Hepatitis B - Chronic
Rahul Soman, M. Pharm
Definition
Chronic Hepatitis B
Chronic necroinflammatory disease of the liver due to hepatitis B virus (HBV) infection characterized by the presence of hepatitis B surface antigen (HBsAg) for longer than 6 months
Hepatitis B virus infection
* Hepatitis Be antibody measurement: Development of antibodies to hepatitis B e Ag (anti-HBe) indicates remission of active disease and reduced infectivity, and usually reflects an inactive carrier state . Anti-HBe may be present in the serum of HBeAg-negative chronic hepatitis patients and occult hepatitis B patients who have recovered .
Hepatitis B virus infection
* Hepatitis Be antigen measurement: Serum hepatitis B e antigen (HBeAg) indicates active viral replication and should be measured in the evaluation and surveillance of all patients with chronic hepatitis B virus infection .
Suspected or known hepatitis B virus infection
* Hepatitis B nucleic acid assay, Quantitative: Serial hepatitis B virus DNA testing is important for monitoring disease progression and determining the need for antiviral treatment .
Suspected or known hepatitis B virus infection
* Alanine aminotransferase measurement: Measurement of ALT is necessary for diagnosing acute hepatitis, monitoring chronic hepatitis B virus infection, and assessing treatment response .
Suspected liver disease
* Aspartate aminotransferase measurement: Elevated serum aminotransferase levels suggest hepatocellular injury and death .
Suspected or known liver disease
* Bilirubin, total measurement: Conjugated hyperbilirubinemia may suggest acute viral hepatitis, autoimmune hepatitis, or toxic or ischemic liver injury when it occurs in the presence of substantially elevated aminotransferase levels .
Suspected hepatitis B
* Complete blood count with white cell differential, automated: Thrombocytopenia may suggest advanced liver disease in patients with hepatitis .
Suspected abnormal liver function
* Prothrombin time: A prolonged prothrombin time (PT) may be a sign of serious liver dysfunction, vitamin K deficiency, or coagulopathy .
Suspected hepatitis C in patients with evidence of clinical liver disease
* Hepatitis C antibody test: A positive screening test with high signal-to-cutoff (s/co) ratio indicates past or present infection; positive screening tests with lower s/co ratios require confirmatory testing .
Suspected hepatitis D (delta) infection
* Hepatitis D virus measurement: Detection of delta antigen or antibodies in serum assists in diagnosing hepatitis D virus (HDV) .
Suspected HIV infection
* Rapid HIV test: A positive result on a rapid HIV assay suggests HIV infection and requires repeat confirmatory testing for diagnosis .
Suspected hepatocellular carcinoma .
* Ultrasonography of liver
Screening for hepatocellular carcinoma in at-risk patients
* Alpha-1-fetoprotein measurement, serum: Screening for hepatocellular carcinoma using alpha-fetoprotein (AFP) with ultrasonography (US) is indicated in patients with cirrhosis ; AFP screening in at-risk chronic hepatitis B patients is indicated when US is not available .
Suspected or known hepatitis B and hepatitis C
* Biopsy of liver: Liver biopsy results may guide treatment decisions or predict prognosis in chronic hepatitis B and C .
Reassessment
Ongoing Monitoring of Patients Not Considered for Treatment Initially
Suspected or known hepatitis B virus infection
* Alanine aminotransferase measurement: Measurement of ALT is necessary for diagnosing acute hepatitis, monitoring chronic hepatitis B virus infection, and assessing treatment response .
Hepatitis B virus infection
* Hepatitis Be antigen measurement: Serum hepatitis B e antigen (HBeAg) indicates active viral replication and should be measured in the evaluation and surveillance of all patients with chronic hepatitis B virus infection .
Suspected or known hepatitis B and hepatitis C
* Biopsy of liver: Liver biopsy results may guide treatment decisions or predict prognosis in chronic hepatitis B and C .
Determining a Successful Response to Antiviral Therapy
Suspected or known hepatitis B infection and screening
* Hepatitis B surface antigen measurement: The presence of hepatitis B surface antigen (HBsAg) indicates acute or chronic active infection .
Hepatitis B virus infection
* Hepatitis Be antigen measurement: Serum hepatitis B e antigen (HBeAg) indicates active viral replication and should be measured in the evaluation and surveillance of all patients with chronic hepatitis B virus infection .
Hepatitis B virus infection
* Hepatitis Be antibody measurement: Development of antibodies to hepatitis B e Ag (anti-HBe) indicates remission of active disease and reduced infectivity, and usually reflects an inactive carrier state . Anti-HBe may be present in the serum of HBeAg-negative chronic hepatitis patients and occult hepatitis B patients who have recovered .
Suspected or known hepatitis B virus infection
* Hepatitis B nucleic acid assay, Quantitative: Serial hepatitis B virus DNA testing is important for monitoring disease progression and determining the need for antiviral treatment .
Suspected or known viral hepatitis
* Alanine aminotransferase measurement: Marked increases in aminotransferase levels from 5-fold to more than 10-fold above the upper reference limit occur in acute viral hepatitis .
Suspected or known hepatitis B and hepatitis C
* Biopsy of liver: Liver biopsy results may guide treatment decisions or predict prognosis in chronic hepatitis B and C .
