Summary
Definition
History and exam
Key diagnostic factors
- high risk of exposure
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
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
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
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
Treatment algorithm
acute HBV infection
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
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.
Diagnósticos diferenciais
- Hepatitis A
- Hepatitis C
- Hepatitis D
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