Table 1. Characteristics and Clinical Prognosis of the Different Phases of Chronic Hepatitis B Infection

CHB Phase	Serum HBV DNA (IU/mL)	HBeAg	Anti-HBeAg	HBsAg, log₁₀ (IU/mL)	ALT^*	Liver Disease	Precore/Core Promoter HBV Variant	Age (Years)	Prognosis
Immune tolerant	>2 × 10^6–7	+	−	4.5–5.0	Normal	None/minimal	WT	<20–25	No or minimal liver disease development as long as ALT remains normal
Immune clearance (HBeAg-positive disease)	2 × 10^4–5	+	−	3.0–4.5	Persistently or intermittently elevated (>2× ULN), ALT flares possible (>5× ULN)	Possible necroinflammation; may lead to fibrosis or cirrhosis if HBeAg-positive phase is prolonged	WT > mutant	20–40	Favorable 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	−	+	1.5–3.0	Normal	Necroinflammation may disappear; halt of any liver disease progression	WT > mutant (stable inactive carriers)	>35–40	Favorable prognosis, unless advanced fibrosis/cirrhosis has developed during the HBeAg-positive phase
Inactive carrier	<2 × 10³	−	+	1.5–3.0	Normal		Mutant > WT (patients who will undergo reactivation)	>35–40
Reactivation (HBeAg-negative disease)	Fluctuating, >2 × 10^3–4	−	+	2.5–4.0	Persistently or intermittently elevated	Advanced	Mutant >> WT	>35–40	May 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.