Hepatitis B Vaccination — SCE Infectious Diseases MCQ

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EasyHIV MedicineHepatitis B VaccinationSCE Infectious Diseases

A 42-year-old man with HIV (CD4 340, VL <50 on ART) attends for routine bloods. His hepatitis B serology shows: HBsAg negative, anti-HBs 8 mIU/mL, anti-HBc negative. He has never been vaccinated against hepatitis B. What is the recommended action?

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Correct answer: A — Vaccinate with a standard or double-dose HBV vaccine course and check anti-HBs response

This patient has no evidence of prior HBV infection (anti-HBc negative) and no vaccine-induced immunity (anti-HBs <10). The low anti-HBs may be a lab artefact or cross-reactivity. BHIVA recommends HBV vaccination for all susceptible PLWH. Response rates are lower in HIV (especially CD4 <350) so double-dose (40 µg) or additional doses may be needed. Post-vaccination anti-HBs should be checked 4–8 weeks after completion to confirm seroprotection (≥10 mIU/mL).

Reference: BHIVA 2024 – Vaccination guidelines for adults with HIV; UKHSA 2024 – Green Book Chapter 18: Hepatitis B