Viral and host factors affecting disease progression of hepatitis B virus infection
Journal
Hepatitis B Virus and Liver Disease
ISBN
9789811636158
Date Issued
2021-08-23
Author(s)
Abstract
The clinical outcomes of chronic hepatitis B virus (HBV) infection are heterogeneous, ranging from spontaneous seroconversion of hepatitis B surface antigen (HBsAg) to severe detrimental consequences, including hepatic failure, cirrhosis, and hepatocellular carcinoma (HCC). Four distinctive clinical phases are recognized in the natural course of chronic hepatitis B (CHB), namely, immune tolerance, immune clearance, inactive carrier and HBV reactivation phases. Patients with prolonged immune active phases are prone to develop cirrhosis and HCC. However, a small portion of HBsAg carriers will eventually lose HBsAg and even undergo HBsAg seroconversion. Conventionally, serum HBV DNA level and HBeAg serostatus combined with serum ALT level are utilized to distinguish the disease states in the natural history of CHB. A number of other viral factors, including HBV genotype, naturally occurring viral mutations as well as serum levels of HBsAg and HBV core-related antigen (HBcrAg) have been demonstrated the utility in predicting the long-term prognosis of CHB patients. Additionally, host factors including human leukocyte antigen, serum anti-HBc level, and factors involved in the risk of fibrosis and HCC are also associated with the outcomes of CHB. All these qualitative and quantitative viral factors contribute to the disease progression. With the advance of technology, more new viral biomarkers are emerging. Combination of all current and new viral factors may allow for more sophisticated delineation of disease states, the deeper mechanistic insight into the pathogenesis, and the more optimal management for patients.
Subjects
Chronic hepatitis B | Hepatitis B virus | Host factors | Natural history | Viral factors
SDGs
Type
book part