Natural History of Chronic Hepatitis B Infection

Authors: Brian J. McMahon, MD David H. Spach, MD

Last updated: February 22, 2013

Learning Objectives

A 32-year-old Chinese American woman whose mother was born in China presents to clinic. Her mother was recently informed she had chronic hepatitis B, so the patient asks to be tested for hepatitis B virus (HBV). Results from her hepatitis B testing and liver aminotransferase levels are as follows:

Hepatitis B surface antigen (HBsAg): positive
Hepatitis B core antibody (total anti-HBc): positive
Hepatitis B core antibody (IgM anti-HBc): negative
Hepatitis B surface antibody (anti-HBs): negative
Hepatitis “e” antigen (HBeAg): positive
Hepatitis “e” antibody (anti-HBe): negative
HBV DNA: 1.1 x 107 IU/ml
Alanine aminotransferase (ALT): 25 U/L (normal 10 to 40 U/L)
Aspartate aminotransferase (AST): 18 U/L (normal 10 to 40 U/L)

The provider elects to measure repeat aminotransferase levels in 3 months time. At that point, both the ALT and the AST are within the normal range.

Which of the following describes the phase of this patient’s hepatitis B infection and what should be done?

A The patient has acute HBV infection and she should be followed closely to see if chronic infection develops.
B The patient is in the immune tolerant phase and should be followed on a regular basis with ALT levels every 3-6 months (and more frequently if they become elevated).
C The patient has evidence of hepatic inflammation and is in the immune active phase of chronic viral hepatitis; she should immediately start on therapy for HBV.
D The patient is in the inactive chronic carrier phase of hepatitis B and can be evaluated again if she develops an increase in hepatic transaminase levels (ALT and AST).