Approach to HBeAg-Negative Patients with Increased Hepatic Aminotransferase Levels

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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.

This answer is correct. The definitive identification of a variant HBV strain with mutations in the precore or core promoter regions requires molecular sequencing of these regions with identification of characteristic mutations in the precore or core promoter region. Because such molecular assays are not available in most commercial laboratories, the diagnosis of HBeAg-negative chronic hepatitis B is usually made presumptively in HBsAg-positive patients with hepatitis B viral loads (HBV DNA) greater than 104 copies/ml. In a HBsAg-positive patient with a flare in liver enzymes, development of infection with an HBeAg-negative strain of hepatitis B is likely, and should be confirmed by measuring a viral load.

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