Approach to HBeAg-Negative Patients with Increased Hepatic Aminotransferase Levels

You answered:

C The patient is likely infected with a precore mutant hepatitis B virus, which would best be diagnosed by obtaining a hepatitis B genotype.

This answer is incorrect. Hepatitis B virus can be divided into 7 genotypes, genotypes A-G. The prevalence of these genotypes differs geographically, with Genotypes A and G being most common in North America and Western Europe. Mutations in the precore and core promoter regions occur more commonly in patients with non-A genotypes, but a diagnosis of HBeAg-negative chronic hepatitis B cannot be made by genotyping alone. Rather, the diagnosis is made by demonstrating high HBV DNA loads (greater than 104 copies/ml) in an HBsAg-positive, HBeAg-negative patient.

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