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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 27, 2025; 17(10): 107735
Published online Oct 27, 2025. doi: 10.4254/wjh.v17.i10.107735
Published online Oct 27, 2025. doi: 10.4254/wjh.v17.i10.107735
Gray zone and the need for expansion in chronic hepatitis B: From theory to clinical practice
Thang Viet Luong, Ngoc Phan Hong Nguyen, Duong Hung Tran, University of Medicine and Pharmacy, Hue University, Hue 530000, Viet Nam
Tri Van Nguyen, Department of Anesthesiology, International Medical Center, Hue Central Hospital, Hue 530000, Viet Nam
Thien Dinh Nguyen, Department of Gastroenterology and Hepatology, Hue Central Hospital, Hue 530000, Viet Nam
Hai Nguyen Ngoc Dang, Faculty of Medicine, Duy Tan University, Da Nang 550000, Viet Nam
Co-first authors: Thang Viet Luong and Ngoc Phan Hong Nguyen.
Co-corresponding authors: Thien Dinh Nguyen and Hai Nguyen Ngoc Dang.
Author contributions: Luong TV and Nguyen NPH are co-first authors and contributed equally to the study's conception, methodology, data collection, analysis, and drafting of the original manuscript; Nguyen TV and Tran DH contributed to the literature review, data interpretation, and manuscript editing; Dinh Nguyen T and Dang HNN are co-corresponding authors, providing overall supervision, critical revisions, and handling correspondence; all the authors read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Thien Dinh Nguyen, MD, Researcher, Department of Gastroenterology and Hepatology, Hue Central Hospital, 16 Le Loi, Hue 530000, Viet Nam.
Received: March 30, 2025
Revised: May 28, 2025
Accepted: September 11, 2025
Published online: October 27, 2025
Processing time: 213 Days and 12.3 Hours
Revised: May 28, 2025
Accepted: September 11, 2025
Published online: October 27, 2025
Processing time: 213 Days and 12.3 Hours
Core Tip
Core Tip: Gray zone patients with chronic hepatitis B represent a critical subgroup that is often overlooked by traditional treatment guidelines. This mini-review highlights the need for a paradigm shift toward a more inclusive and risk-adapted therapeutic approach. By utilizing novel biomarkers, advanced predictive models, and noninvasive tools, clinicians can better identify high-risk patients and implement early antiviral therapy, ultimately reducing the risks of liver fibrosis, cirrhosis, and hepatocellular carcinoma in this vulnerable population.