A 26 year old man was observed to be positive for HBs Ag but negative for HBe Ag. The AST / ALT levls were observed to be within normal limits. The next step in management of this patient should be
**Core Concept**
The patient in question is a 26-year-old man with a positive HBs Ag test result but negative HBe Ag. This indicates that he is infected with hepatitis B virus (HBV) but is not actively replicating the virus. The normal liver enzymes (AST/ALT) suggest that there is no significant liver inflammation or damage at this time.
**Why the Correct Answer is Right**
The next step in management for a patient with chronic HBV infection who is not actively replicating the virus (HBe Ag negative) and has normal liver enzymes is to monitor for potential progression to liver cirrhosis or hepatocellular carcinoma. This is because HBV can cause chronic liver inflammation and fibrosis, leading to cirrhosis and eventually hepatocellular carcinoma, even in the absence of significant liver enzyme elevation. Regular monitoring of liver function tests and HBV DNA levels is essential to assess disease progression.
**Why Each Wrong Option is Incorrect**
**Option A:** Administering antiviral therapy without monitoring HBV DNA levels or liver function tests would be premature and may not be necessary in this patient, given the absence of liver enzyme elevation and HBe Ag negativity.
**Option B:** Performing a liver biopsy would be an invasive procedure and is not currently indicated in the management of this patient, given the normal liver enzymes and absence of symptoms.
**Option C:** Initiating immunosuppressive therapy would be contraindicated in a patient with chronic HBV infection, as it can increase the risk of HBV reactivation and liver damage.
**Clinical Pearl / High-Yield Fact**
Chronic HBV infection can be asymptomatic for many years, and the absence of liver enzyme elevation does not rule out significant liver damage or disease progression. Regular monitoring of HBV DNA levels and liver function tests is essential to detect early signs of disease progression.
**Correct Answer:** C.