Immune tolerant HBV and HCC: time to revise our tolerance levels for therapy?

The immune tolerant (IT) phase, the first phase of chronic hepatitis B virus (HBV) infection, has historically been perceived as a benign period in the natural history of this disease. Perinatal infection leads to a prolonged IT phase, with transition to immune clearance with seroconversion to anti-HBe in the second to third decade, whereas immediate progression to immune clearance usually occurs in newly infected children and adults (1).