Transmission of a homogeneous hepatitis B virus population of A₁₈₉₆- containing strains leading to mild resolving acute hepatitis and seroconversion to hepatitis B e antigen antibodies in an adult

The pre-core variant, A₁₈₉₆, which switches off hepatitis B e antigen (HBeAg) production, is common in hepatitis B e antigen antibody (anti-HBe)-positive chronic hepatitis patients. It has been observed in occasional case reports of acute hepatitis. However, transmission in the absence of HBeAgproducing strains, leading to acute nonfulminant hepatitis and clearance in adults, has not been reported. Here, we show that this event can occur, further confirming that A₁₈₉₆ strains are 'wild-type' and can lead to all the same outcomes as G₁₈₉₆ strains. This is in keeping with phylogenetic evidence that A₁₈₉₆ is transmitted independently on a large scale in the population and explains anti-HBe- positive persons who have not had an HBeAg-positive phase documented.