Globally, hepatitis B virus (HBV) remains a significant yet preventable health issue. In South Africa, seroprevalence prior to the vaccine introduction in 1995 ranged between 0.3and 15% with differences observed in ethnic groups, provinces and rural versus urban areas.1 Vaccination has reduced incidence although with no catch-up schedule, those born before vaccination or incompletely vaccinated, remain at risk.2 Chronic HBV infection elevates the risk of cirrhosis, end-stage liver disease and hepatocellular carcinoma (HCC). Acute HBV carries low mortality but potentially significant morbidity for a professional sportsperson.

We report a professional rugby player, incidentally found to have chronic HBV infection. Born before 1995, his HBV acquisition was likely in childhood before age 5, in keeping with HBV epidemiology in sub-Saharan Africa. He used no alcohol, illicit substances or performance enhancing drugs. Table 1 lists his workup identifying the immune clearance/active phase of chronic HBV infection with HBeAg positive, alanine transaminase >5X elevated and a markedly elevated viral load of >log 9 IU/mL. Examination was normal and …