Hepatitis B 101• Clinical presentation of Hepatitis B Virus (HBV) indistinguishable from other hepatitis

causes and is quite variable from asymptomatic (common) to fulminant hepatic failure (rare).•Prodrome of arthralgia or arthritis may precede the rash (generalized, erythematous, maculopapular, and/or urticarial x 4-7 days) which precedes jaundice and underlying abnormal LFTs.

•Diagnosis by serology of HBsAg positivity. Transmission via Blood/ Body secretions.

•Full recovery takes weeks-months(six) and 5-10% become HBV carriers – with future risk of chronic hepatitis, cirrhosis, and hepatocellular carcinoma.

•Up to 70% born to HBV carrier moms acquire HBV during birth, and 50% of these become chronic HBV carriers (persistent infection).

•Highest prevalence of chronic carriage moms in central Africa, East Asia, Pacific Islands, and among Eskimo populations.

•No HBV test is mandated by JC…but consider getting HBsAg on these high risk groups & any pregnant students (since offspring need immediate Rx with HBIG & vaccinations.

•If HBsAg positive, will check tests shown on chart to clarify status and make Rx plan.

•If not already infected, future HBV disease can be AVOIDED by vaccination series (@ 0, 1, & 4 months intervals).

Understanding Hepatitis B Lab Tests

  

TEST IF Pos, means: Contagious? Immunity? Abnormal LFTs?

HBsAg(Surface Antigen)

A) Active Dz NowB) Persistent infection C) Recent Vaccine

A) YesB) Yes, Especially If HbeAg+C) No 

Pending A) YesB) VariableC) No

HBcAg(Core Antigen)

Active Dz Now 

Yes Pending Yes

HBcABOnly(Core Antibody)

Dz in past- now resolved 

No Yes No

HBsABOnly(Surface Antibody)

Had vaccine No Yes No 

HBcAB &HBsABBoth 

Dz in past-now resolved No Yes No

 

TREATMENT OPTIONS• Acute HBV: No specific therapy for acute HBV is available, i.e., supportive…• But DO contract to prevent transmission via blood/body secretions (condoms).• See attached “Recommended Postexposure Prophylaxis for Exposure to

Hepatitis B Virus” Chart re: contacts.

• Persistent HBV: Consult GI Specialist to give direction re:• Further lab tests, e.g., HCV, HDV, HIV, subsequent LFTs• HBV DNA Assay.• Screening for hepatocellular CA with alpha-fetoprotein and liver ultrasound• Liver biopsy• Vaccination for Hepatitis A - if not already protected.

• Possible Treatments: Alpha Interferon, Lamivudine, Adefovir dipivoxil