{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T06:05:17Z","timestamp":1780380317733,"version":"3.54.1"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003453","name":"Natural Science Foundation of Guangdong Province","doi-asserted-by":"publisher","award":["2024A1515010567"],"award-info":[{"award-number":["2024A1515010567"]}],"id":[{"id":"10.13039\/501100003453","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Guidelines provide limited guidance on antiviral therapy for CHB patients \u226430 years with normal ALT despite occult injury risks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter cross-sectional study included 423 treatment-na\u00efve CHB patients aged \u226430 years with persistently normal ALT who underwent liver biopsy. Significant injury was defined as METAVIR necroinflammation \u2265G2 and\/or fibrosis \u2265S2. A non-invasive model was developed and internally validated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Significant necroinflammation and fibrosis were present in 48.0% and 48.5%, respectively. Independent predictors included anti-HBc, LSM, and AST. The Y-HAL model showed excellent discrimination (AUC: 0.918), outperforming 12 existing models. A three-tier pathway stratified patients into low-risk (monitoring), high-risk (antiviral therapy), and intermediate-risk (biopsy) categories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A substantial proportion of young CHB patients with normal ALT have significant histological injury. The Y-HAL model and three-tier strategy offer an evidence-based framework for early intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1845162","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T05:43:04Z","timestamp":1780378984000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Normal ALT masks occult liver injury in young chronic hepatitis B patients: a call for early treatment intervention"],"prefix":"10.3389","volume":"16","author":[{"given":"Pei-pei","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]},{"name":"Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Zhaoqing Hospital","place":["Zhaoqing, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Yang","sequence":"additional","affiliation":[{"name":"Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]},{"name":"Liver Surgery & Liver Transplantation Center, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang-yong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1715","DOI":"10.1056\/NEJMra2403308","article-title":"Noninvasive assessment of liver fibrosis","volume":"393","author":"Castera","year":"2025","journal-title":"N. 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