Hepatitis B – Q & A
Dr R V S N Sarma MD, FIMSA
www.drsarma.in
Question 1
Your clinic nurse had a needle stick injury
while collecting blood. The patient is known
HBsAg positive. What should you advise her?
Answer 1
Your clinic nurse had a need stick injury while
collecting blood. The patient is known HBsAg
positive. What should you advise her?
Answer: She requires HBIG (Hepatitis B
Immunoglobulin) and HBV vaccination full
course, if she is HBsAg negative and is never
vaccinated.
Question 2
A software engineer reports for a routine
check up. He doesn’t remember if he had
HBV vaccine. Wants to have it now. What
would you do?
Answer 2
A software engineer reports a for routine
check up. He doesn’t remember if he had
HBV vaccine. Wants to have it now. What
would you do?
Answer: Test for HBsAg. If negative – give
him full course of HBV vaccine. If positive
evaluate for activity of the HBV infection.
Question 3
A commercial sex worker seeks your advise
regarding HBV protection. She is HBsAg
negative. She had a course of HBV vaccine.
Will you assure her that she is protected?
How will you ensure that?
Answer 3
A commercial sex worker seeks your advise
regarding HBV protection. She is HBsAg
negative. She had a course of HBV vaccine. Will
you assure her that she is protected? How will
you ensure that?
Answer: As she is a high risk individual, test for
HBsAb titer, if >10mIU/ml, she is protected. If
not, give her HBV vaccine and advise her on
safe sex practices and risks of other STD.
Question 4
A new born baby is seen by you immediately
after birth. Her mother is a known HBsAg
positive. How will you ensure that the baby is
protected fully ?
Answer 4
A new born baby is seen by you immediately
after birth. Her mother is a known HBsAg
positive. How will you ensure that the baby is
protected fully?
Answer: Child must receive HBIG on one arm
and HBV first dose on the other within 12 hrs
of birth. Second and third doses after 1
month and sixth months.
Question 5
A patient is routinely tested for HBsAg and found to be
positive. What will be your next step?
Answer 5
A patient is routinely tested for HBsAg and found to
be positive. What will be your next step?
Answer: Must ascertain the activity of the virus and
must follow the patient for at least two years.
HBeAg, Anti-HBeAb, Total Anti-HBcAb, IgM Anti
HBcAb, Viral DNA copies, ALA and clinical profile
will decide activity and treatment. Has potential
danger for transmission. Advise safe sex practices,
screen spouse and children.
Question 6
A patient has tested for HBsAg and HBeAg. Would
proceed to start on antiviral or what you will do to
decide on antiviral Rx?
Answer 6
A patient has tested for HBsAg and HBeAg.
Would proceed to start on antiviral or what you
will do to decide on antiviral Rx?
Answer: Get the viral load (copies of viral DNA
per ml) and see the ALT levels. If the viral load
is at least 105 copies/ml and if the ALT is 2 times
the upper normal limit, anti viral Rx will be
indicated.
Question 7
A patient’s HBV serology is as follows
HBsAg negative, Tot Anti-HBc negative, AntiHBsAb negative. How do you classify him?
What do you do?
Answer 7
A patient’s HBV serology is as follows
HBsAg negative, Tot Anti-HBc negative, AntiHBsAb negative. How do you classify him?
What do you do?
Answer: Such person is termed as susceptible
He/she needs full 3 doses of HBV vaccine now.
Question 8
A patient’s HBV serology is as follows
HBsAg negative, Tot Anti-HBc positive, AntiHBsAb positive. How do you classify him?
What do you do?
Answer 8
A patient’s HBV serology is as follows
HBsAg negative, Tot Anti-HBc positive, AntiHBsAb positive. How do you classify him?
What do you do?
Answer: Such a person is Immune by natural
infection and does not require any intervention.
He has a totally resolved infection. A few of
such patients may flare up later. So follow.
Question 9
A patient’s HBV serology is as follows
HBsAg negative, Tot Anti-HBc negative, AntiHBsAb positive. How would you classify him?
Answer 9
A patient’s HBV serology is as follows
HBsAg negative, Tot Anti-HBc negative, AntiHBsAb positive. How would you classify him?
