Managing Adult Patients with Chronic HBV

Guidelines for Managing Adult Patients with Chronic Hepatitis B

Coleman I. Smith, M.D., Gastroenterologist/Hepatologist
Minneapolis, MN (*Excerpted from "How to Manage Chronic Hepatitis B Patients" published by Immunization Action Coalition)

Take a clinical history (including family history), looking in particular for evidence of symptomatic liver disease in the patient, family, household members, or sexual partner(s).
Do a physical exam to look for evidence of liver disease such as spider nevi, jaundice, ascites, etc.
Order biochemical tests to assess liver status (AST, ALT, alkaline phosphatase, bilirubin, albumin, prothrombin time). All should be repeated every six months.
Measure HBeAg and HBV DNA yearly to assess if active viral replication is present.
Assess HBsAg and anti-HBs yearly to see if viral clearance has occurred.
Refer individuals who are HBV DNA positive or have an AST>200 to a physician experienced in the management of chronic liver disease for further assessment. Also, refer persons with clinical evidence of liver disease (e.g., jaundice, ascites, variceal hemorrhage). Consideration should be given to liver biopsy. In those with liver disease and active viral replication (HBV DNA positivity), treatment with interferon, lamivudine, or adefovir should be considered.
Monitor all HBsAg carriers for the development of hepatocellular carcinoma. Although there is much debate on the degree of frequency of such monitoring and the modalities to be used, a reasonable approach is to do ultrasound and alpha-fetoprotein (a tumor marker) estimation every six months, especially if the infection has been present for ten years or more.
Test family members of chronically infected persons (including non-sexual contacts), as well as any sexual partners who are at risk of acquiring hepatitis B. If found susceptible, or if they have an indeterminate serologic pattern (an isolated anti-HBc+), they should be vaccinated against hepatitis B, even if pregnant.
Evaluate patients for the presence of antibody to hepatitis A (total anti-HAV). Those with a negative antibody are susceptible and should receive hepatitis A vaccine.
Educate every chronically infected person about hepatitis B. Also, educate his/her household members and sexual partners. Brochures to assist with education are available from the Immunization Action Coalition and the Hepatitis B Foundation.

Excerpted from "How to Manage Chronic Hepatitis B Patients," published by the Immunization Action Coalition. See full article.