Chronic Hepatitis B Carrier

Aka: Chronic Hepatitis B Carrier, Hepatitis B Carrier, HBeAg Negative Chronic Hepatitis B, Chronic Hepatitis B Inactive Carrier

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II. Pathophysiology

  1. Acute Hepatitis B Infection becomes chronic in 10%
  2. Chronic Hepatitis B (HBsAg present >6 months)
    1. Chronic Hepatitis B Carrier
    2. Chronic Hepatitis B Infection
  3. Hepatitis B Carrier contrasted with chronic HBV infection
    1. Low viral load
    2. Normal Liver Function Tests (ALT or SGPT)

III. Risk Factors

  1. Infants exposed in the first years of life (80-90% risk)
  2. Children age <6 years (30 to 50% risk)

IV. Symptoms

  1. Asymptomatic

V. Labs

  1. HBsAg positive
  2. HBeAg negative
  3. xHBeAb positive
  4. Low viral load: HBV DNA hybridization negative
  5. Liver Function Tests (ALT or SGPT) normal
    1. Contrast with HBeAg-/xHBeAb+ Chronic Hepatitis B Infection (see precautions below)

VI. Precautions: HBeAg-/xHBeAb+ Chronic Hepatitis B Infection

  1. A subset of Hepatitis B "Carriers" have chronic active Hepatitis Despite HBeAg-/xHBeAb+
    1. Wildtype HBV may fail to produce HBeAg despite chronic HBV active or persistent infection
  2. HBeAg-/xHBeAb+ Chronic Hepatitis B Infections are associated with elevated liver enzymes
    1. Contrast with HBV inactive carriers who have persistently normal liver enzymes
  3. HBeAg-/xHBeAb+ Chronic Hepatitis B are at high risk for Chronic Hepatitis B complications
    1. Complications include Cirrhosis and Hepatocellular Carcinoma
    2. Contrast with a relatively benign course for inactive carriers with persistently normal liver enzymes
  4. HBV Carrier state liver enzyme monitoring is therefore critical to differentiate inactive carriers from chronic HBV
    1. In the first year of diagnosis, obtain liver enzyme monitoring every 3 months
    2. Thereafter, obtain liver enzymes periodically (every 6-12 months)
  5. HBeAg-/xHBeAb+ Chronic Hepatitis B is treated as Chronic Hepatitis B Infection
    1. See Chronic Hepatitis B Infection
  6. References
    1. Koffas (2021) Hepatol Int 15(2):290-300 +PMID: 33638770 [PubMed]

VII. Management

  1. Recheck liver transaminases every 3 months for the first year of diagnosis
    1. Differentiate inactive carrier from HBeAg-/xHBeAb+ Chronic Hepatitis B Infection (see precautions above)
  2. Observation: primary care visits every 6-12 months
  3. Follow related lab-work at follow-up visits
    1. Liver Function Tests (ALT or SGPT)
    2. HBsAg
    3. HBeAg
    4. xHBeAb

VIII. Course

  1. Spontaneous clearance in 1% of carriers per year
  2. Risk of reactivation to Chronic Hepatitis B Infection
    1. Immunosuppression (e.g. Chemotherapy, Immunotherapy, organ transplant)
    2. HCV coinfection

IX. Prevention: Transmission to Others

  1. Identify all potential exposures
    1. Children
    2. Household contacts
    3. Sexual contacts
  2. Hepatitis B Serology testing for all exposures
  3. Hepatitis B Vaccine for all exposures not immune

X. References

  1. Berenguer in Feldman (2002) Sleisenger GI, p. 1285-303
  2. Lok (2001) Hepatology 34:1225-41 [PubMed]
  3. Malik (2000) Ann Intern Med 132:723-31 [PubMed]

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