Which of the following is NOT a hallmark of chronic HBV infection?

The presence of anti-HBs antibodies is indeed not a hallmark of chronic Hepatitis B virus (HBV) infection. In chronic HBV infection, the immune response is unable to fully clear the virus, which leads to persistent infection and does not typically result in the production of anti-HBs antibodies.

Anti-HBs antibodies are generally produced after successful resolution of a Hepatitis B infection or following vaccination against the virus. In chronic cases, patients can often be HBsAg positive (indicating ongoing infection) but lack the development of these protective antibodies. The presence of anti-HBs would suggest immunity and control of the virus, which is contrary to the nature of chronic infection where the virus continues to replicate.

In chronic HBV infection, it is expected to observe low to moderate levels of HBV DNA in the serum, as well as high levels of HBeAg, indicating active viral replication and increased infectivity. Continued virus replication is a significant characteristic of chronic infection, contrasting with the immune response typically seen in resolved infections where anti-HBs antibodies would be present.