Immunopathogenesis of chronic Hepatitis B and the clinical events that shape its natural history

Abstract

It is estimated that more than two billion people worldwide have been exposed to hepatitis B virus (HBV) and as many as 350 million people have chronic infection [1, 2]. HBV is a major cause of chronic liver disease, liver failure, and hepatocellular carcinoma (HCC). Chronic HBV infection is currently the most common risk factor for HCC worldwide, accounting for more than half of cases and resulting in significant morbidity and mortality [3, 4]. The natural history of HBV infection involves a complex interplay between viral factors and immunologic determinants of spontaneous resolution, chronic infection, and progression of chronic liver disease within the host. In this chapter, we will primarily review the current knowledge about the immunological interface between host response and HBV in addition to the many clinical correlates supporting the assertion that these are critical to viral persistence, disease progression, and response to antiviral therapy.