TABLE 4.

Phases of chronic hepatitis B^a

Characteristics of the following phase:
Immune-tolerant phase	Immune activation	Low replication	Reactivation	Remission
Occurs in patients with perinatally acquired infection	High or fluctuating HBV DNA levels	Low or nondetectable HBV DNA levels	Fluctuating ALT and HBV DNA levels	After many years, some patients may enter a remission phase
Minimal liver inflammation	High or fluctuating ALT levels	Normal ALT levels	Usually older patients with more advanced liver disease	Not considered a cure because trace HBV DNA is still present
May last from 1 year to decades	Active inflammation and liver damage	Mild hepatitis and minimal fibrosis	Chronic hepatitis
Can lead to chronic infection	Can lead to chronic infection	Cirrhosis may be present due to previous liver damage	HBsAg positive
ALT levels normal	HBeAg positive → HBeAg negative and anti-HBe positive	Chronic infection	HBeAg negative, anti-HBe positive
HBV DNA levels high	HBsAg positive	HBsAg positive		HBeAg negative, anti-HBe positive
HBeAg positive		HBeAg negative, anti-HBe positive		HBsAg negative
HBsAg positive

^aThe characteristics are taken from information published previously (17, 270, 271). CHB follows a nonlinear clinical course; not all patients go through each phase.