Navigating the Maze of Hepatitis B Treatments Anna Suk–Fong Lok  Gastroenterology  Volume 132, Issue 4, Pages 1586-1594 (April 2007) DOI: 10.1053/j.gastro.2007.02.040 Copyright © 2007 AGA Institute Terms and Conditions

Figure 1 Natural course of chronic HBV infection showing 4 phases: immune tolerance, immune clearance (HBeAg-positive chronic hepatitis), inactive carrier state, and reactivation (HBeAg-negative chronic hepatitis). Not all patients go through all 4 phases. Immune tolerance phase may be short-lived or nonexistent in patients with adult acquired HBV infection. Immune clearance phase may be brief or protracted; in the latter case, serious liver damage with progression to cirrhosis and hepatocellular carcinoma may occur even while the patient is still HBeAg positive. Prognosis of inactive carriers is favorable if liver damage accrued during the immune clearance phase is mild and if the patient remains in this phase. Not all patients progress to HBeAg-negative chronic hepatitis. Patients in this last phase tend to be older and have more advanced liver disease. Adapted from Yim and Lok.52 Gastroenterology 2007 132, 1586-1594DOI: (10.1053/j.gastro.2007.02.040) Copyright © 2007 AGA Institute Terms and Conditions