Hepatitis B e antigen (HBeAg)-negative chronic hepatitis B refers to an atypical presentation of chronic hepatitis B characterized by the absence of HBeAg but with clinical and histologic evidence of chronic hepatitis and the presence of ongoing viral replication. It Is caused by a variety of mutations affecting transcription and translation of the precore-core RNA, the most common being the precore and double core promoter mutations. They have a worldwide distribution and development of the precore variant is genotype dependent. These variants may present as fulminant hepatitis but more commonly present as asymptomatic hepatitis during the natural course of chronic infection. The most characteristic pattern is one of severe flares followed by remissions. Long-term response to therapy is poor.
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