Infectious Disease Compendium

Hepatitis B

Microbiology

A virus.  A variety of genotypes, C progresses faster.

Epidemiologic Risks

Exposure to contaminated blood. So, if you are sharing needles as part of your heroin use, might I suggest it is a suboptimal idea. Sex. And maybe maybe maybe sweat (PubMed). Now whatcha gonna do at the gym with that sweaty barbell?

Reactivates with rituximab and ofatumumab (anti CD20); check before starting.

Syndromes

Hepatitis (acute and chronic), cirrhosis and hepatic cancer. Can get a 'flair' reaction with e seroconversion.

Treatment

(Treatment Guidelines)

Treatment is suppressive, not curative, so for life.

Treat if ALT 2x normal and e antigen-positive and elevated (>20,000) DNA. If ALT up and DHA < 20,000, look for another reason for increased ALT. All cirrhotics should be treated if any viral load.

Entecavir is&nbsp; approved for chronic Hepatitis B but it breeds resistance in HIV (PubMed).

or

Tenofovir. Maybe the better of the two. The Tenofovir alafenamide form is less toxic (bone and kidney but more expensive.

It should be better 70% of the time after a year. Check viral load at 3 months then q 6 thereafter.

Prophylaxis

Chemotherapy and immunosuppression can lead to reactivation/flair.

Check surface antigen, core antibody, and anti-surface antigen.

Positive DNA < 20,000 needs prophylaxis.

Reactivation with surface antigen-positive is 50%; the big risk is stem cell transplant, B cell depleting therapy, anthracycline medications and long term (> 4 weeks) steroids and needs prophylaxis. (Review)

Notes

There is a vaccine. It is very effective, good for at least 30 years. However, in HCW's who do not respond to the initial series do not get a better response with more jabs.

"Discontinuation of tenofovir disoproxil fumarate treatment rather than entecavir treatment is associated with earlier relapse (PubMed)..."

Chronic hepatitis B infection increases the risk of colorectal liver metastasis. Odd (PubMed).

Chronic Hepatitis B increases the risk of death with acute Hepatitis E (PubMed).

While treatment will cause cirrhosis to regress, there is still a risk for cancer and need q 6-month screening.

Last Update: 11/122919.