Should Indications for Antiviral Therapy for Hepatitis B Be Broadened to Include Immune-Tolerant Patients, Inactive Carriers, or Patients in the “Gray Zone”?

Purpose of Review: Current antiviral therapy effectively suppresses hepatitis B virus (HBV) replication and improves the prognosis. It cannot cure HBV infection. Current clinical guidelines do not advocate universal treatment for all with chronic hepatitis B. However, recent studies are deliberating the expansion of treatment eligibility criteria to encompass those in immune-tolerant, inactive carrier, and gray zone statuses. This review examines the updated information regarding this issue. Recent Findings: For immune-tolerant patients and patients in the gray zone, treatment eligibility might be considered for those with active or significant fibrosis/inflammation, especially those that remain in the immune-tolerant phase older than 30–40. Current evidence does not suggest that antiviral treatment would be beneficial for true inactive carriers. Summary: Evidence-based management is crucial in current antiviral therapy. Appropriate monitoring and evaluation help identify individuals who would benefit from antiviral treatment. Expanding indications may hinge on new evidence or curative therapies with finite durations if available.