Table 2.
Natural history and assessment of patients with chronic HBV infection based upon HBV and liver disease markers[1,3]
| Phases | HBsAg/HBeAg | HBV DNA | ALT | Liver inflammation | Old terminology and Observations |
|---|---|---|---|---|---|
| PHASE 1Chronic HBV infection | High/Positive | High (>107 IU/mL) | Normal | None/minimal | “Immune tolerant” This phase is more frequent and more prolonged in subjects infected prenatally or in the first years of life. Patients are highly contagious. |
| PHASE 2 Chronic hepatitis B |
High-Intermediate/Positive | Lower (104-107 IU/mL) | Increased | Moderate/severe | “Immune reactive HBeAg positive“ This phase may last for several weeks to years. It may occur after several years of immune tolerance and is more frequently in subjects infected during adulthood. |
| PHASE 3 Chronic HBV infection |
Low/Negative | Low or undetectable (<2,000 IU/mL)a | Normal | None | “Inactive carrier” This state confers a favorable long-term outcome with low risk of cirrhosis or HCC. |
| PHASE 4 Chronic hepatitis B |
Intermediate/Negative | Fluctuating levels (>2,000 IU/mL) | Fluctuating levels/Elevated* | Moderate/severe | “HBeAg negative chronic hepatitis” Characterized by periodic reactivations. It is sometimes difficult to distinguish true inactive HBV carriers (good prognosis) from patients with active HBeAg-negative CHB (have active liver disease with a high risk of progression to advanced hepatic fibrosis, cirrhosis, and HCC) |
| PHASE 5 Resolved HBV infection |
Negative/Negative | Undetectable (<10 IU/mL) | Normal | None (HCC risk if cirrhosis has developed before HBsAg loss) | “HBsAg negative/anti-HBc positive” Reduced risk of cirrhosis, decompensation, and HCC. Immunosuppression may reactivate HBV in these patients. |
aHBV DNA levels can be between 2,000 and 20,000 IU/ml in some patients without signs of chronic hepatitis. *Persistently or intermittently