Inactive Carriers of Hepatitis B Virus: A Never Ending Story

t o b The so-called inactive carriers are regularly revisited in hepatologist’s literature, but many pending issues are yet unsolved. Magalhães et al looked back in to a cohort of patients carefully followed with serial assessment of some blood parameters, trying to indirectly validate their own strategy of monitoring. Patients infected with hepatitis B virus (HBV) present several patterns of serological markers and viral activity. When adopting viremia as an indicator of HBV replication, subsets of patients may be defined: HBs Ag positive patients with persistent and on-going viral replication; Hbs Ag positive patients with permanent or temporary inhibition of viral replication: this is a highly heterogeneous group and included coinfected patients with HDV, HCV, inactive carriers and patients with fluctuating viral load levels detectable with more sensitive HBV DNA assays. It is also known that although HBV is not cytopathogenic, patients with chronic HBV infection have a significant risk of developing severe liver diseases. During the natural course of chronic hepatitis B virus (CHB) infection, different immune phases have identified as immune tolerant phase, immune clearance (or immuneactive, phase, low replicative phase and asymptomatic chronic carrier state). The low replication phase, being referred as the inactive HBsAg carrier state, occurs after HBeAg seroconversion and is usually characterized with a marked reduction or undetectable level of serum HBV DNA, ALT normalization and