A 28-year-old pregnant woman has a positive HBsAg test. Further serology shows HBeAg positive, anti-HBe negative, HBV DNA > 2 × 10^6 IU/mL, and ALT is 22 U/L (normal). Her HBsAg has been positive for 3 years. This serological pattern is best classified as:
- A Immune active chronic hepatitis B (HBeAg-positive)
- B Immune escape (HBeAg-negative chronic hepatitis B)
- C Immune tolerant phase of chronic HBV infection ✓
- D Inactive HBsAg carrier state
Explanation
The immune tolerant phase is defined by: HBeAg positivity, very high HBV DNA (> 1 × 10^6 IU/mL), persistently normal ALT, and minimal liver inflammation — reflecting a state of high viral replication without significant immune-mediated hepatocellular injury. This phase is common in perinatally acquired HBV and in young adults. Immune active HBeAg-positive hepatitis shows elevated ALT with active liver inflammation. HBeAg-negative chronic hepatitis B occurs after HBeAg seroconversion with precore/basal core promoter mutations. The inactive carrier state has low or undetectable HBV DNA and normal ALT.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.