# Situation: A 31-year-old man was diagnosed with human immunodeficiency virus (HIV) infection and chronic hepatitis B at the same visit. He is enrolled at a treatment hub and starts one tablet of tenofovir–lamivudine–dolutegravir once daily. He works rotating day and night shifts at a call center and lives with his female partner, whose hepatitis B status is unknown. His partner is tested. Her results are: hepatitis B surface antigen (HBsAg) negative; antibody to hepatitis B surface antigen (anti-HBs) negative; antibody to hepatitis B core antigen (anti-HBc) negative. Which instruction should the nurse give the couple?

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> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: A 31-year-old man was diagnosed with human immunodeficiency virus (HIV) infection and chronic hepatitis B at the same visit. He is enrolled at a treatment hub and starts one tablet of tenofovir–lamivudine–dolutegravir once daily. He works rotating day and night shifts at a call center and lives with his female partner, whose hepatitis B status is unknown.

His partner is tested. Her results are: hepatitis B surface antigen (HBsAg) negative; antibody to hepatitis B surface antigen (anti-HBs) negative; antibody to hepatitis B core antigen (anti-HBc) negative. Which instruction should the nurse give the couple?

## 보기

1. Start her hepatitis B vaccine series and use condoms until she is immune **✔ 정답**
2. She needs no vaccine, as her negative results show she is already immune
3. Once his viral load is undetectable, she will be safe from hepatitis B too
4. Keep his own dishes and cups apart from hers until she is vaccinated

**정답: 1**

## 해설

All three markers are negative, so she has no current infection, no past infection, and no vaccine immunity: she is susceptible. Sexual and household contacts of a person with hepatitis B who are not immune should be vaccinated, and condoms are used until immunity is confirmed; razors and toothbrushes are not shared. Immunity would show as a positive antibody to the surface antigen, and an undetectable HIV viral load prevents sexual transmission of HIV only.

## 심화 해설

Interpretation of the partner’s serology
The partner’s results show HBsAg negative, anti-HBs negative, and anti-HBc negative. This triple-negative pattern means she has no current hepatitis B infection, no evidence of past infection, and no vaccine-induced immunity. She is therefore considered susceptible to hepatitis B virus (HBV). In contrast, immunity would be demonstrated by a positive anti-HBs result, which is absent here.
Because she is a sexual and household contact of a person with chronic hepatitis B, the priority is to initiate the hepatitis B vaccine series immediately. Until the series is completed and immunity is confirmed by a positive anti-HBs titer, barrier protection with condoms is needed to reduce sexual transmission risk. The vaccine series is the core preventive measure; condoms are a temporary adjunct during the window before immunity develops.
Watch out! Option 2 is incorrect because negative anti-HBs does not indicate immunity. Option 3 is incorrect because an undetectable HIV viral load prevents sexual transmission of HIV only, not hepatitis B. Option 4 is incorrect because hepatitis B is not spread through shared dishes or cups; transmission occurs through blood, semen, and other body fluids, so the focus should be on vaccination and safe sexual practices rather than separating utensils.

| Marker | Result | Clinical meaning |
| --- | --- | --- |
| HBsAg | Negative | No current HBV infection |
| Anti-HBs | Negative | No immunity from vaccine or past infection |
| Anti-HBc | Negative | No past exposure to HBV |

The triple-negative profile defines a susceptible person who requires vaccination. This aligns with postexposure and preventive guidance for susceptible contacts of individuals with chronic HBV infection. In occupational and household exposure settings, hepatitis B vaccination is the standard intervention for unvaccinated susceptible persons [3].
Sexual transmission of HBV is a well-recognized route, and studies of high-risk populations confirm that HBV serologic markers are common among individuals with HIV or high-risk sexual behavior [1][2]. Coinfection with HIV and HBV is clinically significant, but the partner’s immediate risk is from HBV exposure, not from the partner’s HIV status. The instruction to use condoms until immunity is confirmed addresses the sexual transmission route specifically.
Key point! Hepatitis B vaccine series plus condom use until anti-HBs is confirmed positive is the correct dual strategy for a susceptible sexual partner of a person with chronic hepatitis B.
References (research sources)

- [1]Hepatitis B markers in men seeking human immunodeficiency virus antibody testing in Mexico City.Research articleJuárez-Figueroa LA, Uribe-Salas FJ, Conde-Glez CJ, Hernández-Avila M, Hernández-Nevárez P, Uribe-Zúñiga P (1997) · DOI: 10.1097/00007435-199704000-00005

- [2]Prevalence of Sexually Transmitted Viral and Bacterial Infections in HIV-Positive and HIV-Negative Men Who Have Sex with Men in Toronto.Research articleRemis RS, Liu J, Loutfy MR, Tharao W, Rebbapragada A, Huibner S (2016) · DOI: 10.1371/journal.pone.0158090

- [3]Postexposure prophylaxis for deadly bloodborne viral infections.Research articleEdlich RF, Gubler K, Wallis AG, Clark JJ, Dahlstrom JJ, Long WB (2010) · DOI: 10.1615/jenvironpatholtoxicoloncol.v29.i4.30

## 임상 시나리오

HBV Susceptible Contact ManagementTriple-negative partner of chronic HBV patient
A triple-negative panel (HBsAg negative, anti-HBs negative, anti-HBc negative) means no infection, no past exposure, and no vaccine immunity. The partner is susceptible and requires immediate hepatitis B vaccine series.

Use condoms during sexual contact until immunity is confirmed by a positive anti-HBs titer. Vaccination is the core preventive measure; barrier protection is a temporary adjunct during the window before immunity develops.

CautionDo not rely on undetectable HIV viral load for HBV protection—it prevents sexual transmission of HIV only. HBV is not spread through shared dishes or cups; focus on vaccination and safe sexual practices, not utensil separation.

## 핵심 개념

- **HBsAg** — Hepatitis B surface antigen; positive indicates current HBV infection.
- **anti-HBs** — Antibody to hepatitis B surface antigen; positive indicates immunity from vaccine or past infection.
- **anti-HBc** — Antibody to hepatitis B core antigen; positive indicates past or ongoing HBV exposure.
- **triple-negative serology** — HBsAg negative, anti-HBs negative, anti-HBc negative; indicates susceptibility to HBV.
- **hepatitis B vaccine series** — Multi-dose immunization to induce protective anti-HBs; core prevention for susceptible contacts.

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