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Last Updated: 6/4/2015  

Hepatitis B

Prevention
  • Provide hepatitis B vaccine and HBIg to newborns with HBV-infected mothers and mothers with unknown HBV status.

  • 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
  • Acute infection: 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 hepatitis or unexplained acute liver failure.

  • Chronic infection: Use hepatitis B serologic tests, HBsAg, and anti-HBc (IgG) or total anti-HBc to identify potentially infected patients with risk factors for hepatitis B, unexplained chronic hepatitis, liver cancer, or unexplained acute liver failure.

  • Chronic infection: Use quantitative HBV DNA, HBeAg, and anti-HBe to confirm chronic active infection.

  • Consider the presence of other liver diseases in HBV-infected 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.

  • Screen for HIV.

  • 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

  • Use anti-viral therapy in patients at risk for reactivation with immune modulatory therapy.

    • Screen for liver cancer in at risk individuals.

    • Monitor for re-activation, anti-HBe, and anti-HBs seroconversion.

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.

  • 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.
Author(s) and Disclosures:
Robert J. Fontana, MD has nothing to disclose. 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. Nancy Reau, MD has grants/contracts from Gilead, BMS, Merck, AbbVie.

One or more of the present or past ACP Smart Medicine physician editors worked on this module and had nothing to disclose: Davoren Chick, MD, FACP; Deborah Korenstein, MD, FACP; Marjorie Lazoff, MD, FACP; Richard Lynn, MD, FACP.

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