PHASES OF CHRONIC HEPATITIS B INFECTION

Phase

Liver histology

HBV DNA

ALT

HBeAg

Anti-HBe

Duration

Natural history

Immune tolerance

Minimal inflammation

>20,000 IU/ml

Normal

Present

-

20-30 years

Low risk of progression to advanced liver disease

Immune clearance

Variable inflammation +/- fibrosis

>20,000 IU/ml (fluctuating)

Elevated (fluctuating)

Present

+/-

Can be protracted

Associated with hepatic flares

Immune control

Minimal inflammation and liver damage

<2000 IU/ml

Normal

Absent

+

Years

Low risk of advanced liver disease. HBsAg loss: 1% per year. 10-20% have reactivation of HBV replication after many years

Immune escape (HBeAg negative CHB)

Inflammation and often significant fibrosis

2000-20,000 IU/ml

Elevated

Absent

+

-

Can enter this phase from immune clearance or immune control phase. High risk of progression to advanced liver disease