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Critical analysis of the immune tolerance phase of chronic HBV infection: Natural history and diagnosis

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Abstract

Hepatitis B virus (HBV) infection is the major cause of cirrhosis and hepatocellular carcinoma worldwide. Based on virus-host interactions, the natural history of HBV carriers can be divided into four phases. In the prolonged immune tolerance phase, HBV carriers are positive for hepatitis B e antigen (HBeAg) and have high HBV replication but minimal liver disease. Early termination of immune tolerance and subsequent HBeAg seroconversion usually confer a favorable outcome, whereas delayed HBeAg seroconversion may accelerate the progression of liver disease. In recent years, viral and host factors such as the rapid decline of serum HBV DNA level, HBV genotype, possible naturally occurring mutants, and specific HLA haplotypes have been shown to affect the loss of immune tolerance in chronic hepatitis B. HBV carriers with an immune tolerant phenotype may be defined as having HBeAg positivity, persistently low-normal serum alanine aminotransferase, and serum HBV DNA greater than 2 × 107 IU/mL. These patients should be monitored; many have a rapid transition to an inactive carrier state with favorable outcomes.

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Authors and Affiliations

  1. National Taiwan University College of Medicine and the University Hospital, 7 Chung-Shan South Road, Taipei, 10002, Taiwan, China

    Ding-Shinn Chen

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  1. Jia-Horng Kao
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  2. Ding-Shinn Chen
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Correspondence to Ding-Shinn Chen.

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Kao, JH., Chen, DS. Critical analysis of the immune tolerance phase of chronic HBV infection: Natural history and diagnosis. Curr hepatitis rep 7, 5–11 (2008). https://doi.org/10.1007/s11901-008-0015-1

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