Prof Howard Thomas highlights the importance of identification, treatment, and vaccination in an overview of chronic hepatitis B
Natural history of chronic hepatitis B infection
Case identification in primary care
- offer testing for hepatitis B surface antigen to:
- adults and children at increased risk of infection, particularly migrants from medium- or high-prevalence countries and people who inject or have injected drugs
- people who are newly registered with the practice and belong to a group at increased risk of infection
- ask newly registered adults if they have ever injected drugs, including image and performance enhancement substances, at their first consultation
- offer HBsAg testing and HBV vaccination to men who have sex with men who are offered a test for HIV and have not previously tested positive for hepatitis B antibodies
- offer hepatitis B vaccination to people who test negative for hepatitis B but remain at increased risk of infection
- ensure people diagnosed with hepatitis B are referred to specialist care.
Monitoring treatment response
- normalisation of ALT levels
- decrease in inflammation scores
- no worsening (or improvement in) fibrosis on liver biopsies
- suppression of viraemia—serum HBV DNA dropping below detection level
- loss of HBeAg and seroconversion to HBe antibody (anti-HBe); loss of HBsAg and seroconversion to HBs antibody (anti-HBs).
NICE. Hepatitis B (chronic): diagnosis and management of chronic hepatitis B in children, young people and adults. Clinical Guideline 165. NICE, 2013. Available at: www.nice.org.uk/guidance/CG165
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Liaw Y, Sung J, Chow W et al. Cirrhosis Asian Lamivudine Multicentre Study Group. Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med 2004; 351 (15): 1521–1531.
Chu C, Karayiannis P, Fowler M et al. Natural history of chronic hepatitis B virus infection in Taiwan: studies of hepatitis B virus DNA in serum. Hepatology 1985; 5 (3): 431–434.
NICE. Hepatitis B and C: ways to promote and offer testing to people at increased risk of infection. Public Health Guidance 43. NICE, 2012. Available at: www.nice.org.uk/guidance/PH43
Chowhan H and Pentney V. People with hepatitis B need support to access and receive treatment. Guidelines in Practice, October 2014. Available at: GinP.co.uk/oct_14_Chowan_Pentney_HepB
British Society of Gastroenterology website. Chronic management: management of patients with chronic liver diseases. www.bsg.org.uk/clinical/commissioning-report/management-of-patients-with-chronic-liver-diseases.html (accessed 22 October 2014).