Hepatitis B Epidemiology, Pathogenesis, Diagnosis, and Natural History

  • Author: Marc G. Ghany, MD (More Info)
  • Editor In Chief: Stefan Zeuzem, MD
  • Last Reviewed: 7/2/18 (What's New)


  • The outcome of chronic HBV infection is variable; approximately one half of individuals transition to an inactive carrier state, 30% progress to cirrhosis, and the remainder to chronic hepatitis (Figure 4)[Kao 2008]
  • Per AASLD guidance, chronic HBV infection can generally be characterized by 1 of 4 phases: immune tolerant, immune-active HBeAg positive, inactive, or immune-active HBeAg negative (Table 7)
  • Hepatitis B e Antigen–Positive Immune-Tolerant Chronic Hepatitis B
    • HBeAg-positive immune-tolerant chronic hepatitis B is characterized by the presence of HBeAg in serum, normal or minimally elevated ALT levels, and high HBV DNA levels (typically > 1 million IU/mL) in serum (Table 7)[Terrault 2018; Chu 1985]
      Hepatitis B e Antigen–Positive Immune-Active Chronic Hepatitis B
        Inactive Chronic Hepatitis B
          Hepatitis B e Antigen–Negative Immune-Active Chronic Hepatitis B

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