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Last Updated: 6/2/2014  

Hepatitis B

Prevention
  • Provide hepatitis B vaccine and hepatitis B immunoglobulin to newborns with HBV-infected mothers.

  • Administer hepatitis B vaccination to all infants.

  • Administer hepatitis B vaccine to high-risk adult populations, including intravenous drug users, sexual partners of patients with hepatitis B, and patients with HIV infection.

  • Administer hepatitis B vaccine with HBIg as postexposure prophylaxis for inadvertent percutaneous or permucosal exposure to HBsAg-positive blood, sexual exposure to a HBsAg-positive person, or household exposure to a person with acute hepatitis B.

Screening
  • Screen all pregnant women for hepatitis B at the first prenatal visit.

  • Test for HBsAg and anti-HBc in persons with hepatitis B risk factors, including those from endemic areas, intravenous drug users, sexual partners with hepatitis B, and patients with HIV infection.

Diagnosis
  • Use hepatitis B serologic tests, HBsAg, and anti-HBc (IgM), to confirm the diagnosis in patients with risk factors for hepatitis B or unexplained acute or chronic hepatitis or unexplained acute liver failure.

  • Establish the diagnosis of acute or chronic hepatitis B with appropriate lab tests.

  • Consider the presence of other liver diseases in patients with unexplained acute and chronic hepatitis, and consider concurrent hepatic diseases in all who are infected with HBV.

Therapy
  • Recommend avoidance of alcohol.

  • Recommend vaccination against hepatitis A.

  • Use anti-viral therapy for the treatment of selected patients with chronic hepatitis B who are at risk for progression to cirrhosis, liver failure, or liver cancer.

  • Consider the following as evidence of risk for developing significant liver injury, although none of these indicators alone is sufficient to suggest that treatment is necessary:

    • Persistent elevation of ALT level

    • HBV DNA concentration >2000 IU/mL (except in the immunotolerant phase)

    • Liver biopsy evidence of inflammation or significant fibrosis

Follow-up
  • Provide appropriate follow-up for patients with hepatitis B who are untreated, being treated with anti-viral agents, and after treatment with anti-viral agents.

  • Patient Education

  • Inform HBsAg-positive patients to:

    • Avoid blood, tissue, or semen donation

    • Avoid sharing razors, nail clippers, or toothbrushes

    • Use bleach to clean up blood spills

    • Use barrier protection during sexual intercourse if partner is not vaccinated or naturally immune

    • Inform all health care providers of HBV infection

    • Inform sexual and household contacts of the transmissibility of HBV and that they also should be screened for HBV infection if not already vaccinated or naturally immune.

DOI: 10.7326/d476
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
Robert J. Fontana, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Anna S. F. Lok, MD is a consultant for GlaxoSmithKline, Roche, Gilead; received honorarium from GlaxoSmithKline, Roche, Gilead; received grants from GlaxoSmithKline, Roche, Gilead, Schering-Plough, Bristol Myers Squibb. Morris Sherman, MD has acted as an advisor and speaker for Gilead Sciences and Bristol Myers Squibb.
The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, Editor.
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