Gastroenterology Book

http://www.fpnotebook.com/

Chronic Hepatitis B InfectionAka: Chronic Hepatitis B

Advertisement

  1. See Also
    1. Viral Hepatitis
    2. Hepatitis B
    3. Chronic Hepatitis B Carrier
  2. Pathophysiology
    1. Acute Hepatitis B Infection becomes chronic in 10%
    2. Chronic Hepatitis B (HBsAg present >6 months)
      1. Chronic Hepatitis B Carrier
      2. Chronic Hepatitis B Infection
    3. Contrast with Chronic Hepatitis B Carrier
      1. High viral load
      2. Elevated Liver Function Tests (ALT or SGPT)
  3. Labs
    1. HBsAg positive
    2. HBeAg positive
    3. xHBeAb negative
    4. Liver Function Tests (ALT or SGPT) elevated
    5. High viral load: HBV DNA hybridization positive
    6. Evaluation for Hepatitis B complications
      1. Serum Alpha-fetoprotein
      2. Hepatic Ultrasound
      3. Liver biopsy
  4. Associated Conditions
    1. Polyarteritis nodosa
    2. Systemic Vasculitis
    3. Glomerulonephritis
  5. Management
    1. See prevention below
    2. Prevent transmission to close contacts
      1. See Chronic Hepatitis B Carrier
    3. Gastroenterology Referral
    4. Vitamin E 400 IU/day
    5. Antiviral Agents
      1. Goal of therapy
        1. Viral suppression
        2. Prevention of Hepatitis B complications
        3. Rarely results in complete Hepatitis B eradication
      2. Indications
        1. HBV DNA positive and
          1. Serum ALT > twice normal or
          2. Cirrhosis (not decompensated)
        2. HBe Antigen positive
          1. Serum ALT > twice normal
        3. Moderate to severe hepatitis on liver biopsy
      3. Interferon alpha-2b (Intron A)
        1. Adult Dose Options
          1. 5 million IU SQ or IM qd for 16 weeks
          2. 10 million IU SQ or IM 3x/week for 16 weeks
        2. Following 4 month treatment: 33% sustained response
      4. Lamivudine (Epivir-HBV)
        1. Adult Dose: 100 mg qd for up to one year
        2. Viral suppression only persists while on medication
        3. Resistance at 1 year: 24%
      5. Adefovir dipivoxil (Hepsera)
        1. Adult dose: 10 mg qd for one year (up to 48 months)
        2. Hadziyannis (2003) N Engl J Med 348:800
        3. Marcellin (2003) N Engl J Med 348:808
  6. Complications
    1. Cirrhosis
      1. Annual risk: 12%
    2. Hepatocellular Carcinoma (Hepatoma)
      1. Higher risk if HBeAg positive with HBsAg positive
        1. Yang (2002) N Engl J Med 347:168
      2. Screening for Hepatocellular Carcinoma
        1. Indications for Chronic Hepatitis B patients
          1. Men over age 45 years
          2. Cirrhosis as diagnosed by liver biopsy
          3. Family History of Hepatocellular Carcinoma
        2. Protocol: Every 6 months (AASLD recommendation)
          1. Hepatic ultrasound
          2. Serum Alpha-fetoprotein
    3. Mortality
      1. Lifetime risk of death: 15 to 25%
  7. Prevention of disease progression
    1. See Prevention of Liver Disease Progression
    2. Tobacco Cessation (decreases risk of Hepatoma)
    3. Avoid Alcohol and other liver toxins
  8. References
    1. Berenguer in Feldman (2002) Sleisenger GI, p. 1285-303
    2. Dienstag (1999) N Engl J Med 341:1256
    3. Lok (2001) Hepatology 34:1225
    4. Malik (2000) Ann Intern Med 132:723

Navigation Tree