Course of chronic HBV infection

The course of chronic HBV infection is considered to consist of four phases: immune tolerance, immune clearance (HBeAg-positive chronic hepatitis), inactive carrier, and reactivation (HBeAg-negative chronic hepatitis), although not all patients go through every phase.

• Immune tolerance: HBeAg+, high HBV DNA (usually >10⁸ IU/mL), and persistently normal ALT
• HBeAg-positive chronic hepatitis: HBeAg+, fluctuating high HBV DNA (usually >10⁵ IU/mL), and fluctuating ALT (usually >ULN)
• Inactive carrier: HBeAg–, persistently low HBV DNA (usually <2000 IU/mL), and normal ALT
• HBeAg-negative chronic hepatitis: HBeAg–, fluctuating moderate HBV DNA (usually 10³-10⁷ IU/mL), and fluctuating ALT (usually >ULN but may be intermittently normal)