Critical analysis of the immune tolerance phase of chronic HBV infection: Natural history and diagnosis
Journal
Current Hepatitis Reports
Journal Volume
7
Journal Issue
1
Pages
5-11
Date Issued
2008
Author(s)
Abstract
Hepatitis B virus (HBV) infection is the major cause of cirrhosis and hepatocellular carcinoma worldwide. Based on virus-host interactions, the natural history of HBV carriers can be divided into four phases. In the prolonged immune tolerance phase, HBV carriers are positive for hepatitis B e antigen (HBeAg) and have high HBV replication but minimal liver disease. Early termination of immune tolerance and subsequent HBeAg seroconversion usually confer a favorable outcome, whereas delayed HBeAg seroconversion may accelerate the progression of liver disease. In recent years, viral and host factors such as the rapid decline of serum HBV DNA level, HBV genotype, possible naturally occurring mutants, and specific HLA haplotypes have been shown to affect the loss of immune tolerance in chronic hepatitis B. HBV carriers with an immune tolerant phenotype may be defined as having HBeAg positivity, persistently low-normal serum alanine aminotransferase, and serum HBV DNA greater than 2 x 10 7 IU/mL. These patients should be monitored; many have a rapid transition to an inactive carrier state with favorable outcomes. Copyright ? 2008 by Current Medicine Group LLC.
Other Subjects
alanine aminotransferase; CD4 antigen; CD45RO antigen; hepatitis B(e) antigen; HLA antigen class 1; HLA antigen class 2; interleukin 2 receptor alpha; virus DNA; alanine aminotransferase blood level; blood level; disease course; genotype; haplotype; hepatitis B; Hepatitis B virus; HLA system; human; immunological tolerance; liver cell carcinoma; liver cirrhosis; nonhuman; outcome assessment; patient monitoring; review; seroconversion; virus mutant; virus replication
Type
review