Despite the availability of safe and effective vaccines for more than 2 decades, worldwide there are approximately 350 million hepatitis B virus (HBV) carriers. Our understanding of the natural history of chronic HBV infection has steadily evolved over the past few decades. Availability of sensitive HBV DNA assays and application of sophisticated immunologic techniques have led to the recognition that HBV replication persists throughout the course of chronic HBV infection, and host immune response plays a pivotal role in HBV-related liver disease and recovery. Knowledge that HBV replicates via reverse transcription of an RNA intermediate, a process similar to human immunodeficiency virus (HIV) replication, has led to rapid development in HBV treatments, many of which were initially developed for treatment of HIV infection.
Dynamics of the different phases of chronic hepatitis B virus (HBV) infection. The solid gray horizontal line represents the normal alanine aminotransferase (ALT) level and an HBV DNA value lower than 5 log10 copies/mL. The immune tolerant phase is usually characterized by high HBV DNA (thin black line) and low ALT levels (thick black line), while the immune clearance and the reactivation phases are characterized by persistently elevated ALT levels and high HBV DNA values or by fluctuating ALT (dashed black line) and/or HBV DNA levels (dotted black line). HBeAg indicates hepatitis Be antigen.
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