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World J Hepatol. Apr 27, 2014; 6(4): 226-229
Published online Apr 27, 2014. doi: 10.4254/wjh.v6.i4.226
To treat or not to treat the "immunotolerant phase" of hepatitis B infection: A tunnel of controversy
Mohamed A Mekky
Mohamed A Mekky, Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut 71111, Egypt
Author contributions: Mekky MA designed the work and wrote the paper.
Correspondence to: Mohamed A Mekky, MD, PhD, Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut 71111, Egypt.
Telephone: +2-88-4710955 Fax: +2-88-2343308
Received: September 15, 2013
Revised: December 8, 2013
Accepted: February 20, 2014
Published online: April 27, 2014

Hepatitis B virus (HBV) infection is a global public health problem, with an estimated 350 million people worldwide chronically infected and approximately 500000 who die annually from HBV-related liver diseases. Management of chronic HBV is challenging and waves of guidelines emerge every year. One of the hottest topics and a matter of debate is the management of patients in their early immunotolerant phase of infection. With the lack of evidence, dealing with this particular subset of patients creates a great conflict with opposing views. In this review, the author highlights the pros and cons of these views and proposes a reasonable solution to resolve this dilemma.

Keywords: Liver biopsy, Hepatitis B Virus, Immunotolerant phase, Polymerase chain reaction, Nucleotide analogue

Core tip: In this mini review, the author discusses the management dilemma of this peculiar subset of patients suffering from chronic hepatitis B in the immunotolerant phase. As already known, the immunotolerant phase of hepatitis B virus may last for a long period and hence there may be a potential for subtle liver damage. A thorough review of the updated published reports was carried out and a merge of the various management options, with a special point of view of the author, is stated.