Approach to HBeAg-Negative Patients with Increased Hepatic Aminotransferase Levels

You answered:

A The patient has most likely developed hepatocellular carcinoma and should be scheduled immediately for a triple phase liver computed tomography (CT) scan.

This answer is incorrect. Although the risk of developing liver cancer is increased in all patients with chronic hepatitis B patients, in this case hepatocellular carcinoma (HCC) is not the most likely diagnosis. Although HCC is 2-10 times more likely to occur in chronic HBsAg-positive hepatitis B carriers compared with HBsAg-negative individuals, only a fraction of carriers are expected to develop HCC within their lifetime. In addition to HBsAg positivity, risk factors for HCC include male gender, age over 40, being HBeAg positive, high serum HBV DNA levels, and underlying cirrhosis.

Choose another answer:

B The patient likely has a precore or core promoter mutant hepatitis B virus, which could be presumptively diagnosed by obtaining a serum hepatitis B viral load.
C The patient is likely infected with a precore mutant hepatitis B virus, which would best be diagnosed by obtaining a hepatitis B genotype.
D The patient’s liver enzyme elevation is probably unrelated to his hepatitis B. He may have developed fatty liver disease, and an ultrasound should be ordered to evaluate him for this condition.

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