Natural history of chronic hepatitis B

Chronic hepatitis B virus infection can cause chronic hepatitis, cirrhosis, liver failure and hepatocellular carcinoma. Chronic hepatitis B is characterized by an early replicative phase with hepatitis B e antigen positivity, high serum HBV-DNA levels and disease activity (HBeAg positive chronic hepatitis) and a late inactive phase with anti-HBe seroconversion, low or undetectable serum HBV-DNA and liver disease remission (inactive carrier state). Another form is characterized by active disease due to HBV variants not expressing HBeAg (HBeAg negative chronic hepatitis). Both types of chronic hepatitis B can lead to cirrhosis and its complications. The incidence of cirrhosis is 2-5/100 person years, but may be as high as 8-10 in HBeAg negative cases. The incidence of HCC varies geographically and increases with the duration and severity of liver disease (0.1-8/100 person years). The prognosis is reasonably good in compensated cirrhosis, but very poor following decompensation. Viral, host and environmental influence the natural history of chronic hepatitis B and explain the heterogeneity of its clinical outcomes.