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Management of Hepatitis B

Management of Hepatitis B. Dr Neil McDougall Consultant Hepatologist Royal Victoria Hospital. Spectrum of Disease. Acute HBV infection. 90% neonates. 25–30% children. <10% adults. ~2%. Chronic infection. 15–40%. Fulminant hepatic failure. Progressive chronic hepatitis.

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Management of Hepatitis B

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  1. Management of Hepatitis B Dr Neil McDougall Consultant Hepatologist Royal Victoria Hospital

  2. Spectrum of Disease Acute HBV infection 90% neonates 25–30% children <10% adults ~2% Chronic infection 15–40% Fulminant hepatic failure Progressive chronic hepatitis Inactivecarrier state Cirrhosis Decompensated cirrhosis Death HCC EASL Consensus Guidelines. J Hepatol 2003;Lok, McMahon. Hepatology 2004 (AASLD Guidelines)

  3. Hepatitis B in N Ireland • Period Jan 2002 – Jan 2007 • 323 newly detected HBsAg positive cases • 93 acute cases • 230 chronic cases • Of the chronic HBV cases: • Only 57 (23%) attended a GI clinic • 40% of those tested (88) had raised LFTs • THERE IS A GAP

  4. Managing Acute Hepatitis B • Supportive care • Refer to specialist centre if deterioration • Oral antiviral therapy • Liver transplantation • Follow-up for at least 6 months • 5-10% fail to clear virus • CONTACT TRACING

  5. Managing Chronic hepatitis B • Refer to specialist clinic • Monitor blood tests: • Screen for HIV, HCV at 1st visit • LFT • HBV DNA and serology • Test all household / family contacts • Vaccinate household / sexual contacts • Lifestyle advice

  6. Chronic Hepatitis B in pregnancy • Refer all CHB cases, see within 6 wks • Review BEFORE delivery • Check HBV DNA, LFT and HBeAg status • Options • HBsAg positive – active + passive • HBsAg neg but high DNA – active + passive • HBsAg neg – active only • High HBV DNA (>107) – consider Tenofovir • Ensure follow-up

  7. CHB inactive • LFT normal • HBV DNA unrecordable (x3) • USS normal • HBeAg negative • ANNUAL review

  8. CHB mildly active • LFT normal • HBV DNA low level • Review every 6 months • Consider biopsy

  9. CHB active • Abnormal LFTs • High HBV DNA • Liver biopsy (AGE dependent) • Consider treatment • Oral therapy or Peg interferon

  10. Tenofovir • Dose 245mg once daily • Avoid in significant renal dysfunction • Monitoring • U+E and phosphate • Every 4 weeks for 1 year • Then every 3 months

  11. Hepatoma screening in CHB • All cirrhotic patients • All viraemic patients • USS and AFP every 6 months • Incidence 2-3% per year

  12. Managing Chronic Hepatitis B • Screening • Language barriers • Refer ALL patients • Life long monitoring/treatment

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