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Chronic Hepatitis B — SCE Infectious Diseases MCQ

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ModerateHepatitisChronic Hepatitis BSCE Infectious Diseases

A 55-year-old man develops acute hepatitis B (IgM anti-HBc positive, HBsAg positive, HBV DNA 5 × 10⁷ IU/mL). He is jaundiced but not coagulopathic. He is managed supportively. At 6 months follow-up, HBsAg is still positive and IgM anti-HBc has become negative. Anti-HBs is negative. What has occurred?

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Correct answer: A — Progression to chronic hepatitis B (failure to clear HBsAg within 6 months)

Persistence of HBsAg for >6 months after acute HBV infection defines chronicity. Approximately 5% of immunocompetent adults progress from acute to chronic HBV (higher in immunocompromised, neonates ~90%). The disappearance of IgM anti-HBc and persistence of HBsAg without anti-HBs seroconversion confirms the transition. This patient now needs ongoing monitoring (HBV DNA, ALT, FibroScan) and assessment for antiviral therapy per NICE CG165.

Reference: NICE CG165 2013 – Hepatitis B; EASL 2024 – HBV guidelines