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News

Anti-viral therapy in hepatitis B grey zone patients

Anti‐viral therapy can be delayed or avoided in a significant proportion of HBeAg‐negative Caucasian patients in the Grey Zone, reports the latest issue of the Alimentary Pharmacology & Therapeutics.

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Grey Zone is an ill‐defined situation including patients falling between inactive carrier state and HBeAg‐negative chronic hepatitis B (HBeAg‐negative CHB).

Dr Bonacci and colleagues assessed the long‐term outcomes of Grey Zone patients compared to inactive carrier in the absence of treatment.

The researchers performed a retrospective analysis of 287 inactive carrier and Grey Zone HBeAg‐negative patients. 

Patients were classified into 4 groups at baseline: HBV‐DNA <2000 IU/mL and ALT <40 U/L, HBV‐DNA <2000 IU/mL and ALT 40‐80 U/L (GZ‐1), HBV‐DNA 2000‐20 000 IU/mL and ALT <40 U/L (GZ‐2) or ALT 40‐80 U/L (GZ‐3). 

Data were also analyzed using AASLD ALT criteria.


HBsAg loss occurred in about 15% inactive carriers or Grey Zone patients
Alimentary Pharmacology & Therapeutics
After a median follow‐up of 8 years, HBsAg loss occurred in about 15% inactive carriers or Grey Zone patients. 

Transition into inactive carrier state occurred in 40% of Grey Zone patients. 

DNA fluctuations >2000 IU/mL correlated inversely with transition into inactive carrier and HBsAg loss. 

The researchers found that HBsAg levels were significantly lower in inactive carriers than in Grey Zone patients. 

Among the latter group, there was an increasing gradient of HBsAg levels from Grey Zone‐1 to ‐3 patients. 

HBeAg‐negative CHB occurred in only 6% of Grey Zone patients. 

No patient developed cirrhosis nor advanced fibrosis. 

ALT/HBV‐DNA fluctuations and HBeAg‐negative CHB development were more frequent in genotype B/C patients, whereas HBsAg loss occurred only in genotype A/D patients.

Dr Bonacci's team comments, "Most Caucasian Grey Zone patients present excellent long‐term outcomes in the absence of treatment, with a high rate of HBsAg loss and low rate of progression to HBeAg‐negative CHB."

"HBV‐genotyping and HBsAg levels could help to predict outcomes and better classify Grey Zone patients."

Aliment Pharmacol Ther 2018: 47(10): 1397-1408
15 May 2018

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