Table 2.
Comparison of terminology and characteristics associated with the natural history of chronic hepatitis B
| Phase 1 | Phase 2 | Phase 3 | Phase 4 | Phase 5 | ||
|---|---|---|---|---|---|---|
| Terminology | ||||||
| KASL | Immune tolerant CHB (CHB, immune tolerant phase) | Immune active HBeAg-positive CHB (HBeAg-positive CHB, immune active phase) | Immune inactive CHB (CHB, Immune inactive phase) | Immune active HBeAg-negative CHB (HBeAg-negative CHB, immune active phase) | Resolved CHB, (HBsAg loss phase) | |
| AASLD | Immune tolerant CHB | Immune active HBeAg-positive CHB | Inactive CHB | Immune active HBeAg-negative CHB | Resolved CHB (functional cure state) | |
| EASL | HBeAg-positive chronic HBV infection | HBeAg-positive CHB | HBeAg-negative chronic HBV infection | HBeAg-negative CHB | Resolved HBV infection | |
| APASL | Immune tolerant chronic HBV infection (immune tolerant phase) | HBeAg-positive CHB (immune reactive phase) | Low replicative chronic HBV infection (low replicative phase) | HBeAg-negative CHB (reactivation phase) | Resolved hepatitis B infection | |
| Characteristics | ||||||
| HBsAg HBeAg | High Positive | High/intermediate Positive | Low Negative | Intermediate Negative | Negative Negative | |
| HBV DNA level | >106–107* IU/mL | >2×104 IU/mL (104–107 IU/mL)‡ | <2,000 IU/mL | >2,000 IU/mL | Undetectable | |
| ALT level | Persistently normal | Elevated | Persistently normal | Elevated | Normal | |
| Histological activity† | None/minimal | Moderate/severe | Minimal | Moderate/severe | None | |
KASL, Korean Association for the Study of the Liver; CHB, chronic hepatitis B; HBeAg, hepatitis B e antigen; HBsAg, hepatitis B surface antigen; AASLD, American Association for the Study of Liver Diseases; EASL, European Association for the Study of the Liver; APASL, Asian-Pacific Association for the Study of the Liver; HBV, hepatitis B virus; ALT, alanine aminotransferase.
HBV DNA >106 IU/mL by the AASLD, HBV DNA >107 IU/mL by the KASL and EASL, and no clear cut-off by the APASL although ranges from >2×106–107 IU/mL are favored.
Activity depends on necroinflammation, and fibrosis stage can vary according to the degree of liver injury accumulation.
EASL criteria for HBeAg-positive chronic hepatitis B.