{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T07:08:03Z","timestamp":1765004883452},"reference-count":41,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2016,1,4]],"date-time":"2016-01-04T00:00:00Z","timestamp":1451865600000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2016,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Immunotolerant patients with chronic hepatitis B virus (<jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content>) infection are characterized by positive <jats:styled-content style=\"fixed-case\">HB<\/jats:styled-content>eAg, high viral replication, persistently normal <jats:styled-content style=\"fixed-case\">ALT<\/jats:styled-content> and no or minimal liver damage. Since the risk of the progression of liver disease and the chance of a sustained response with existing anti\u2010<jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content> agents are low, current guidelines do not recommend treatment but close monitoring with serial alanine aminotransferase (<jats:styled-content style=\"fixed-case\">ALT<\/jats:styled-content>) and <jats:styled-content style=\"fixed-case\">HBV DNA<\/jats:styled-content> measurements instead. However, not treating all these patients is a concern because advanced histological lesions have been reported in certain cases who are usually older (&gt;30\u201340\u00a0years old), and continued high <jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content> replication could increase the risk of hepatocellular carcinoma (<jats:styled-content style=\"fixed-case\">HCC<\/jats:styled-content>). Thus, the optimal management of immunotolerant patients is often individualised according to age, which is associated with histological severity and patient outcome. In particular, immunotolerant patients &lt;30\u00a0years old can be monitored for <jats:styled-content style=\"fixed-case\">ALT<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">HBV DNA<\/jats:styled-content>, while treatment is often recommended in the few patients over 40. A liver biopsy and\/or non\u2010invasive assessment of fibrosis may be helpful to determine the therapeutic strategy in patients between 30 and 40\u00a0years old. Moreover, there are three specific subgroups of immunotolerant patients who often require treatment with oral anti\u2010<jats:styled-content style=\"fixed-case\">HBV<\/jats:styled-content> agents: patients who will receive immunosuppressive treatment or chemotherapy, women with serum <jats:styled-content style=\"fixed-case\">HBV DNA<\/jats:styled-content> &gt;10<jats:sup>6\u20137<\/jats:sup>\u00a0IU\/ml during the last trimester of pregnancy and certain healthcare professionals with high viraemia levels. More studies are needed to further clarify the natural history for the optimal timing of treatment in this setting.<\/jats:p>","DOI":"10.1111\/liv.12996","type":"journal-article","created":{"date-parts":[[2016,1,4]],"date-time":"2016-01-04T09:23:32Z","timestamp":1451899412000},"page":"93-99","source":"Crossref","is-referenced-by-count":18,"title":["HBV: Do I treat my immunotolerant patients?"],"prefix":"10.1111","volume":"36","author":[{"given":"Jiannis","family":"Vlachogiannakos","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Medical School of National and Kapodistrian University of Athens Laiko General Hospital Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George V.","family":"Papatheodoridis","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Medical School of National and Kapodistrian University of Athens Laiko General Hospital Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,1,4]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0801644"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(07)70264-5"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60220-8"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2007.11.011"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.01.002"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v19.i47.8822"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/cld.160"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.antiviral.2015.06.008"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2007.08.039"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.22930"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.22898"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10875-010-9379-4"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.2217\/17460794.1.2.189"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.3349\/ymj.2012.53.5.875"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/0016-5085(91)90286-T"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1203\/00006450-199101000-00002"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2012.02.010"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.23190"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-012-9365-4"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2007.01.005"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21724"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2007.07.022"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.02.075"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.09.052"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.23348"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2008.10.023"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2005.11.016"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.295.1.65"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2014.07.019"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2013-306409"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2011.02.032"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27837"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12726"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2002.34294"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2014.01.044"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840100502"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-109-2-95"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.08.061"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.24555"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.12719"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.14.6902"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fliv.12996","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fliv.12996","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.12996","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T13:57:22Z","timestamp":1694613442000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.12996"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,1]]},"references-count":41,"journal-issue":{"issue":"S1","published-print":{"date-parts":[[2016,1]]}},"alternative-id":["10.1111\/liv.12996"],"URL":"https:\/\/doi.org\/10.1111\/liv.12996","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"value":"1478-3223","type":"print"},{"value":"1478-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,1]]}}}