CHRONIC HEPATITIS B
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Follows up to 1–2% of cases of acute hepatitis B in immunocompetent hosts; more frequent in immunocompromised hosts. Spectrum of disease: asymptomatic antigenemia, chronic hepatitis, cirrhosis, hepatocellular cancer; early phase often associated with continued symptoms of hepatitis, elevated aminotransferase levels, presence in serum of HBeAg and HBV DNA, and presence in liver of replicative form of HBV; later phase in some pts may be associated with clinical and biochemical improvement, disappearance of HBeAg and HBV DNA and appearance of anti-HBeAg in serum, and integration of HBV DNA into host hepatocyte genome. In Mediterranean and European countries as well as in Asia, a frequent variant is characterized by readily detectable HBV DNA, but without HBeAg (anti-HBeAg-reactive). Most of these cases are due to a mutation in the pre-C region of the HBV genome that prevents HBeAg synthesis (may appear during course of chronic wild-type HBV infection as a result of immune pressure and may also account for some cases of fulminant hepatitis B). Chronic hepatitis B ultimately leads to cirrhosis in 25–40% of cases (particularly in pts with HDV superinfection or the pre-C mutation) and hepatocellular carcinoma in many of these pts (particularly when chronic infection is acquired early in life).