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
• 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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