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Natural history of chronic hepatitis B

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Abstract

Chronic hepatitis B virus (HBV) infection can cause chronic hepatitis, cirrhosis, liver failure, and hepatocellular carcinoma (HCC). Chronic hepatitis B is characterized by an early replicative phase with hepatitis B e antigen (HBeAg) positivity, high serum HBV-DNA levels and disease activity (HBeAgpositive chronic hepatitis), and a late inactive phase with anti-HBe seroconversion, low or undetectable serum HBV-DNA, and liver disease remission (inactive carrier state). Another form is characterized by active disease due to HBV variants not expressing HBeAg (HBeAg-negative chronic hepatitis). Both types of chronic hepatitis B can lead to cirrhosis and its complications. The incidence of cirrhosis is two to five per 100 person-years, but may be as high as eight to 10 in HBeAg-negative cases. The incidence of HCC varies geographically and increases with the duration and severity of liver disease (0.1 to 8 per 100 person-years). The prognosis is reasonably good in compensated cirrhosis, but very poor following decompensation. Viral and environmental factors influence the natural history of chronic hepatitis B and explain the heterogeneity of its clinical outcomes.

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  1. Department of Clinical and Experimental Medicine, Clinica Medica 5, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy

    Alfredo Alberti MD & Giovanna Fattovich MD

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  1. Alfredo Alberti MD
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  2. Giovanna Fattovich MD
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Alberti, A., Fattovich, G. Natural history of chronic hepatitis B. Curr hepatitis rep 3, 54–60 (2004). https://doi.org/10.1007/s11901-004-0010-0

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