Last reviewed: 6 Apr 2021
Last updated: 23 Oct 2020



History and exam

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

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
  • alpha-fetoprotein
  • CT/MRI abdomen
  • testing for co-infections
  • drug resistance testing
  • HBV genotype

Treatment algorithm


Professor of Medicine

Division of Liver Diseases

Mount Sinai Hospital

New York



JA declares that he has no competing interests.

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. 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 reviewersVIEW ALL


Hepatology Section

Department of Medicine

University of Connecticut Health Center




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


Clinical Epidemiology Unit

Marilia Medical School

Sao Paulo



LOC declares that she has no competing interests.


Bangladesh Primary Care Research Network




MAM declares that he has no competing interests.

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