Hepatitis B — SCE Infectious Diseases MCQ

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HardHepatitisHepatitis BSCE Infectious Diseases

A 35-year-old man with HIV (CD4 320, viral load <50 on DTG/TAF/FTC) presents for routine screening. His results show: HBsAg negative, anti-HBs <10 mIU/mL, anti-HBc positive. What is the most likely interpretation?

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Correct answer: D — Isolated anti-HBc (possible occult HBV or false positive)

Isolated anti-HBc (HBsAg negative, anti-HBs negative, anti-HBc positive) has several possible interpretations: resolved infection with waned anti-HBs, occult HBV infection, false-positive anti-HBc, or acute HBV in the window period. In an HIV-positive patient, occult HBV is a real possibility and HBV DNA should be checked. This patient is on Tenofovir AF/Emtricitabine, which provides HBV suppression, so even if occult HBV is present, it is being treated. If ART is changed, HBV reactivation risk must be considered.

Reference: BHIVA 2023 – Hepatitis B and HIV co-infection; NICE CKS 2024 – Hepatitis B serology