What is A male patient is observed to be HBs Ag antigen positive HBe Ag antigen negative and anti-HBe antibody positive. HBV DNA copies are observed to be 100,000/m1 while SGOT and SGPT are elevated to 6 times the upper limit of normal value. What is the likely diagnosis: and explain in detail?
Answer is B (HBV pre-core mutant) Evidence of chronic active hepatitis B (suggested by elevated liver enzymes) in a patients with detectable HBV DNA but negative HBe Ag suggests a diagnosis of precore mutant chronic hepatitis B Precore mutant chronic hepatitis B Precore mutant form of chronic hepatitis B represents an infection with a molecular variant of the hepatitis B virus that results in an unusual serologic -- clinical profile. Such patients have severe chronic hepatitis B infection with detectable HBV DNA levels, but HBe Ag antigen is typically negative This results from an infection with an HBV mutant that contains an alteration in the precore regions rendering the virus incapable of encoding HBe Ag Patients with such mutations in the precore region are unable to secrete HBc Ag, have a negative HBe Ag phenotype but tend to have severe liver disease that progresses more rapidly to cirrhosis Characteristic' of such HBe Ag negative (precore mutant) chronic hepatitis B are lower levels of HBV DNA (< 105 copies /m1) and one of several patterns of aminotransferase activity -- persistent elevation, periodic fluctuation above the normal range and periodic fluctuations between the normal and elevated range HBe Ag negative chronic hepatitis B with mutation in the pre-core region is now the most frequently encountered form of hepatitis B in the Mediterranean countries and in Europe. HBs Ag Anti HBs Antibody Anti HBc Antibody HBe Ag Anti HBe Antibody HBV DNA Acute Hepatitis B (early) + + - + Acute Hepatitis B - (window period) - IgM + - + - Acute Hepatitis B (recovery) + + IgG - + ? Chronic Hepatitis B, high replication - IgG + - + Chronic Hepatitis B, low/non-replicati Ye phase - IgG - + - Chronic Hepatitis B Precore Mutant - IgG 4- + Chronic Hepatitis B inactive carrier + - IgG - +7- Low-level + Chronic hepatitis B reactivation + - IgM + - Hepatitis B vaccine - - -