And the quintessential question that I'll put to Bob first, Dr. Gish, is whether you treat or observe this patient.

May I start with a scientific immunovirologic comment, Ira? Of course.

And that is this term immune-tolerant is out of date and should have been phased out over a decade ago.

There are no current scientific viral immunologic manuscripts inexistent that support the use of that term.

And there is a great review in the book that I published in 2022 from Carolina Bonnie, a wonderful viral immunologist from Italy, who basically laid out all the data, the current data, and said, we need to get rid of this term.

And in fact, there is a global effort going on right now with all the international societies with leads to correct and use the correct terminology.

So let's say these people are not immune tolerant.

How often do you use this information to talk to your patients, and how often is it a deciding factor?

So now that there's an effective treatment, do you think all chronic HBV infected patients in the country should be automatically screened for hepatitis D?

Well, I believe 10, 20 years ago, we should have been screening for Delta, even though there wasn't an effective treatment because these people were sicker, higher risk of cancer, higher risk of progression.

We should have started testing 20 years ago, but there were a couple of problems with that.

There's the psychology of the provider community that we only test for diseases where we have an immediate treatment.

That's wrong, but that's reality.

And the other is access to tests.

So 2013, we had no tests.

Do you have any other points that you'd like to add about screening, testing, or monitoring patients with hep B and hep D?