immune tollerant:
no liver damage or very mild due to bad quality food and not virus
ast alt normal
hbsag more than 20000iu/ml
hbvdna very high in the millions
immune clearance:
no liver damage or mild liver damage
ast alt abnormal
hbsag less than 20000iu/ml
hbvdna any quantity, even undetactable
hbvdna alone means nothing because hbv is not cytopatic, it means it makes no damage to us at all, it s our immune system to make the damage killing infected cells but failing to clear hbv
so you have to check first of all if there is any liver damage, if not immune system cant see the virus and is making no damage, this is the best situation of an hbv cronic carrier because the carrier is absolutely healthy but very very infective so all people in contact need hbv vaccine, this is immune tollerant stage.of course at this stage no drug must be taken both because not needed and because all drugs will fail because there is no drug that cures hbv directly
you need the following tests to monitor hbv status:
fibroscan, only way to detect liver damage and monitor (biopsy is obsolete and not accurate)
hbsag quantity in iu/ml by abbott architect with diluition for correct quantity of hbsag detection
ast/alt
ultrasound is useless to monitor liver damage but it is needed to check for liver cancer every 6 month