a form of the virus that does not cause infected cells to secrete HBeAg has been discovered (sometimes called the 'precore mutant' strain)
people can be infected with the so-called HBeAg-negative form of the virus from the beginning, or the viral mutation can emerge later in the course of infection in people initially infected with the HBeAg-positive form of the virus
prevalence of HBeAg-negative hepatitis varies geographically; it is more common in Asia and the Mediterranean region than in Northern Europe
infection with HBeAg-negative chronic hepatitis B is associated with a fluctuating course and a poor prognosis. Active disease is associated with either persistent elevation of ALT or an erratic pattern of ALT changes with flare-ups resembling acute hepatitis B that can be severe or even fatal
few patients with HBeAg-negative chronic hepatitis B achieve a lasting remission. Progression to cirrhosis of the liver has been estimated to occur in 8-10% of people with HBeAg-negative chronic hepatitis B each year
Reference:
NICE. Adefovir dipivoxil and peginterferon alfa-2a for the treatment of chronic hepatitis B. Technology appraisal guidance TA96. Published February 2006
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