The natural history of chronic hepatitis B.
The natural history of chronic hepatitis B is dependent on the age of acquiring the hepatitis B infection. Those who are infected at adolescence or adulthood (including most of the Caucasians) tend to have stable disease after hepatitis B e antigen seroconversion with normal serum alanine aminotransaminase (ALT) and hepatitis B virus (HBV) DNA levels <10(5) copies/mL (20 000 IU/mL). In contrast, those who are infected at birth or early childhood (including the majority of the world's hepatitis B carriers, i.e. Asians) have a prolonged immune tolerance phase followed by a prolonged immune clearance phase. A proportion of these patients have progressive disease after HBeAg seroconversion with HBV DNA <10(4) copies/mL (<2000 IU/mL) and ALT between 0.5 and 2x upper limit of normal. Core promoter mutations may play a part in the development of cirrhosis-related complications. However, continuing viral replication, even at a relatively low level of <10(4) copies/mL (<2000 IU/mL), is probably the most important factor for the development of complications.
Lai
C-L
CL
Department of Medicine, The University of Hong Kong, Hong Kong. hrmelcl@hkucc.hku.hk
Yuen
M-F
MF
D000367:Age Factors; D006510:Hepatitis B Antibodies / Q000276:immunology; D006513:Hepatitis B e Antigens / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000276:immunology* / Q000473:pathology / Q000821:virology; D006801:Humans
D006510:Hepatitis B Antibodies; D006513:Hepatitis B e Antigens