Histopathological Evaluation and Treatment Necessity in Patients with Immune-Tolerant, Inactive, and Gray-Zone Chronic Hepatitis B

Yıl 2026, Cilt: 53 Sayı: 1, 159 - 168, 10.03.2026

Mehmet Kasim Aydin

https://doi.org/10.5798/dicletip.1906472

https://izlik.org/JA67FA97ZC

Öz

Objective: To evaluate the need for antiviral therapy in chronic hepatitis B (CHB) patients with normal ALT levels who are HBeAg-positive (Immune tolerant phase), HBeAg-negative (Inactive phase), or in the gray-zone, by assessing liver fibrosis stage and histological activity index (HAI).
Methods: This retrospective cross-sectional study included 36 immune-tolerant HBeAg-positive, 21 inactive HBeAg-negative, and 193 gray-zone CHB patients without prior antiviral therapy. The inactive phase was defined as persistently normal ALT and HBV DNA <2000 IU/mL, while patients with normal ALT but HBV DNA ≥2000 IU/mL were classified as gray-zone. Liver biopsies were evaluated using HAI and the Ishak fibrosis scoring system. Antiviral therapy indication was defined as fibrosis stage ≥2 and/or HAI ≥6.
Results: A total of 250 patients (mean age 44.2 ± 12.2 years; 44.4% male) were analyzed. Of these, 14.4% were immune-tolerant and 85.6% were in inactive/gray-zone phases. Among inactive/gray-zone patients, HBV DNA was <2000 IU/mL in 9.8% and ≥2000 IU/mL in 90.2%. Overall, 37.6% (94/250) met antiviral therapy criteria, including 41.6% of immune-tolerant, 33.3% of inactive, and 37.3% of gray-zone patients.
Conclusion: A notable proportion of CHB patients with normal ALT show histological evidence warranting antiviral therapy. These results emphasize that phase classification at a single time point is inadequate; dynamic and comprehensive evaluation is essential.

Anahtar Kelimeler

Hepatitis B , inactive phase , immune-tolerant phase , gray-zone , fibrosis , antiviral therapy

Etik Beyan

This retrospective study was approved by the Clinical Research Ethics Committee of the Faculty of Medicine (Approval Date: 30.04.2025; Approval No: 458).

Kronik Hepatit B’de Sessiz Tehdit: İmmün Toleran, İnaktif ve Gri Zon Fazlarında Gizli Fibrozis ve Tedavi Endikasyonları

https://izlik.org/JA67FA97ZC

Öz

Amaç: ALT düzeyleri normal olan kronik hepatit B (KHB) hastalarında — HBeAg pozitif (immün toleran faz), HBeAg negatif (inaktif faz) veya gri zon fazında bulunan olgularda — karaciğer fibrozis evresi ve histolojik aktivite indeksi (HAI) değerlendirilerek antiviral tedavi gereksiniminin belirlenmesi amaçlanmıştır.
Yöntemler: Bu retrospektif kesitsel çalışmada, daha önce antiviral tedavi almamış 36 immün toleran HBeAg pozitif, 21 inaktif HBeAg negatif ve 193 gri zon KHB hastası incelendi. İnaktif faz, sürekli normal ALT ve HBV DNA <2000 IU/mL olarak tanımlanırken, ALT normal fakat HBV DNA ≥2000 IU/mL olan hastalar gri zon olarak sınıflandırıldı. Karaciğer biyopsileri HAI ve Ishak fibrozis skorlama sistemi ile değerlendirildi. Tedavi endikasyonu fibrozis evresi ≥2 ve/veya HAI ≥6 olarak kabul edildi.
Bulgular: Toplam 250 hasta (ortalama yaş 44,2 ± 12,2 yıl; %44,4 erkek) çalışmaya dahil edildi. Hastaların %14,4’ü immün toleran, %85,6’sı inaktif/gri zon fazdaydı. Genel olarak, %37,6’sı (94/250) antiviral tedavi kriterlerini karşıladı.
Sonuç: Normal ALT düzeyine rağmen birçok KHB hastasında antiviral tedavi gereksinimi bulunmaktadır. Bu durum, KHB’nin dinamik doğasını ve faz sınıflandırmasının tek bir zaman noktasına göre yetersizliğini göstermektedir.

Anahtar Kelimeler

Hepatit B , inaktif faz , immün toleran faz , gri zon , fibrozis , antiviral tedavi

Kaynakça

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