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We assessed the phenotype of hepatitis B of 1,390 adult participants enrolled in the Hepatitis B Research Network Cohort Study, using a computer algorithm. Only 4% were immune tolerant, while 35% had chronic hepatitis B (18% e antigen positive and 17% e antigen negative) while 23% were inactive carriers. Strikingly, 38% of participants did not fit clearly into any one of these groups and were considered indeterminant. The largest subset of indeterminants had elevated serum aminotransferases with low levels of <jats:styled-content style=\"fixed-case\">HBV DNA<\/jats:styled-content> (less than 10,000\u00a0iu\/mL). Subsequent determination of hepatitis B phenotype on the next available laboratory tests showed that 64% remained indeterminant. These findings call into question the validity of conventional staging of hepatitis B, in large part because of the substantial proportion of patients who do not fit readily into one of the usual stages or phases. Further studies are needed of the indeterminant category of chronic hepatitis B viral infection, including assessments of whether patients in this group are perhaps in transition to another phase or if they are a distinct phenotype with a need to assess liver disease severity and need for antiviral therapy. (ClinicalTrials.gov identifier <jats:styled-content style=\"fixed-case\">NCT<\/jats:styled-content>01263587).<\/jats:p>","DOI":"10.1111\/jvh.12643","type":"journal-article","created":{"date-parts":[[2016,12,5]],"date-time":"2016-12-05T06:43:46Z","timestamp":1480920226000},"page":"320-329","source":"Crossref","is-referenced-by-count":77,"title":["Determination of hepatitis B phenotype using biochemical and\u00a0serological markers"],"prefix":"10.1111","volume":"24","author":[{"given":"A. M.","family":"Di Bisceglie","sequence":"first","affiliation":[{"name":"Saint Louis University Liver Center  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Lombardero","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Graduate School of Public Health  Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Teckman","sequence":"additional","affiliation":[{"name":"Saint Louis University Liver Center  St. Louis MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Roberts","sequence":"additional","affiliation":[{"name":"Mayo Clinic Foundation  Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. L. 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