Answer: This individual is properly immunized
by HBV vaccine. He is protected. If the titer of
Anti-HBsAb is >10 mIU/ml, it shows good
immunity.
Question 10
A patient’s HBV serology is as follows
HBsAg positive, IgM AntiHBc positive,
AntiHBsAb negative. He has jaundice. What is
his clinical status. What would you do?
Answer 10
A patient’s HBV serology is as follows
HBsAg positive, IgM Anti-HBc positive, AntiHBsAb negative. He has jaundice. What is his
clinical status. What would you do?
Answer: This patient has Acute Hepatitis B
disease. Usually it resolves and recovers. A
few patient may become Immune Active or
Immune Resolved and will be a case of
Chronic active B hepatitis (CHBV)
Question 11
A patient’s HBV serology is as follows
HBsAg positive, Total Ig Anti-HBc positive,
Anti-HBsAb negative. What is his clinical
status. What would you do?
Answer 11
A patient’s HBV serology is as follows
HBsAg positive, Total Ig Anti-HBc positive,
Anti-HBsAb negative. What is his clinical
status. What would you do?
Answer: This patient suffered HBV infection in the
past (Total Ig Anti HBc positive) and has not
recovered fully (HBsAg positive). He is a chronic
carrier. He may become Immune Active or Immune
resolved. He needs follow up every 3 months.
Question 12
A patient’s HBV serology is as follows
HBsAg negative, IgTotal AntiHBc positive,
AntiHBsAb negative ? Why is it that IgG
AntiHBc alone is positive?
Answer 12
A patient’s HBV serology is as follows
HBsAg negative, IgTotal AntiHBc positive, AntiHBsAb
negative ? Why is it that IgG AntiHBc alone is positive?
Answer: There are three reasons for this scenario –
namely 1. The patient is in window period and yet to
develop HBsAg positivity. 2. Patient may have had very
remote infection and dropped his HBsAg and his anti
HBsAb waned off but the memory remains or 3. The
isolated AntiHBc positivity is a false positive result.
Question 13
You want to test a patient for HBV infection
status. What test(s) do you order? And in what
order?
Answer 13
You want to test a patient for HBV infection status. What
test(s) do you order? And in what order?
Answer: The first step is screening test – HBsAg test . If
this is negative, do Anti HBsAb to confirm if he is already
immune (immune patient will be positive for AntiHBsAb).
If the patient is HBsAg positive, as a second step, we
need to know the activity of the virus – order for HBeAg.
If HBeAg is positive, the third step would be to order for
HBV DNA quantitative assessment (copies/ml) to decide
on the Antiviral Rx. We need serum ALT level to assess
the liver injury.
Question 14
What tests you order in a full panel of HBV
serology?
Answer 14
What tests you order in a full panel of HBV serology?
Answer:
1. HBsAg
2. HBsAb
3. AntiHBcAb IgM
4. AntiHBcAb Total
5. HBeAg
6. AntiHBeAb
Viral DNA count (copies/ml) if HBeAg is positive
If viral multiplication + ve, serum ALT; Only rarely liver biopsy.
Never test for HBcAg in serum. This never appears in blood
Question 15
What are the three phases of chronic HBV infection?
Answer 15
What are the three phases of chronic HBV infection?
Answer
A. Immune Tolerant
B. Immune Active wild and Immune Active (mutant)
C. Inactive Carrier
Question 16
What do you understand by the term Immune Tolerant
phase of chronic HBV disease.
Answer 16
What do you understand by the term Immune Tolerant
phase of chronic HBV disease.
This patient is in harmony with the virus. He has active
viral replication but no liver injury as yet. His/her
1. AntiHBcAb total will be negative
2. HBeAg will be positive
3. His viral DNA copies will be high
4. But his liver enzyme ALT will be normal
Question 17
What do you understand by the term Immune Active
phase of HBV disease.
Answer 17
What do you understand by the term Immune Active
phase of HBV disease.
This patient the virus took the upper had and liver injury
has stated. He has active viral replication too. His/her
1. AntiHBcAb total will be negative
2. HBeAg will be positive in wild and negative in mutant
3. His viral DNA copies will be high
4. But his liver enzyme ALT will be increased.