Table 5:

Phases of chronic HBV infection according to revised and classical definitions

	Phase 1: HBeAg + chronic infection (old terminology immune tolerance)	Phase 2: HBeAg + chronic hepatitis (old terminology immune active)	Phase 3: HBeAg – chronic infection (old terminology inactive carrier)	Phase 4: HBeAg – chronic hepatitis (old terminology, HBeAg-negative chronic hepatitis)	Phase 5: HBsAg negative or OHB
HBsAg	Positive	Positive	Positive	Positive	Negative
HBsAb	Negative	Negative	Negative	Negative	Positive or negative
HBeAg	Positive	Positive	Negative	Negative	Negative
HBV DNA IU/mL*	Often > 107	104–107	Often < 2,000; sometimes > 2,000	103–107	Negative or trace amount
ALT	Normal	Elevated or fluctuating	Normal	Often fluctuating	Normal
Phase	Mostly in young patients but could extend into the 4th or 5th decades	Young patients to 5th decade with active hepatitis	Variable duration with HBV immune control	Mostly in older patients with intermittent flare of hepatitis	Immune clearance of HBV or immune control of the virus with OHB
Non-invasive fibrosis assessment or biopsy	Normal (recent data suggesting that individuals may be at higher risk HCC)	Abnormal	Normal or mildly abnormal	Abnormal	Normal
Treatment	No	Yes (if no signs of spontaneous seroconversion because prolonged duration of hepatitis increases fibrosis risk)	No	Yes	No (except during immunosuppression)

Note: All patients should be fully evaluated, including history, physical exam, liver tests, etc. (see section 4.0) to determine need for treatment. ALT = alanine aminotransferase; HBeAg = HBV e antigen; HBsAb = hepatitis B surface antibody; HBsAg = hepatitis B surface antigen; HBV = hepatitis B virus; HBV DNA = viral load; HCC = hepatocellular carcinoma; OHB = occult hepatitis B

*IU/mL = ~5 virus copies/mL