Looking into the crystal ball: biomarkers for outcomes of HBV infection

Excerpt

Chronic hepatitis B virus (HBV) infection exhibits complex host–virus interactions, leading to distinctive clinical features at different disease stages. The natural history of HBV acquired in the perinatal period or childhood can be divided into four chronological phases: immune tolerance (IT), immune clearance (IC), inactive carrier or low-replication (LR) and reactivation or HBeAg-negative hepatitis (ENH) [1]. Liver cirrhosis and hepatocellular carcinoma (HCC) are the long-term detrimental consequences of chronic HBV infection. The risk of chronic hepatitis B (CHB) patients for the development of end-stage liver disease is as high as 40 % in the lifetime [2]. The main driving force for disease progression is the viral replication and immune-mediated hepatic necroinflammation. Current guidelines recommend that antiviral therapy should be given to patients with active viral replication, hepatic necroinflammation and significant hepatic fibrosis, primarily for those at the IC or ENH phases [3]. Therefore, precise determination of the clinical phase of a given patient is important to provide timely antiviral therapy to improve long-term outcomes. …