A 28-year-old IVDAs tests positive for HBsAg. His HBeAg is negative, anti-HBe positive, HBV DNA is 22,000 IU/mL and ALT is elevated. This serological profile is consistent with:
- A Immune-tolerant phase of chronic HBV infection
- B HBeAg-negative chronic hepatitis B (pre-core mutant disease) ✓
- C Resolved HBV infection
- D Acute hepatitis B in window period
Correct answer: B. HBeAg-negative chronic hepatitis B (pre-core mutant disease)
Explanation
HBeAg-negative chronic hepatitis B with anti-HBe positivity and detectable HBV DNA (>2,000 IU/mL) with elevated ALT is characteristic of HBeAg-negative chronic hepatitis B, caused by pre-core or basal core promoter mutations preventing HBeAg expression. The immune-tolerant phase has high viral load (>10^7 IU/mL) but NORMAL ALT. Resolved HBV shows loss of HBsAg with anti-HBs. Window period has anti-HBc IgM positive with both HBsAg and anti-HBs negative.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
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