The clinical course of chronic hepatitis type B is variable. For patients with HBsAg positive chronic hepatitis who are still asymptomatic, the main factor affecting outcome is the presence or absence of active hepatitis B virus (HBV) replication with its associated liver inflammation. Chronic hepatitis B may resolve after termination of HBV replication with generation of the healthy HBsAg-carrier state. Eradication of HBV infection with HBsAg clearance may occur at the rate of approximately 1-2% per year in adult HBV carriers. On the other hand patients with sustained HBV replication and severe chronic hepatitis are at very high risk of progression to cirrhosis. Morbidity and mortality in chronic hepatitis B are linked to evolution to cirrhosis or HCC. Life expectancy is relatively long in patients with compensated cirrhosis due to HBV, as decompensation or liver cancer usually occur at a relatively late stage in the natural course of the disease. Although the most important characteristic of chronic delta hepatitis appears to be its propensity to rapidly progress to cirrhosis, longitudinal studies conducted in patients with compensated cirrhosis type B indicate that concomitant HDV infection does not seem to increase the rate of liver-related death. When decompensated liver disease develops, the prognosis is extremely poor.
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