Editorial: grey zone, a new area of interest in chronic hepatitis B

Abstract

Editorial: grey zone, a new area of interest in chronic hepatitis B.hronic hepatitis B virus (HBV) infection is a major health problemworldwide. One of the main issues in the management of this diseaseis to decide which patient will benefit from antiviral treatment. In2017, the European Association for the Study of the Liver (EASL) pub-lished a new version of their Clinical Practice Guidelines (CPG) on themanagement of HBV infection and defined 5 phases in the natural his-tory of HBV: hepatitis B e-antigen (HBeAg)-positive chronic infection,HBeAg-positive chronic hepatitis, HBeAg-negative chronic infection,HBeAg-negative chronic hepatitis and HBsAg-negative phase.1Gener-ally, patients within chronic hepatitis phases need to be treated.2Most patients fall into one of these phases, but some individualsfall into an indeterminate area, and treatment decision needs to beindividualised.1,2In a recent issue of AP&T, a study by Bonacci andcolleagues describes what happen in patients falling in one of thisindeterminate areas.3They described a ?Grey Zone? (GZ) betweenHBeAg-negative chronic infection (formerly called inactive carriers[IC]) and HBeAg-negative chronic hepatitis, since HBV-DNA andALT levels may fluctuate over time making difficult a precise classifi-cation of the patient clinical situation. They defined 3 GZ categoriesbased on HBV-DNA and ALT levels and compared clinical and viro-logical outcomes with patients in the HBeAg-negative chronic infec-tion phase or IC.