The natural course of hepatitis B virus infection The chronic hepatitis B virus infection in humans goes through three stages, but they cannot be separated distinctly, and can fluctuate repeatedly clinically. The duration of each stage is also related to the strength of immunity against the hepatitis B virus. The first phase is the immune tolerance phase, where the hepatitis B virus invades the human body and does not alarm the immune system, and the immune cells are oblivious to the hepatitis B virus, do not recognize it, do not attack it, and seem to be sleeping, allowing it to do whatever it wants and reproduce, but the hepatitis B virus also has some rules, and they do not go to scourge the human liver, and do not damage the liver cells even if they settle in them. During this period, although the hepatitis B virus is replicating, the major triad, HBVDNA is strongly positive, but the inflammatory response of the liver is very light, so the blood transaminases are not elevated, and the infected person has no symptoms. This stage can last 10 to 20 years. This is the case for most hepatitis B carriers. Antiviral therapy is ineffective, and specific immunotherapy can break immune tolerance and promote early recovery from the disease. The second phase is the immune clearance phase, when the hepatitis B virus reproduces unchecked in the body and finally angers the immune cells, which awaken and begin to respond to the invaders by attacking the hepatitis B virus, and the most intense battle undoubtedly takes place inside the hepatocytes, the home base of the harboring hepatitis B virus. As the battle heats up, the liver cells are inevitably damaged and the transaminases they contain enter the bloodstream, so of course a blood test will reveal elevated transaminases, which undoubtedly indicate liver cell damage and that the immune system is clearing the hepatitis B virus. The result of the battle is that the living force of the hepatitis B virus is wiped out and the body pays the price in liver cell damage and death. It is thus clear that hepatitis is not directly caused by the hepatitis B virus but is induced to occur by the immune cells attacking the hepatitis B virus. This condition occurs mostly between the ages of 20 and 45, and is characterized by abnormal liver function, gradual transformation of major triplets to minor triplets, gradual decline in HBVDNA, disappearance of HBVDNA in some patients, and clinical improvement. It is the best time for antiviral treatment. The third stage is the low replication or residual stage, the battle against the hepatitis B virus is basically over, the arrogance of the hepatitis B virus is knocked out, there are still some “remnants” left in the body, they are also difficult to make waves. This is also the recovery period, manifested as a small triplet, HBVDNA negative or low levels, often after the age of 40. However, about 10-20% of this low replication status may experience viral reactivation during the course of the disease for reasons that are not yet clear, HBVDNA reappears, liver lesions are aggravated again and are highly susceptible to the development of cirrhosis or liver cancer. Therefore, the focus of this period is to enhance the anti-hepatitis B virus immunity to prevent the reactivation of the virus and the transformation to liver cancer.