Thursday, March 11, 2010

Hepatitis B

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

SYSTEM BASED CLASSIFICATION OF DISEASES

SYSTEM BASED CLASSIFICATION OF DISEASES

Bone and Joint Diseases

  1. Gout and Hyperurecemia
  2. Osteoarthritis
  3. Rheumatoid Arthritis
  4. Acute coronary Syndroms

Cardiovascular Diseases

  1. Arrhymias
  2. Cardiopulmanary Resuscitation
  3. Heart Failure
  4. Hypertension
  5. Hyperlipidemia
  6. Ischemic Heart Diseases
  7. Shock
  8. Stroke
  9. Venous Thromboembolism

Dermatrologic Diseases

  1. Acne
  2. Psoriasis
  3. Skin Disorders and Cutaneous Drug Eruptions

Endocrine Diseases

  1. Cirrhosis
  2. Portal Hypertension

Gastrointestinal Diseases

  1. Irritable Bowel Syndrome
  2. Constipation
  3. Diarrhea
  4. Gastroesophagal Reflux Disease
  5. Hepatitis, Viral
    1. Hepatitis A
    2. Hepatitis B
    3. Hepatitis C
  6. Nausea and Vomiting
  7. Pancreatitis
  8. Peptic Ulcer disease

Gynecologic and Obstetric Diseases

  1. Contraception
  2. Hormone therapy

Hematologic Diseases

  1. Anemia
    1. Megaloblastic Anemia

i. Megaloblastic Anemia due to Folate Deficiency

ii. Megaloblastic Anemia due to Vitamine B12 Deficiency

    1. Sickle Cell anemia
    2. Hemolytic Anemia
    3. Iron Deficiency Anemia
    4. Aplastic Anemia
    5. Iron Deficiency Anemia

Infectious Diseases

  1. Central Nervous System infections
  2. Endocarditis
  3. Fungal infections, Invasive
  4. Gastrointestinal Infection
  5. HIV / AIDS
  6. Intra-Abdominal Infection
  7. Respiratory Tract infections, Lower
  8. Respiratory Tract infections, Upper
  9. Sepsis and Septic Shock
  10. Sexually transmited Diseases (STD)
  11. Skin and soft tissue infection
  12. Tuberculosis
  13. Urinary tract infection and prostatitis

Neurologic Diseases

  1. Epilepsy
  2. Headache
    1. Migraine
    2. Cluster Headache
  3. Pain management
  4. Parkinson’s Diseases
  5. Status epilepticus

Nutritional Diseases

  1. Enteral Nutrition
  2. Obesity
  3. Parentaral Nutrition

Onchologic Diseases

  1. Breast cancer
  2. Colorectal Cancer
  3. Lung cancer
  4. Lymphomas
  5. Prostate cancer
  6. Cervical Cancer
  7. Esophageal Cancer
  8. Gastric Cancer
  9. Head and Neck Cancer
  10. Lung Cancer
  11. Ovarian Cancer
  12. Pancreatic Cancer
  13. Primary bone Cancer
  14. Primary Brain cancer
  15. Testicular Cancer
  16. Thyroid Gland Cancer
  17. Urinar Bladder cancer
  18. Uterine Cancer

Ophtalmic Diseases

  1. Glaucoma

Psychiatric Diseases

  1. Alzhimer’s Diseases
  2. Anxiety Disease
  3. Bipolar Diseases
  4. Depressive diseases
  5. Schizophrenia
  6. Sleep Diseases
  7. Substance-Related Diseases

Renal Diseases

  1. Acid base Diseases
  2. Acute renal Failure
  3. Chronic Renal Failure
  4. Drug Dosing in renal insufficiency
  5. Electrolyte Homeostasis

Respiratory Diseases

  1. Allergic Rhinitis
  2. Asthma
  3. Chronic Obstructive Pulmonary Diseases

Urologic Diseases

  1. Benign Prostatic, Hyperplasia
  2. Erectile Dysfunction
  3. Urinary Incontinence