A 42-year-old man with HBeAg-negative chronic hepatitis B has ALT persistently twice the upper limit of normal. His HBV DNA is 5,000 IU/mL. According to standard treatment thresholds, what does this value indicate?
- A Below the usual threshold of 2,000 IU/mL, so antiviral therapy is not indicated
- B Above the usual threshold of 2,000 IU/mL, and with raised ALT this meets criteria for antiviral therapy ✓
- C HBV DNA below 10,000 IU/mL always indicates inactive carrier state regardless of ALT
- D Quantitative HBV DNA is not useful in HBeAg-negative disease and liver biopsy is mandatory before any decision
Correct answer: B. Above the usual threshold of 2,000 IU/mL, and with raised ALT this meets criteria for antiviral therapy
Explanation
For HBeAg-negative chronic hepatitis B, major guidelines use serum HBV DNA above 2,000 IU/mL together with persistently elevated ALT as the threshold for considering antiviral therapy. This patient exceeds both criteria. Inactive carrier state requires repeatedly normal ALT with low or undetectable DNA, which contradicts his ALT. Biopsy may refine fibrosis staging but is not mandatory when these thresholds are met.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.