Should Individuals in the HBV Immune Tolerant Phase with a Family History of Cirrhosis Consider Antiviral Therapy?

The immune tolerant phase of chronic hepatitis B is typically seen in children and young adults. During this stage, patients often show high levels of hepatitis B surface antigen (HBsAg), usually above 7-8×10^9 IU/mL, along with positive e antigen (HBeAg) and high viral load (HBV-DNA >7×10^8 IU/mL). Despite these markers, liver enzymes remain normal and liver biopsies reveal minimal inflammation or fibrosis.

For individuals under the age of 30 without a significant family history of liver disease, antiviral therapy may not be necessary. The disease tends to progress slowly during this period, and treatment responses to antiviral medications are generally poor due to the nature of immune tolerance.

However, if there is a family history of cirrhosis or hepatocellular carcinoma (HCC), antiviral treatment should be considered once the patient reaches the age of 30 or older. As people age, immune function changes, increasing the risk of disease progression. In those with a genetic predisposition, the likelihood of developing serious complications such as liver cancer or cirrhosis also rises.

Experts recommend proactive antiviral therapy for patients over 30 who are in the immune tolerant phase and have a familial background of advanced liver disease. Early intervention may help reduce the long-term risks associated with chronic hepatitis B infection and improve clinical outcomes.

Regular monitoring and personalized medical advice from a liver specialist are strongly advised for individuals in this category to determine the most appropriate management strategy.