A 35-year-old male is found to have HBsAg positive, anti-HBe positive, HBeAg negative, and HBV DNA of 12,000 IU/mL with ALT twice the upper limit of normal. This serological pattern is most consistent with which phase of HBV infection?
- A HBeAg-negative chronic hepatitis B (immune reactivation) ✓
- B Immune tolerant phase
- C Immune active (HBeAg positive) phase
- D Inactive HBsAg carrier state
Correct answer: A. HBeAg-negative chronic hepatitis B (immune reactivation)
Explanation
HBeAg-negative chronic hepatitis B is characterized by HBsAg positive, HBeAg negative, anti-HBe positive, elevated HBV DNA (>2,000 IU/mL), and abnormal ALT — reflecting active viral replication via a precore or core promoter mutation that prevents HBeAg production. The inactive carrier state has HBV DNA <2,000 IU/mL and normal ALT. This pattern requires antiviral treatment consideration.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
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