A patient with chronic hepatitis B is found to have HBsAg positive, anti-HBc positive, but HBeAg negative and anti-HBe positive. What is the likely viral status?

Explanation

## HBeAg-Negative Chronic Hepatitis B: Serological Interpretation **Key Point:** HBeAg negativity with anti-HBe positivity in a chronic HBsAg-positive patient indicates **low or absent viral replication** and an **inactive carrier state** (also called HBeAg-negative chronic HBV). ### Serological Profiles in Chronic HBV | Profile | HBsAg | Anti-HBc | HBeAg | Anti-HBe | HBV DNA | Clinical Status | |---------|-------|----------|-------|----------|---------|----------| | **HBeAg-positive chronic** | + | + | + | − | High | Active replication; high infectivity | | **HBeAg-negative chronic** | + | + | − | + | Low/absent | Inactive carrier; low infectivity | | **Acute HBV** | + | + (IgM) | ± | − | High | Acute phase; resolves in 6 months | | **Resolved infection** | − | + | − | + | − | Immunity; non-infectious | **High-Yield:** The **HBeAg-to-anti-HBe seroconversion** marks transition from high to low viral replication. This is a favorable prognostic sign in chronic HBV. ### Clinical Significance **HBeAg-negative chronic HBV:** - Represents ~10–15% of chronic HBV globally; higher in Mediterranean and Asian populations - Often results from mutations in the precore or core promoter region of HBV genome - HBV DNA may still be detectable (low levels) despite HBeAg negativity - Risk of cirrhosis and HCC remains; periodic monitoring is required - Treatment indicated if HBV DNA >2000 IU/mL or evidence of active hepatitis **Clinical Pearl:** HBeAg-negative patients can have flares of hepatitis despite low baseline HBV DNA; they require long-term surveillance. **Mnemonic:** **ANTI-HBe = ANTI-replication** — Anti-HBe positivity signals reduced viral output and transition to a less active phase.