Phenotype, clinical profile and treatment eligibility of Hepatitis-B infected patients lying in gray zone in a tertiary care center of Eastern India - an observational study.

EASL has described 4 well defined stages of hepatitis B infection pertaining to well characterised immunological states – based on HBV DNA levels and ALT levels as biochemical surrogate for necro-inflammation. There however remain states in between where there is in- congruity between viral dynamics (HBV DNa levels and Hepatitis B  e antigen status) and ALT levels – these are known as grey zones. Individuals in the grey zone can be up to 1/3rd of all treatment naïve new CHB patients These patient populations have not been properly characterised– especially since increasing Volume of literature suggest grey zones of hepatitis B are not benign and not always quiescent – there are ongoing disease activity even progressing to higher levels of Liver fibrosis.

This study aims to characterise these grey zone population – including and up to histopathological evidence of disease activity and liver fibrosis. It aims to explore the hypothesis that significant underlying liver disease activity might be present in clinical grey zones and also describe the distribution of these baseline and further characteristics among grey zone subgroups.