A patient with chronic HBV infection has the following serology: HBsAg (+), HBeAg (-), Anti-HBe (+), HBV DNA 5×10^5 IU/mL, elevated ALT. This pattern represents which clinical entity?
- A HBeAg-negative chronic hepatitis B, caused by pre-core or core promoter mutations ✓
- B Inactive HBsAg carrier state (low viral replication)
- C Acute HBV infection with HBeAg to anti-HBe seroconversion
- D Resolved HBV infection with persistence of surface antigen
Correct answer: A. HBeAg-negative chronic hepatitis B, caused by pre-core or core promoter mutations
Explanation
HBeAg-negative chronic hepatitis B occurs when mutations in the pre-core region (G1896A stop codon, most common) or basal core promoter prevent HBeAg synthesis while replication continues via HBV DNA. These patients have detectable HBV DNA (often >2000 IU/mL), elevated ALT, and ongoing liver damage despite anti-HBe positivity. It is more common in Mediterranean and Asian patients and has a more aggressive course than HBeAg-positive disease. Inactive carrier state would have very low/undetectable HBV DNA.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
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