Title: Patients with chronic hepatitis B who have persistently normal alanine aminotransferase
or aged < 30 years may exhibit significant histologic damage
Version: 2 Date: 06 Feb 2024
Reviewer:  Leon Louis Seifert
Reviewer's report:
As pointed out in my first review report, the findings presented by Wei et al. are very interesting
especially with regard to ongoing discussions concerning the questions when and in whom to
start antiviral therapy in HBV infected individuals. Very commonly it is recommended not to
start antiviral therapy in patients <30. This manuscript shows that even in patients <30 and
even in patients without ALT elevation, significant fibrosis can be observed. These findings
can potentially contribute to current discussions which may result in lowering the threshold to
antiviral therapy in these particular groups of patients. The large cohort size reported in this
manuscript promises that these findings are potentially generalizable. It has to be kept in mind
though, that important HBV patient parameters differ among regions (HBV genotypes, life-
style, way of transmission etc.). Most of these are nicely discussed by the authors.
The authors have addressed most of the points I have raised in my initial review report. I
understand that due to retrospective character of this study, many parameters cannot be reported.
Given the fact that a large amount of this data has been extracted from non-electronic patient
files in times when a lot of HBV parameters I requested were not routinely available, I accept
that this data cannot be provided by the authors.
Nonetheless I believe that the results of this study are exciting and well presented and I therefor
recommend to accept this manuscript for publication.
I recommend though to add minor changes to the results part 3.3 Factors associated with
significant liver histological damage. In addition to the p-values, the OR should be provided
in the text.
Title: Patients with chronic hepatitis B who have persistently normal alanine aminotransferase
or aged < 30 years may exhibit significant histologic damage
Version: 2 Date: 06 Feb 2024
Reviewer:  Leon Louis Seifert
Reviewer's report:
As pointed out in my first review report, the findings presented by Wei et al. are very interesting
especially with regard to ongoing discussions concerning the questions when and in whom to
start antiviral therapy in HBV infected individuals. Very commonly it is recommended not to
start antiviral therapy in patients <30. This manuscript shows that even in patients <30 and
even in patients without ALT elevation, significant fibrosis can be observed. These findings
can potentially contribute to current discussions which may result in lowering the threshold to
antiviral therapy in these particular groups of patients. The large cohort size reported in this
manuscript promises that these findings are potentially generalizable. It has to be kept in mind
though, that important HBV patient parameters differ among regions (HBV genotypes, life-
style, way of transmission etc.). Most of these are nicely discussed by the authors.
The authors have addressed most of the points I have raised in my initial review report. I
understand that due to retrospective character of this study, many parameters cannot be reported.
Given the fact that a large amount of this data has been extracted from non-electronic patient
files in times when a lot of HBV parameters I requested were not routinely available, I accept
that this data cannot be provided by the authors.
Nonetheless I believe that the results of this study are exciting and well presented and I therefor
recommend to accept this manuscript for publication.
I recommend though to add minor changes to the results part 3.3 Factors associated with
significant liver histological damage. In addition to the p-values, the OR should be provided
in the text.
Please review this paper.
user
Title: Patients with chronic hepatitis B who have persistently normal alanine aminotransferase
or aged < 30 years may exhibit significant histologic damage
Version: 2 Date: 06 Feb 2024
Reviewer:  Leon Louis Seifert
Reviewer's report:
As pointed out in my first review report, the findings presented by Wei et al. are very interesting
especially with regard to ongoing discussions concerning the questions when and in whom to
start antiviral therapy in HBV infected individuals. Very commonly it is recommended not to
start antiviral therapy in patients <30. This manuscript shows that even in patients <30 and
even in patients without ALT elevation, significant fibrosis can be observed. These findings
can potentially contribute to current discussions which may result in lowering the threshold to
antiviral therapy in these particular groups of patients. The large cohort size reported in this
manuscript promises that these findings are potentially generalizable. It has to be kept in mind
though, that important HBV patient parameters differ among regions (HBV genotypes, life-
style, way of transmission etc.). Most of these are nicely discussed by the authors.
The authors have addressed most of the points I have raised in my initial review report. I
understand that due to retrospective character of this study, many parameters cannot be reported.
Given the fact that a large amount of this data has been extracted from non-electronic patient
files in times when a lot of HBV parameters I requested were not routinely available, I accept
that this data cannot be provided by the authors.
Nonetheless I believe that the results of this study are exciting and well presented and I therefor
recommend to accept this manuscript for publication.
I recommend though to add minor changes to the results part 3.3 Factors associated with
significant liver histological damage. In addition to the p-values, the OR should be provided
in the text.
assistant