An 18 year old medical student has his hepatitis B and C status checked as part of his occupational health screening for entrance to medical school. His results are as follows: LFTs: Bilirubin 12 μmol/L (0.70 mg/dL) ALT 19 U/L HCV antibody not detected Hepatitis B surface antigen (HBsAg) positive Antibody to HBsAg (anti-HBs) negative Antibody to hepatitis B core antigen (anti-HBc) IgM negative Anti-HBc IgG positive What is the next step in his management?
ExplanationThis medical student has chronic hepatitis B. Hepatitis B surface antigen is the hallmark of chronic HBV infection if present for more than 6 months. This patient is unlikely to have acute infection with normal transaminases and negative anti-HBc IgM. Further management of the patient will depend on HBeAg status and HBV DNA to distinguish disease phase.