In chronic hepatitis B, the serum marker pattern shows: HBsAg positive, HBeAg negative, anti-HBe positive, with markedly elevated HBV DNA on PCR. Liver biopsy shows active hepatitis. This pattern is most consistent with:
- A Inactive HBsAg carrier state
- B Occult HBV infection with resolved acute hepatitis
- C HBV superinfection with hepatitis D virus (HDV)
- D HBeAg-negative chronic hepatitis B (pre-core/core promoter mutant) ✓
Explanation
HBeAg-negative chronic hepatitis B results from mutations in the pre-core region (G1896A stop codon mutation) or basal core promoter (A1762T/G1764A) that prevent or reduce HBeAg production despite active viral replication (high HBV DNA). The patient has HBsAg+, HBeAg-, anti-HBe+, elevated HBV DNA, and active histological hepatitis — the hallmarks of pre-core mutant HBV infection. The inactive carrier state has low/undetectable HBV DNA and normal liver histology. Occult HBV has undetectable HBsAg. HDV superinfection requires HBsAg positivity but typically presents with acute-on-chronic hepatitis with anti-HDV serology.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.