Table 1. Characteristics and Clinical Prognosis of the Different Phases of Chronic Hepatitis B Infection
CHB PhaseSerum HBV DNA (IU/mL)HBeAgAnti-HBeAgHBsAg, log10 (IU/mL)ALT*Liver DiseasePrecore/Core Promoter HBV VariantAge (Years)Prognosis
Immune tolerant>2 × 106–7+4.5–5.0NormalNone/minimalWT<20–25No or minimal liver disease development as long as ALT remains normal
Immune clearance (HBeAg-positive disease)2 × 104–5+3.0–4.5Persistently or intermittently elevated (>2× ULN), ALT flares possible (>5× ULN)Possible necroinflammation; may lead to fibrosis or cirrhosis if HBeAg-positive phase is prolongedWT > mutant20–40Favorable prognosis if HBeAg seroconversion occurs (inactive carrier state) The shorter the duration of the immune clearance phase, the better the prognosis and the lower the risk of liver disease development or progression
Inactive carrier<2 × 103+1.5–3.0NormalNecroinflammation may disappear; halt of any liver disease progressionWT > mutant (stable inactive carriers)>35–40Favorable prognosis, unless advanced fibrosis/cirrhosis has developed during the HBeAg-positive phase
Mutant > WT (patients who will undergo reactivation)
Reactivation (HBeAg-negative disease)Fluctuating, >2 × 103–4+2.5–4.0Persistently or intermittently elevatedAdvancedMutant >> WT>35–40May lead to fibrosis progression or cirrhosis
  • Data compiled from Liaw et al,11 Liaw,22 and Kwon and Lok.23

  • * Alanine aminotransferase (ALT) upper limit of normal: 19 IU/mL in women, 30 IU/mL in men.

  • CHB, chronic hepatitis B; HBeAg, hepatitis B e antigen; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; ULN, upper limit of normal; WT, wild type.