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Hepatitis B

Last reviewed: 16 Aug 2025
Last updated: 24 Jun 2025

Summary

Definition

History and exam

Key diagnostic factors

  • high risk of exposure
Full details

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
Full details

Risk factors

  • perinatal exposure in an infant born to an HBV-infected mother
  • high-risk sexual behaviors
  • 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
  • hemodialysis
  • solid organ transplantation
Full details

Diagnostic investigations

1st investigations to order

  • hepatic panel
  • CBC
  • basic metabolic panel
  • 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
Full details

Investigations to consider

  • abdominal ultrasound
  • liver biopsy
  • transient elastography
  • serum liver fibrosis biomarkers
  • aspartate aminotransferase-to-platelet ratio index (APRI)
  • alpha-fetoprotein
  • CT/MRI abdomen
  • testing for hepatitis D coinfection
  • testing for other coinfections
  • drug resistance testing
  • HBV genotype
Full details

Treatment algorithm

ACUTE

acute HBV infection

ONGOING

chronic HBV infection: adult nonpregnant without coinfection or cirrhosis

chronic HBV infection: adult nonpregnant with cirrhosis

chronic HBV infection: adult nonpregnant with HIV coinfection

chronic HBV infection: adult nonpregnant with hepatitis C coinfection

chronic HBV infection: adult nonpregnant with hepatitis D coinfection

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

Declarações

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

Declarações

LOC declares that she has no competing interests.

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

Chairman

Bangladesh Primary Care Research Network

Dhaka

Bangladesh

Declarações

MAM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018 Apr;67(4):1560-99.Texto completo  Resumo

European Association for the Study of the Liver. EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection. J Hepatol. 2017 Aug;67(2):370-98.Texto completo  Resumo

World Health Organization. Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection. Mar 2024 [internet publication].​Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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  • Diretrizes

    • Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection
    • Treatment of chronic hepatitis B
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    Hepatitis B: should I have the vaccine?

    Mais Folhetos informativos para os pacientes
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