Response to: 'Prognosis of immune-tolerant phase chronic hepatitis B by Chu and Liaw

We appreciate the interest given to our article1 by Chu and Liaw.2

Determining disease phases of patients with chronic hepatitis B (CHB) is essential for assessing patient prognosis and need for treatment. Distinguishing between the immune-tolerant and immune-active phases among patients with hepatitis B e antigen (HBeAg)-positive CHB is best determined by identifying significant necroinflammation and/or fibrosis through liver biopsy. However, given the dynamic nature of CHB and the risks and costs of repeated liver biopsy, this recommendation may not always be realistic, especially in regions with high CHB prevalence.

Current practice guidelines recommend considering HBeAg positivity and serum levels of HBV DNA and alanine aminotransferase (ALT) to determine the phases of CHB, and ALT levels are a crucial criterion for determining treatment initiation in patients with CHB. However, the HBV DNA cut-off levels for the immune-tolerant phase vary among guidelines. More importantly, as observed in our study,...

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