Hepatitis B - Diagnosis and Management Summary
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Hepatitis B - Diagnosis and Management Summary

Risk Factors: Vertical transmission (in SE Asia), sexual contact, IVDU, needlestick, unvacc. (in US before 1994), immunosupp.

Clinical Presentation: Fever, malaise, RUQ pain. Extrahepatic: membranous nephropathy/MPGN, polyarteritis nodosa, aplastic anemia.

Diagnosis: HBsAg, anti-HBs, anti-HBc (identifies all infected, even in “window period”).

Treatment: First line: tenofovir or entecavir (Hepatology 2016;63:284) Goal: suppress HBV DNA, lose HBsAg and HBeAg.

Seromarkers and Serology Interpretation:

 • HBsAg - Hallmark of active HBV infxn. Recovery → disappearance f/b appearance of anti-HBs (persists)

 • anti-HBs - Indicates recovery and immunity

 • HBeAg - Indicates HBV replication/infectivity (~↑ HBV DNA), though pre-core mutants (HBeAg-) still replicate

 • anti-HBe - Correlates w/lower level of HBV DNA, infectivity

 • anti-HBc - anti-HBc IgM indicates acute infxn, anti-HBc IgG persists in recovery and chronic HBV.

 • HBV DNA - Measures disease activity, used for monitoring

Treatment Criteria:

 • Acute Liver Failure - Acute hepatitis, chronic w/ flare

 • Decompensated Cirrhosis - HBV DNA+ 

 • Compensated Cirrhosis - HBV DNA >2k 

 • HBeAg+* - HBV DNA >2k, ALT >2x ULN 

 • HBeAg-* - HBV DNA>2k, ALT >2x ULN 

 • Immunosuppression - HBsAg+ *or* anti-HBc+ are at risk for reactivation, even if anti-HBs+

 • Hepatocellular CA - Patients with HCC and HBV 

 • Coinfection with HCV - Rx HBV simultaneously with HCV. Causes severe hepatitis.



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