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Last Updated: 1/28/2013  

Hepatitis B

Prevention
  • Screen all pregnant women for HBsAg at their first prenatal visit.

  • Administer hepatitis B vaccination to all infants.

  • Administer hepatitis B vaccine to high-risk adult populations (see detailed list).

  • 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.

  • See recommendations below under Patient Education.

Screening
  • Test for HBsAg and anti-HBc in persons with hepatitis B risk factors (see detailed list).

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 for and given presentations on behalf of Gilead Sciences, Bristol Myers Squibb on topics related to hepatitis B and the drugs that are produced by these companies.
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
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