A 56-year-old lady had acquired chronic HBe-Ag-negative hepatitis B following blood transfusions for a bleeding complication at child delivery 25 years ago. She has become HBV-DNA negative on entecavir but still has high serum levels of HBsAg (22 512 IU/L). She is referred by her primary care physician because he is concerned about persistently 1.5- to 2.5-fold elevated serum aminotransferases and increased hepatic echogenicity on ultrasound.