High rates of transition to immune active disease in a cohort of strictly defined immune tolerant patients with chronic hepatitis B: results from the RADICAL consortium

The authors aimed to investigate the natural history of immune tolerant (IT) patients with chronic hepatitis B, specifically assessing the risk of transitioning to immune active (IA) disease, fibrosis progression, and hepatocellular carcinoma (HCC). Their findings revealed that over half of the IT patients transitioned to IA disease within five years, with a notable association between high-normal ALT levels and increased risk of this transition, while the risks of significant fibrosis and HCC remained low. This suggests that IT patients, particularly those with elevated ALT, may require closer monitoring or pre-emptive therapy.