The immune tolerant phase of chronic HBV infection: new perspectives on an old concept
Antonio Bertoletti1,2 and Patrick T Kennedy3
1Emerging Infectious Diseases (EID) Program, Duke-NUS Graduate Medical School, Singapore
2Viral Hepatitis Laboratory, Singapore Institute for Clinical Sciences, Agency of Science Technology and Research (A*STAR), Singapore
3Blizard Institute, Barts and The London School of Medicine & Dentistry, London, UK
Correspondence: Dr A Bertoletti, Emerging Infectious Diseases Program, Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore. E-mail: [email protected]; Dr P Kennedy, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK. E-mail: [email protected]
Received 11 July 2014; Revised 28 July 2014; Accepted 29 July 2014
Advance online publication 1 September 2014
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Abstract
Chronic hepatitis B virus (HBV) infection progresses through distinct disease phases that are strongly associated with patient age. The so-called immune tolerant (IT) phase represents the classical early phase of infection; it is associated with high levels of HBV replication and lack of clinical signs of liver Inflammation. Whether this phase of HBV infection is also associated with immunological features of “tolerance' has recently been challenged. Here, we review the data that dispute this concept of immune tolerance and then propose an alternative interpretation of the immunopathological events that take place during this early phase of CHB infection.
