9. What is e-antigen negative chronic hepatitis B?

So let’s review what is somewhat new to many physicians in practice, what we now simply call e-antigen negative chronic hepatitis B. They mostly harbor the two variants that I mentioned, the precore or the core promoter; they’re not acquired de novo, or all by themselves. They’re selected out during the immune clearance phase. That occurs usually in early adult life. So the wild type switches and undergoes a mutation. How do we make the diagnosis in our routine day in and day out practice? Well, we see a patient that has a negative e-antigen, a positive e-antibody, a DNA that has to be at least 10 to the fourth, so it’s a log 4 copies, ALT is usually elevated, but it may be intermittently elevated. This confuses physicians, because the first visit for a patient, the ALT may be normal. So with a normal ALT and a negative e-antigen, it looks like there’s inactive hepatitis B. That’s why it’s important that all hepatitis B patients see their physicians about twice a year to do routine blood work, because it may take serial blood work in order to make a clear diagnosis. Another thing is that with the two oral agents, sustained remission is uncommon, so what’s intimidating for patients with e-Negative chronic hepatitis B, is when you initiate therapy, it’s probably going to be long-term therapy, maybe lifetime therapy. And e-Negative also has somewhat of a more progressive course than does the wild type.