How do you approach the surveillance and serologic evaluation of a patient in whom you suspect has a hepatitis B pre-core mutant?

HBeAg- HBeAb+/- with HBV DNA > 2 log likely precore mutant. Surveillance similar to wild-type with ALT and HBV DNA q6mos to assess for reactivation (abnormal ALT, DNA > 2000IU) that you would consider treating. If considering treatment, qHBsAg might be useful to identify patients who might be able to be treated for a finite time period. Agre-related HCC surveillance is even more critical with these patients.