochrane Library, and Wanfang Data from inception to 5 December 2023, was conducted. Studies reporting on key outcomes such as HBV DNA undetectability, HBeAg loss or seroconversion, HBsAg loss or seroconversion, and hepatocellular carcinoma (HCC) incidence in patients in the IT phase of chronic HBV infection were included. In total, 23 studies were incorporated. Approximately 4% of patients in the IT phase achieved spontaneous HBeAg loss over 48\u00a0weeks of follow\u2010up. Antiviral therapy demonstrated a favourable impact on HBV DNA negative conversion (Children: risk ratios [RR]\u00a0=\u00a06.83, 95% CI: 2.90\u201316.05; Adults: RR\u00a0=\u00a025.84, 95% CI: 6.47\u2013103.31) and HBsAg loss rates (Children: RR\u00a0=\u00a09.49, 95% CI: 1.74\u201351.76; Adults: RR\u00a0=\u00a07.35, 95% CI: 1.41\u201338.27) for patients in the IT phase. Subgroup analysis revealed that in adult patients in the IT phase, interferon plus nucleos(t)ide analogues (NA)\u2010treated patients exhibited a higher pooled rate of HBsAg loss or seroconversion than those treated with NA monotherapy (9% vs. 0%). Additionally, the pooled annual HCC incidence for patients in the IT phase was 3.03 cases per 1000 person\u2010years (95% CI: 0.99\u20135.88). Adult patients in the IT phase had a significantly lower HCC incidence risk than HBeAg\u2010positive indeterminate phase patients (RR\u00a0=\u00a00.46, 95% CI: 0.32\u20130.66), with no significant differences observed between IT and immune\u2010active phases. Presently, there is insufficient evidence solely based on reducing the risk of HCC incidence, to recommend treating patients in the IT phase of chronic HBV infection. However, both adult and paediatric patients in the IT phase responded well to antiviral therapy, showing favourable rates of HBsAg loss or seroconversion.<\/jats:p>","DOI":"10.1002\/rmv.2570","type":"journal-article","created":{"date-parts":[[2024,7,5]],"date-time":"2024-07-05T01:19:51Z","timestamp":1720142391000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Estimating the key outcomes and hepatocellular carcinoma risk in patients in immune\u2010tolerant phase of chronic hepatitis B virus infection: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"34","author":[{"given":"Min","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Infectious Disease and Hepatic Disease The First People's Hospital of Yunnan Province The Affiliated Hospital of Kunming University of Science and Technology  Kunming Yunnan China"},{"name":"Faculty of Life Science and Technology Kunming 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