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13. What are the consequences of chronic HBV infection?

The hepatitis B virus can stay in the liver quiescently, indefinitely and cause no further inflammation in some people. Those people are called carriers. Although they are asymptomatic, carriers remain at risk for liver cancer and are capable of transmitting the disease. So a lot of the people walking around will have normal liver enzyme tests but could be carrying the virus. They are a little bit of a time bomb for themselves and for the rest of the population. A lot of these people who developed or acquired hepatitis at birth walk around with huge viral counts of like fifteen million viral particles per cc of blood and you can imagine the potential infectivity of a patient like that to their wife, to their family, or other contacts. The virus may continue to aggressively replicate and cause continuing damage leading to fibrosis, cirrhosis, and a high rate of cancer in part of the population and then you have the other part that are carriers. But it’s constantly switching over. So a person could by an asymptomatic carrier, particularly again in the Asian population and then suddenly for an assortment of reasons, the virus starts to attack the liver and they go from being what they thought was an asymptomatic carrier to someone at risk for more disease.