Viral hepatitis: Milestones, unresolved issues, and future goals

Table 2 New classification of chronic hepatitis B phases

HBsAg+ ≥ 6 mo
HBeAg-positive chronic infection (1)
HBe: HBeAg+; HBV DNA: very high; ALT: persistently normal; Liver disease: minimal or absent	Ex “immune-tolerant;” Typical of children and young adults infected at birth; HBV DNA: > 1 million IU/mL; highly contagious people; Low rate of spontaneous HBeAg loss.
HBeAg-positive chronic hepatitis (2)
HBe: HBeAg+; HBV DNA: high; ALT: elevated; Liver disease: moderate or severe	Ex “immune reactive HBeAg-positive;” People infected in adulthood are likely to enter this phase; HBV DNA > 20000 IU/mL; rapid progression to fibrosis; Frequent HBe seroconversion.
HBeAg-negative chronic infection (3)
HBe: HBeAg-, anti-HBe+; HBV DNA: low or undetectable; ALT: normal; Liver disease: low	Ex “inactive HBV carrier;” HBV DNA: < 2000 IU/mL; it can also be > 2000 IU/mL but usually < 20000 IU/mL; Low risk of progression to cirrhosis or HCC; HBsAg loss in 1%–3%/yr.
HBeAg-negative chronic hepatitis (4)
HBe: HBeAg-, anti-HBe+; HBV DNA: moderate or high; ALT: elevated (variable); Liver disease: moderate or severe	HBV DNA: 2000-20000 IU/mL; Older people, frequent mutant precore HBV; Fluctuating levels of HBV DNA and ALT; Rare spontaneous remission and rapid progression to cirrhosis.

HBV: Hepatitis B virus; HBeAg: Hepatitis B E antigen; HBsAg: Hepatitis B surface antigen; ALT: Alanine aminotransferase; HCC: Hepatocellular carcinoma.