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Summary of Hepatitis B for GENERAL PRACTITIONERS
HIV & HCV Education Projects | School of Medicine | The University of Queensland
Last Updated: Oct 2007
Clinical Spectrum
Acute HBV Infection
If infected as neonate
or infant there is a high likelihood of
development of
chronic HBV. However, if infected
as an adult, with a competent immune
system spontaneous
clearance of the virus is more likely.
90-95% for a neonate 50% for a Child
Fulminant Hepatic Failure
2%
Chronic HBV Infection HBsAg Reactive (ie positive) Anti-HBs Undetectable(<10 IU/ml)
Anti-HBc Reactive (ie positive)
Remainder
Recovery and Immunity
from acute infection HBsAg Non Reactive (ie negative) Anti-HBs Detectable (≥10 IU/ml) Anti-HBc Reactive (ie positive)
Cirrhosis
Decompensated
cirrhosis
Hepatocellular
carcinoma
Death
*Incidence per 100 person years
2-8*
3-4*
2-10*
Up to 3*
Up to 3*
15 - 40% of patients with chronic HBV will die of their infection if left untreated
Epidemiology Two billion people worldwide have been infected with hepatitis B (HBV) and 360 million have chronic infection. 600
000 people die each year from HBV-related liver disease or hepatocellular carcinoma. In Australia, it is estimated up to
160,000 people have chronic HBV. Over 50% of chronic HBV
infection in Australia is among individuals from highly endemic areas such as Asia, Africa and the Pacific.
Management of chronic hepatitis B infection Alcohol: abstinence best, otherwise aim for 1 standard
drink/day and avoid binging. Refer to Alcohol and Drug Service as necessary.
Weight management: Aim for ideal body weight
Immunisation for sero-negative household and sexual partners
Vaccinate for hepatitis A
Transmission prevention information
Psychological support and counselling
Consider antiviral therapy
Adapted from Alberti A & Fattovich G Natural History of chronic Hepatitis B Curr Hepatitis Rep 2004: 3, 54-60
Page 1 of 2. See over
Transmission DNA virus. Found in all bodily fluids and is transmitted vertically (mother to baby), sexually
and through exposure to blood products. In developing countries transmitted predominantly
from mother to child. In developed countries
mainly transmitted through sexual contact; injecting drug use and tattooing.
Only 5% for an Adult
Vaccination There is no cure for HBV however, vaccination is 95% effective in preventing infection. The ‘Queensland Health Policy for Hepatitis B Immunisation’ 2006 states that mothers should be screened for HBV. Free vaccination is available for all
babies at birth and at 2, 4 and 12 months of age. HBV vaccine is also recommended and available free of charge in Queensland for Aboriginal and Torres Strait Islanders up to age of 18 years, people up to 18 years of age from other
high risk countries, and sero-negative individuals in other high risk groups including: sexual and household contacts of
acute and chronic HBV patients, injecting drug users, individuals with chronic liver disease or hepatitis C infection. Year 8 students will be offered hepatitis B vaccination in the School Based Vaccination Program. HBV vaccine is
recommended (but not free) for a range of other groups (see Australian Immunisation Handbook).
Symptoms of Chronic HBV Fatigue
Abdominal pain
Loss of appetite
Nausea, vomiting
Joint Pain
Jaundice
70% of
individuals have no
signs or symptoms
© 2007 Compiled by A/Prof Graeme Macdonald and the
Viral Hepatitis Education Program Advisory Committee
Interpreting Hepatitis B Serology
Additional Investigations for referral LFTs – esp. ALT (Note: ALT is usually >AST in viral hepatitis)
HBV DNA viral load testing
Assessment of liver function
INR & albumin (Hepatic synthetic function)
Bilirubin (Hepatic excretory function)
FBC (Cirrhosis and Portal hypertension result in low
Platelet & Neutrophil counts)
Exclude other liver disease, esp. hepatitis C
Ultrasound (looking for Space Occupying Lesions, gallbladder,
hepatic echogenicity, evidence of portal hypertension)
Page 2 of 2. See over
Antiviral Therapy There are 2 types of antiviral therapies for chronic hepatitis B: Pegylated Interferon and nucleotide/ nucleoside analogues. Decisions about which to use and when are based on the severity and activity of liver disease and whether
the patient is HBeAg positive or negative. Pegylated interferon works best in an immunocompetent host with HBeAg positive infection and a raised ALT (although it can be successful in other situations). Pegylated interferon is given
by weekly injection for 48 weeks. The advantage is that it is a defined course of treatment, the disadvantage is that
this can be associated with significant side effects. The nucleotide and nucleoside analogues directly suppress viral replication. They can be used in nearly all patients with chronic HBV infection. The disadvantage is that they
generally need to be taken indefinitely and the HBV virus eventually will become resistant to them. These are the pre-ferred agents to use in patients with decompensated liver disease or those immunosupressed. The goals of antiviral
therapy are long term suppression of viral replication. This can be assessed by measuring HBV DNA. Decision about
the initiation of antiviral therapy and the agent to use should be made by a doctor with experience in the management of hepatitis B.
Summary of Hepatitis B for GENERAL PRACTITIONERS
HIV & HCV Education Projects | School of Medicine | The University of Queensland
No if: Anti Hepatitis B core antigen non
reactive (Anti HBc -)
Yes if: Anti Hepatitis B core antigen
reactive (Anti HBc+)
IgM exposure <6 months ago
IgG exposure > 6 months ago
2. Is the infection ongoing?
Yes if: Hepatitis B surface antigen
reactive HBsAg+)
No if: Hepatitis B surface antigen
non reactive (HBsAg -) and surface antibody reactive (Anti-HBs+)
3. What other tests should I do if patient has ongoing HBV infection?
HBV DNA (A measure of viral load)
HBeAg (The HBV envelope antigen) Anti-HBe (Anti Hepatitis B envelope antigen)
For more information: HIV & HCV Education Projects, School of Medicine,
The University of Queensland
Phone: 07 3346 4813 Fax: 07 3346 4757
Email: [email protected]
W: www.som.uq.edu.au/hivandhcvprojects
Hepatitis Council of Queensland Phone: 07 3236 0610 or 1800 648 491 Email: [email protected]
Web: www.hepqld.asn.au
Queensland Health: Web: www.health.qld.gov.au Queensland Health Policy for Hepatitis B
Immunisation. October 2006
Remember, if: HBsAg Reactive
Anti-HBs Undetectable <10 IU/ml Anti-HBc Reactive
Patient has Chronic Hepatitis B
Remember, if: HBsAg Non Reactive
Anti-HBs Detectable ≥10 IU/ml
Anti-HBc Reactive Patient has had previous infection and is immune
1. Has the patient been exposed to hepatitis B?
