**Question:** Heera lal, a 35-year-old man, tested positive for HBs Ag & HBe Ag during a blood donation screening. His liver enzymes (SGOT and SGPT) are within normal range. What should be the next step?

**Core Concept:** Hepatitis B virus (HBV) infection can lead to chronic hepatitis, liver inflammation, and potentially cirrhosis or liver cancer. In acute HBV infection, liver enzyme levels can be normal or mildly elevated. HBsAg and HBeAg tests confirm HBV infection, while SGOT and SGPT are liver enzymes that can indicate liver damage.

**Why the Correct Answer is Right:** Given that Heera lal is HBsAg and HBeAg positive, it indicates an acute or recent HBV infection. In acute HBV infection, liver enzymes like SGOT and SGPT can be normal or only mildly elevated. Since the liver enzymes in this case are normal, it suggests an acute HBV infection rather than chronic liver disease.

**Why Each Wrong Option is Incorrect:**

A. **HBeAg negative:** HBeAg positivity in acute HBV infection indicates active viral replication, while negativity suggests a less aggressive course. However, the presence of HBsAg indicates current infection, not necessarily the absence of HBeAg.

B. **Chronic hepatitis B:** While chronic hepatitis B is a possibility, the normal liver enzymes indicate that the infection is likely acute.

C. **Hepatitis C:** Hepatitis C is a different virus causing chronic liver disease with elevated liver enzymes. Since the liver enzymes are normal, hepatitis C is less likely.

D. **Autoimmune hepatitis:** Autoimmune hepatitis typically presents with elevated liver enzymes, not normal levels.

**Clinical Pearl:** In acute HBV infection, normal liver enzymes are more common than initially presumed. However, follow-up tests, including HBeAg and anti-HBe, should be conducted after 6 months to determine if the infection progresses to chronicity. If the patient remains HBsAg positive and HBeAg negative, the risk of chronic hepatitis B increases.

**Correct Answer:** B. Chronic hepatitis B.

**Why the Correct Answer is Right:** Given that Heera lal tested positive for HBsAg, it indicates an acute or recent HBV infection. While the normal liver enzymes suggest an acute infection, the progression to chronic hepatitis B is possible. Further follow-up tests, including HBeAg and anti-HBe, are essential to determine if the infection becomes chronic. If the patient remains HBsAg positive and HBeAg negative, the risk of developing chronic hepatitis B increases.

**Why Each Wrong Option is Incorrect:**

A. HBeAg negative: This indicates a less aggressive course, but not necessarily absence of chronicity.

C. Anti-HCV: Hepatitis C is a different virus causing chronic hepatitis, not indicated in this scenario.

D. Autoimmune hepatitis: Normal liver enzymes are less common in autoimmune hepatitis, making it less likely in this case.