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In adults, ∼30% will present with jaundice and hepatitis and 0.1–0.5% develop fulminant liver failure [3].

During acute infection, hepatitis B surface antigen (HBs Ag) and hepatitis B e antigen (HBe Ag) can be detected in the serum and there are high levels of Ig M antibodies to the viral core antigen (Ig M anti-HBc) [4].

Epidemiological studies suggest that HBV genotype may influence disease progression, with Genotypes A and B associated with more favourable outcomes than Genotypes C and D [10–12].

The natural history of CHB can be divided into five phases.

There are currently seven drugs available for the treatment of CHB: five nucleos(t)ide analogues and two interferon-based therapies.

Long-term treatment is often required, and the decision to treat is based on clinical assessment including the phase of CHB infection and the presence and extent of liver damage.

Chronic hepatitis B (CHB) infection is associated with an increased risk of cirrhosis, hepatic decompensation and hepatocellular carcinoma (HCC).Not all patients experience every phase, and the duration of each phase can be highly variable.Reversion or reactivation between different phases can occur seemingly without warning, and therefore, clinical management can be challenging [13].Similarly, immigration of individuals with CHB from countries of intermediate and high HBV prevalence has been estimated to account for 95% of the estimated annual incidence of CHB infections in England [9].HBV virus can be subdivided into different genotypes.Of those chronically infected, it is estimated that 65 million will die from liver disease due to their HBV infection [1]. We also searched the websites of various expert organizations, including Centers for Disease Control (CDC), National Institute for Clinical Excellence (NICE), European Association for Study of Liver Disease (EASL) and American Association for the Study of Liver Disease (AASLD).