MCQs:Hepatitis B serology: Answers

1) Most positive HBsAg results picked up on ante-natal screening represent chronic infection? T/F

True, probably more than 95% of such results represent chronic infection, most of whom have probably had the infection for years or even since birth.

2) IgM Anti-HBc can be used to differentiate acute from chronic Hepatitis B infection? T/F

True, but in my opinion only occasionally needed to confirm acute infection in someone who is either symptomatic or has had a recent contact with Hepatitis B. For the majority of cases, chronic infection can be assumed.

3) A patient with negative HBeAg will always have a low HBV viral load? T/F

False. Hepatitis B viruses containing “pre-core mutants” may be HBeAg -ve but still have high HBV DNA levels.

4) Anti-HBc (total) is usually negative in chronic Hepatitis B infection? T/F

False: Anti-HBc should always be positive in chronic Hepatitis B infection. If it is negative, it should prompt you to look at the validity of your HBsAg result.

5) A patient who has had acute Hepatitis B infection in the past and has cleared the virus, will have positive anti-HBc and anti-HBs? T/F


6) Hepatitis B vaccination induces a strong anti-HBc response? T/F

False: Hepatitis B vaccination does not produce anti-HBc so thus differentiates it from immunity due to resolved acute infection (as in Q5)

7) The incubation period after exposure to Hepatitis B virus until symptoms appear is approximately 1 week? T/F

False: Can be anything between a few weeks to a few months.

8) Expectant mothers who are HBsAg +ve may be candidates for anti-viral treatment? T/F

True: Expectant mothers with abnormal LFTs, HBeAg +ve, or with high HBV viral loads may all be candidates for anti-viral treatment during pregnancy. See this algorhythm

9) Patients who are anti-HBc +ve, but negative for HBsAg and anti-HBs. This can represent a range of scenarios, the most common being resolved acute infection? T/F

True: See this article

10) Patients who are HBsAg +ve and also anti-HBe +ve are not infective to others? T/F

False. Patients who are HBsAg +ve are potentially infective to others regardless of their other serology results.

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