44-year-old man is concerned about abnormal liver tests drawn for his preemployment physical 6 months ago. His serum aminotransferase levels were two times normal at that time and remain unchanged after repeat testing. On further questioning, he denies regular alcohol use but states that he used to inject heroin. Currently, he reports some fatigue but says he feels well otherwise. His primary care physician orders serologic testing, which reveals HBsAg-positive, anti-HBs-negative, and anti-HBc-positive IgG. Anti-HDV and anti-HCV tests are both negative. Questions A. Based on these antigen and antibody tests, what is the patient's diagnosis? B. What percentage of patients with acute hepatitis B remain chronically infected with HBV? Of those patients, how many develop chronic active disease? What are the significant complications of chronic active infection? C. What is the significance of hepatitis D superinfection? D. What evidence exists supporting immune-mediated damage in chronic active hepatitis?
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