Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar;57(5):464-474.
doi: 10.1111/apt.17272. Epub 2022 Nov 2.

Significant histological disease of patients with chronic hepatitis B virus infection in the grey zone

Jian Wang  1   2 , Xiaomin Yan  1 , Li Zhu  3 , Jiacheng Liu  1   4 , Yuanwang Qiu  5 , Yiguang Li  5 , Yilin Liu  4 , Ruifei Xue  6 , Jie Zhan  6 , Suling Jiang  6 , Yu Geng  4 , Yawen Wan  7 , Ming Li  4 , Minxin Mao  4 , Dongmei Gao  8 , Shengxia Yin  1   2 , Xin Tong  1   2 , Juan Xia  1 , Weimao Ding  8 , Yuxin Chen  2   9 , Jie Li  1   2 , Chuanwu Zhu  3 , Rui Huang  1   2   4 , Chao Wu  1   2   4
Affiliations

Significant histological disease of patients with chronic hepatitis B virus infection in the grey zone

Jian Wang et al. Aliment Pharmacol Ther. 2023 Mar.

Abstract

Background: Many patients with chronic hepatitis B (CHB) do not meet the definitions of the traditional natural phases and are classified as being in the grey zone (GZ).

Aims: To investigate liver histology, and to establish a management strategy for patients with CHB in the GZ.

Methods: This study included 1043 patients with CHB who underwent liver biopsy. Phases of natural history were determined according to the AASLD 2018 hepatitis B guidance. CHB patients in the GZ were divided into HBeAg-positive, normal ALT and HBV DNA ≤106 IU/ml (GZ-A); HBeAg-positive, elevated ALT and HBV DNA ≤2 × 104 IU/ml (GZ-B); HBeAg-negative, normal ALT and HBV DNA ≥2 × 103 IU/ml (GZ-C) and HBeAg-negative, elevated ALT and HBV DNA ≤2 × 103 IU/ml (GZ-D). Significant histological disease was defined as liver inflammation ≥G2 and/or liver fibrosis ≥S2.

Results: Two hundred and forty two (23.2%) patients were in the GZ. Approximately 72.7% had significant histological disease. HBeAg-positive GZ CHB patients had a higher proportion of significant histological disease than HBeAg-negative GZ patients (91.1% vs. 68.5%, p = 0.002). GZ-D (42.6%) was the dominant category, followed by GZ-C (38.8%), GZ-A (10.3%) and GZ-B (8.3%). The highest proportion of significant histological disease was observed patients in GZ-B (100.0%), followed by GZ-A (84.0%), GZ-D (69.9%) and GZ-C (67.0%). Prothrombin time (PT) was an independent risk factor of significant histological disease in the HBeAg-negative GZ.

Conclusions: Over 70% of GZ CHB patients had significant histological disease. We recommend antiviral treatment for HBeAg-positive and HBeAg-negative GZ CHB patients with high PT.

PubMed Disclaimer

Comment in

References

REFERENCES

    1. Polaris Observatory Collaborators. Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study. Lancet Gastroenterol Hepatol. 2018;3:383-403.
    1. Liaw YF, Chu CM. Hepatitis B virus infection. Lancet. 2009;373:582-92.
    1. Terrault NA, Lok ASF, McMahon BJ, Chang KM, Hwang JP, Jonas MM, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67:1560-99.
    1. Yao K, Liu J, Wang J, Yan X, Xia J, Yang Y, et al. Distribution and clinical characteristics of patients with chronic hepatitis B virus infection in the grey zone. J Viral Hepat. 2021;28:1025-33.
    1. Di Bisceglie AM, Lombardero M, Teckman J, Roberts L, Janssen HLA, Belle SH, et al. Determination of hepatitis B phenotype using biochemical and serological markers. J Viral Hepat. 2017;24:320-9.

Publication types

LinkOut - more resources