Medical History
* Sexual exposure
* Hepatitis B contact
* Intravenous drug user
* Patient immunocompromised
* Fetus or neonate affected by maternal infection
* Surgical procedure
* Healthcare Worker
* Transfusion of blood product
* Hemodialysis
Findings
* Fatigue
* Malaise
* Loss of appetite
Tests
Suspected or known hepatitis B infection and screening
* Hepatitis B surface antigen measurement: The presence of hepatitis B surface antigen (HBsAg) indicates acute or chronic active infection .
Suspected hepatitis B virus infection
* Hepatitis B core antibody measurement: A positive antibody to hepatitis B core antigen (anti-HBc) test indicates hepatitis B virus infection. IgM class anti-HBc is consistent with an acute or recent infection, while IgG class anti-HBc is consistent with a chronic or past infection .
Hepatitis B virus infection
* Hepatitis Be antibody measurement: Development of antibodies to hepatitis B e Ag (anti-HBe) indicates remission of active disease and reduced infectivity, and usually reflects an inactive carrier state . Anti-HBe may be present in the serum of HBeAg-negative chronic hepatitis patients and occult hepatitis B patients who have recovered .
Hepatitis B virus infection
* Hepatitis Be antigen measurement: Serum hepatitis B e antigen (HBeAg) indicates active viral replication and should be measured in the evaluation and surveillance of all patients with chronic hepatitis B virus infection .
Suspected or known hepatitis B virus infection
* Hepatitis B nucleic acid assay, Quantitative: Serial hepatitis B virus DNA testing is important for monitoring disease progression and determining the need for antiviral treatment .
Suspected or known hepatitis B virus infection
* Alanine aminotransferase measurement: Measurement of ALT is necessary for diagnosing acute hepatitis, monitoring chronic hepatitis B virus infection, and assessing treatment response .
Differential Diagnosis
* Hepatitis C - Chronic
* Alcoholic liver disease
* Non-alcoholic fatty liver
* Drug-induced liver disease - Chronic
* Wilson's disease
* Alpha-1-antitrypsin deficiency - Chronic
Treatment
Drug Therapy
Adults with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B
PEGINTERFERON ALFA-2A
Adults: 180 mcg subQ once weekly for 48 weeks
ADEFOVIR DIPIVOXIL
Adults: 10 mg orally once daily until HBeAg seroconversion has been achieved; continue for at least 6 additional months after HBeAg seroconversion
ENTECAVIR
Adults: 0.5 mg orally once daily (no prior lamivudine treatment) or 1 mg orally once daily (if refractory or resistant to lamivudine) until HBeAg seroconversion has been achieved; continue for at least 6 months after HBeAg seroconversion
Children with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B and ALT levels greater than 2 times normal for longer than 6 months
INTERFERON ALFA-2B
Pediatrics: 6 million units/m2 subQ 3 times a week (maximum, 10 million units) for 16 to 24 weeks
LAMIVUDINE
Pediatrics: 3 mg/kg/day orally once daily (maximum 100 mg/day) until HBeAg seroconversion has been achieved; continue for at least 6 months after HBeAg seroconversion
Adults with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B
PEGINTERFERON ALFA-2A
Adults: 180 mcg subQ once weekly for 48 weeks
ADEFOVIR DIPIVOXIL
Adults: 10 mg orally once daily until hepatitis B surface antigen (HBsAg) clearance has been achieved
ENTECAVIR
Adults: 0.5 mg orally once daily (no prior lamivudine treatment) or 1 mg orally once daily (if refractory or resistant to lamivudine) beyond 1 year, until HBsAg clearance has been achieved
Chronic hepatitis B with compensated cirrhosis (no signs of liver failure)
ADEFOVIR DIPIVOXIL
Adults: 10 mg orally once daily; if positive for hepatitis B e antigen (HBeAg), continue until confirmed seroconversion and completion of at least 6 months of consolidation treatment; if negative for HBeAg, continue until confirmed hepatitis B surface (HBsAg) clearance
ENTECAVIR
Adults: 0.5 mg orally once daily (no prior lamivudine treatment) or 1 mg orally once daily (if refractory or resistant to lamivudine); if positive for HBeAg continue until confirmed seroconversion and completion of at least 6 months of consolidation treatment; if negative for HBeAg, continue until confirmed HBsAg clearance
Chronic hepatitis B with decompensated cirrhosis
ADEFOVIR DIPIVOXIL - LAMIVUDINE
Adults: Adefovir 10 mg orally once daily AND lamivudine 100 mg orally once daily for life
Prevention of hepatitis A infection in nonimmune persons with chronic hepatitis B infection
HEPATITIS A VACCINE, INACTIVATED
Adults: Havrix® 1 mL (1440 ELISA Units) IM in the deltoid. Administer a booster dose at 6 to 12 months
Adults (alternate): Vaqta® 1 mL (50 units); administer a booster dose at 6 to 18 months
Procedural Therapy
Reportable infectious diseases
* Infectious disease notification: In the United States, specific infectious diseases must be reported to the state or local public health department .
Non-Procedural Therapy
Type B viral hepatitis, chronic
* Alcohol Abstinence
Type B viral hepatitis, chronic
* Counseling and Prevention of Disease Transmission
No comments:
Post a Comment