Hepatitis B

Last reviewed: 3 Sep 2022
Last updated: 19 Apr 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
More key diagnostic factors

Other diagnostic factors

  • asymptomatic
  • jaundice
  • hepatomegaly
  • ascites
  • fever/chills
  • malaise
  • maculopapular or urticarial rash
  • right upper quadrant pain
  • fatigue
  • nausea/vomiting
  • arthralgia/arthritis
  • palmar erythema
  • spider angiomata
  • splenomegaly
  • asterixis
Other diagnostic factors

Risk factors

  • perinatal exposure in an infant born to an HBV-infected mother
  • high-risk sexual behaviours
  • injection drug use
  • male sex
  • born in highly endemic region
  • family history of HBV, hepatocellular carcinoma, and/or chronic liver disease
  • infected with HIV
  • infected with hepatitis C virus
  • blood or blood product transfusion
  • healthcare workers
  • household contact with HBV infection
  • history of incarceration
  • haemodialysis
  • solid organ transplantation
More risk factors

Diagnostic investigations

1st investigations to order

  • liver function tests
  • FBC
  • urea and electrolytes
  • coagulation profile
  • serum hepatitis B surface antigen
  • serum antibody to hepatitis B surface antigen
  • serum antibody to hepatitis B core antigen
  • serum hepatitis B e antigen
  • serum antibody to hepatitis B e antigen
  • serum HBV DNA
More 1st investigations to order

Investigations to consider

  • abdominal ultrasound
  • liver biopsy
  • transient elastography
  • serum liver fibrosis biomarkers
  • alpha-fetoprotein
  • CT/MRI abdomen
  • testing for co-infections
  • drug resistance testing
  • HBV genotype
More investigations to consider

Treatment algorithm

ACUTE

acute HBV infection

ONGOING

chronic HBV infection: adult non-pregnant without co-infection or cirrhosis

chronic HBV infection: adult non-pregnant with cirrhosis

chronic HBV infection: adult non-pregnant with HIV co-infection

chronic HBV infection: adult non-pregnant with hepatitis C co-infection

chronic HBV infection: adult non-pregnant with hepatitis D co-infection

chronic HBV infection: adult pregnant or breastfeeding

chronic HBV infection: children

Contributors

Authors

Jawad Ahmad, MD, FRCP, FAASLD

Professor of Medicine

Division of Liver Diseases

Mount Sinai Hospital

New York

NY

Disclosures

JA declares that he has no competing interests.

Acknowledgements

Dr Jawad Ahmad would like to gratefully acknowledge Dr Sateesh R. Prakash, Dr Siddarth Verma, Dr Smruti R. Mohanty, and Dr Jared Hossack, previous contributors to this topic.

Disclosures

SRP, SV, and JH declare that they have no competing interests. SRM serves as a speaker bureau for Bristol-Myers Squibb regarding the use of entecavir for the treatment of chronic hepatitis B.

Peer reviewers

George Y. Wu, MD, PhD

Chief

Hepatology Section

Department of Medicine

University of Connecticut Health Center

Farmington

CT

Disclosures

GYW is on the medical advisory boards of Gilead Sciences and Bristol-Myers Squibb.

Lucieni Oliveira Conterno, MD, PhD

Director

Clinical Epidemiology Unit

Marilia Medical School

Sao Paulo

Brazil

Disclosures

LOC declares that she has no competing interests.

Mamun-Al-Mahtab, MB BS, MSc, MD

Chairman

Bangladesh Primary Care Research Network

Dhaka

Bangladesh

Disclosures

MAM declares that he has no competing interests.

  • Hepatitis B images
  • Differentials

    • Acute hepatitis A virus infection
    • Acute hepatitis C virus infection
    • Chronic hepatitis C virus infection
    More Differentials
  • Guidelines

    • Recommended immunization schedule for adults aged 19 years or older - United States, 2022
    • Recommended immunization schedule for children and adolescents aged 18 years or younger - United States, 2022
    More Guidelines
  • Patient leaflets

    Hepatitis B: should I have the vaccine?

    6-in-1 vaccine (diphtheria, hepatitis B, Haemophilus influenzae type B, polio, tetanus, whooping cough)

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer