{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T11:18:35Z","timestamp":1763032715358,"version":"3.45.0"},"reference-count":37,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT, South Korea","doi-asserted-by":"publisher","award":["2018M3A9H3020844"],"award-info":[{"award-number":["2018M3A9H3020844"]}],"id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT, South Korea","doi-asserted-by":"publisher","award":["2020R1G1A1101354"],"award-info":[{"award-number":["2020R1G1A1101354"]}],"id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    The long\u2010term prognosis of immune tolerant (IT) phase patients remains unclear. This study aimed to identify true IT\u2010phase patients with favourable outcomes and distinguish grey\u2010zone IT patients. We retrospectively analysed 1064 chronic hepatitis B (CHB) patients (516 clinically inclusive IT, 548 antiviral\u2010treated immune active [AVT\u2010IA]). Clinically inclusive IT\u2010phase was defined as HBeAg\u2010positive, no cirrhosis, HBV DNA\u2009\u2265\u200910^6 IU\/mL, and ALT\u2009&lt;\u200980\u2009U\/L. Favourable prognosis was defined as the absence of HCC development and IA progression during follow\u2010up. IT\u2010phase patients had significantly lower 10\u2010year HCC rates compared to AVT\u2010IA patients (1.7% vs. 2.7%). Among the clinically inclusive IT group, favourable prognosis was associated with younger age (&lt;\u200935\u2009years), female gender, stringent low ALT (&lt;\u200935\u2009U\/L for males, &lt;\u200925\u2009U\/L for females), high HBV DNA (&gt;\u200910^8 IU\/mL), and no family history of HCC. Patients meeting these criteria showed no HCC cases and had a lower likelihood of progression to IA (~50%) within 10\u2009years. The strict criteria demonstrated 90.3% specificity for identifying true IT\u2010phase patients within the clinically inclusive IT group. Family history of HCC was an independent risk factor for HCC development (HR 6.059,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.019), while stringent low ALT, younger age, and female gender were linked to lower IA progression risk (HR 0.32,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009\u2264\u20090.001). This study highlights the importance of applying strict criteria in distinguishing true IT\u2010phase patients from grey\u2010zone patients. True IT patients are at minimal risk of HCC or progression to IA, while identifying grey\u2010zone patients is crucial, as they may require early antiviral therapy.\n                  <\/jats:p>","DOI":"10.1111\/jvh.70083","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T18:18:54Z","timestamp":1761070734000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Distinguishing True Immune Tolerant Hepatitis B Patients: Insights From Long\u2010Term Clinical Outcomes"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5484-5864","authenticated-orcid":false,"given":"Jung Hyun","family":"Kwon","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Incheon St. Mary's Hospital, College of Medicine, the Catholic University of Korea  Incheon Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sung Won","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Bucheon St. Mary's Hospital, College of Medicine, the Catholic University of Korea  Bucheon Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9663-132X","authenticated-orcid":false,"given":"Hee\u2010Yeon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Bucheon St. Mary's Hospital, College of Medicine, the Catholic University of Korea  Bucheon Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8278-4878","authenticated-orcid":false,"given":"Do Seon","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine St. Vincent's Hospital, College of Medicine, the Catholic University of Korea  Suwon Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soon Kyu","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Incheon St. Mary's Hospital, College of Medicine, the Catholic University of Korea  Incheon Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heechul","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Uijeongbu St. Mary's Hospital, College of Medicine, the Catholic University of Korea  Uijeongbu Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soon Woo","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Incheon St. Mary's Hospital, College of Medicine, the Catholic University of Korea  Incheon Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Si Hyun","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Eunpyeong St. Mary's Hospital, College of Medicine, the Catholic University of Korea  Seoul Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jong Young","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea  Seoul Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seung Kew","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea  Seoul Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3255-8474","authenticated-orcid":false,"given":"Jeong Won","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea  Seoul Republic of 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