hepatitis%20b
HEPATITIS B

Hepatitis B is transmitted through perinatal, percutaneous, sexual, and close person-to-person contact, ie by open cuts and sores.

Human hepatitis B virus belongs to the family of Hepadnaviridae of small, enveloped, primarily hepatotropic DNA viruses. The virus replicates in the host and assembles exclusively in the hepatocytes and virions are released non-cytopathically through the cellular secretory pathway.

Chronic hepatitis B is defined as a chronic necroinflammatory liver disease due to persistent hepatitis B virus infection.

Hepatitis D infection is found only in patients with hepatitis B as it requires the hepatitis B outer coat. It is transmitted through sexual and percutaneous (especially IV drug use) routes.

Hepatitis B and D both have an incubation period of 30-180 days.

Hepatitis%20b Management

Monitoring

During Therapy

  • Monitor ALT, HBeAg, anti-HBe, and/or HBV DNA at least every 3-6 months; HBsAg every 6-12 months
  • Monitor renal function (eg creatinine, phosphate) if Tenofovir, Entecavir, or Adefovir is used
  • Monitor for adverse effects (ie CBC, TSH) if Interferons are used

End of Therapy

  • Monitor ALT and HBV markers (including HBV DNA) to detect relapse every 3-6 months for the 1st year then every 6-12 months
    • For patients with cirrhosis, may monitor monthly for the 1st 6 months then every 3 months
  • May monitor every 6 months in patients who responded to therapy
  • Further monitoring of HBV DNA every 3-6 months in non-responders is recommended to recognize delayed response and to plan retreatment if required
  • Monitor for hepatocellular carcinoma in high-risk patients every 6-12 months using ultrasound and alpha-fetoprotein

Viral Resistance

  • Testing for viral resistance may be done in patients who have undergone treatment, those with persistent viremia despite nucleos(t)ide analogue therapy, or those who had virological breakthrough (a 10-fold increase from nadir in serum HBV DNA during therapy after an initial virological response) while on therapy

Chronic hepatitis B patients who are not treated but need continuous monitoring:

  • Patients age <30 years without cirrhosis, with PNALT, HBV DNA >20,000 IU/mL
  • HBeAg-negative patients age <30 years without cirrhosis, ALT levels intermittently abnormal, HBV DNA between 2000 and 20,000 IU/mL

Prevention

PREVENTION AND POST-EXPOSURE PROPHYLAXIS OF HEPATITIS B
Patient Group for Whom Prevention or Post-exposure Prophylaxis is Recommended Recommended Prevention or Post-exposure Prophylaxis Regimen
Prevention
Unvaccinated children, adolescents and adults
Premature infants with immediate risk of HBV infection
Unvaccinated persons who attend STD clinics, including pregnant women
Persons with any of the following sexual risk factors: History of STD and HIV, multiple sex partners, sex with an injection drug user, MSM, victims of sexual assault
Illegal IV drug users
Household members, sex partners and drug-sharing partners of a person with chronic HBV infection1
Persons on hemodialysis, are receiving clotting factor concentrates, who have occupational exposure to blood, or are needing immunosuppressive therapy
Healthcare personnel in treatment facilities
Inmates of correctional facilities
Patients with diabetes mellitus, chronic liver disease
Travelers to places with endemic HBV infection
Hepatitis B Vaccine
Post-exposure Prophylaxis
Unvaccinated or nonimmune sex partners of persons with acute hepatitis B
Administer Immunoglobulin and begin hepatitis B vaccination series (if not contraindicated) within 14 days after the most recent sexual contact
1Vaccination of household contacts (especially children and adolescents) of persons with acute HBV infection is also encouraged. Consider postvaccination testing (anti-HBs) for sex partners of persons with chronic HBV infection. Those found to be antibody negative should receive a second, complete, vaccination series.

Follow Up

  • Monitor patient to ensure that fulminant liver failure does not develop
  • Monitor liver function tests (LFT) every 1-4 weeks until normal; ALT every 3-6 months if patient did not meet criteria for treatment
  • Repeat serologic testing 6 months after infection to rule out development of chronic hepatitis
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