A patient is found to be positive for HBs Ag on routine laboratory evaluation. Other serological tests for hepatitis are unremarkable. He is clinically asymptomatic and liver enzymes are within the normal range. Which of the following best describes his diagnosis:
Answer is A (Inactive HBV carrier) Absence of clinical signs and symptoms of liver damage and normal liver enzymes in an HBs Ag positive individual with otherwise unremarkable serological tests suggests a diagnosis of Inactive HBV carrier state. 'An inactive hepatitis B carrier is defined as one with HBs Ag in serum hut without HBe Ag with normal liver function tests and with low/ undetectable levels of HBV DNA (< 103-104 virions/ml) - 'Blue Prints Pocket Gastroenterology' by Grover (Lippincott Williams) 1st (2007) /114 Chronic Hepatitis B carriers (HBs Ag + ye with IgG Anti HBc) Chronic Hepatitis B virus carriers can be divided into two categories based on activity of the virus and evidence of liver damage Inactive HBs Ag Carrier state Patients with negligible virus replication (HBV DNA levels < 103 virions/m1) and /or no clinical signs and symptoms of liver damage and normal liver enzyme levels are characterized as inactive HBV carriers Inactive HBV carriers harbor Hepatitis B virus antigen (HBs Ag), but are clinically asymptomatic, have a normal physical examination with normal liver enzymes (AST & ALT). HBe Ag is typically negative and levels of HBV DNA are less than 103-104 virions/ml Such patients have minimal (if any) liver inflammation or damage, and usually live a normal life. However compared to the general population these patients remain at risk for hepatocellular carcinoma Treatment is currently not recommended for Inactive HBV carrier. However regular observation is advised as there is a risk for reactivation of virus. Chronic Hepatitis B (Active) Patients with active virus replication ( HBV DNA levels > 103 -104 virions/ml) and /or clinical signs and symptoms of liver damage or elevated liver enzyme levels are characterized as chronic hepatitis B patients. Depending on the presence or absence of HBe Ag two type of chronic (active) hepatitis B may be identified. HBe Ag positive chronic hepatitis B These HBs Ag positive, individuals are also positive for HBe Ag and show detectable HBV DNA levels. Such patients are in the replicative phase of chronic hepatitis B infection, have persistently or intermittently elevated liver enzymes and liver biopsy results typically reveals inflammation and damage Patients with chronic (active) hepatitis B may become inactive (relatively non replicative) over time (rate of L-10 % per year) by becoming negative for HBe Ag and HBV DNA (HBV DNA < 10' - 104) virions/ml) Liver injury tend to subside in such patients and these may then be characterized as 'inactive carriers' HBe Ag negative chronic hepatitis B (Precore mutant) Such HBs Ag positive individuals are negative for HBe Ag but show detectable HBV DNA levels. Such patients are also in the replicative phase of chronic hepatitis B (despite negative HBe Ag) and have persistently or intermittently elevated liver enzymes and liver biopsy results typically reveal severe inflammation and damage Negative HBe Ag Status results from a mutant strain of hepatitis B that is characterized by the .failure of the virus to make the hepatitis B 'e' antigen (HBe Ag). This mutation is called the `precore' mutation as it prevents the translation of a precore protein to prevent HBe antigen production. This mutation does not however affect the ability of the virus to replicate
Inactive HBV carrier
Acute Hepatitis B
Chronic Hepatitis B
Active HBV carrier