A 35-year-old Asian man with jaundice and markedly high aminotransferase levels

KEY POINTS

• In immunocompetent adults, most primary HBV infections are self-limited.
• Chronic HBV infection is defined as the persistence of HBV surface antigen in the serum for at least 6 months. Patients having chronic HBV infection can be broadly classified as inactive carriers or having chronic active disease.
• Most patients with chronic active HBV infection are positive for HBV e antigen, except patients in whom the virus has a mutation in the precore or core region of its genome that prevents the production of e antigen.
• Patients who carry inactive HBV or who are immune-tolerant require serial measurements of aminotransferase and HBV DNA levels. Treatment can be considered if the patient has a high viral load (> 2,000 IU/mL), elevated aminotransferases, or active disease on liver biopsy.
• Carriers of chronic active HBV (whether positive or negative for HBV e antigen) should be referred to a hepatologist for consideration of liver biopsy and treatment.
• Interferon should not be used in immunocompromised patients or those with decompensated liver disease because it can further exacerbate the liver disease.
• Liver transplantation should be considered in patients with acute liver failure who have a poor prognosis according to the King’s College Hospital criteria.