Hepatitis B: Screening, Prevention, Diagnosis, and Treatment

 

Am Fam Physician. 2019 Mar 1;99(5):314-323.

  Patient information: See related handout on hepatitis B, written by the authors of this article.

  See related AFP Community Blog post: Family Doctors Can Easily Treat Hepatitis B "In-House"

Author disclosure: No relevant financial affiliations.

Hepatitis B virus (HBV) is a partly double-stranded DNA virus that causes acute and chronic liver infection. Screening for hepatitis B is recommended in pregnant women at their first prenatal visit and in adolescents and adults at high risk of chronic infection. Hepatitis B vaccination is recommended for medically stable infants weighing 2,000 g or more within 24 hours of birth, unvaccinated infants and children, and unvaccinated adults requesting protection from hepatitis B or who are at increased risk of infection. Acute hepatitis B is defined as the discrete onset of symptoms, the presence of jaundice or elevated serum alanine transaminase levels, and test results showing hepatitis B surface antigen and hepatitis B core antigen. There is no evidence that antiviral treatment is effective for acute hepatitis B. Chronic hepatitis B is defined as the persistence of hepatitis B surface antigen for more than six months. Individuals with chronic hepatitis B are at risk of hepatocellular carcinoma and cirrhosis, but morbidity and mortality are reduced with adequate treatment. Determining the stage of liver disease (e.g., evidence of inflammation, fibrosis) is important to guide therapeutic decisions and the need for surveillance for hepatocellular carcinoma. Treatment should be individualized based on clinical and laboratory characteristics and the risks of developing cirrhosis and hepatocellular carcinoma. Immunologic cure, defined as the loss of hepatitis B surface antigen with sustained HBV DNA suppression, is attainable with current drug therapies that suppress HBV DNA replication and improve liver inflammation and fibrosis. Pegylated interferon alfa-2a, entecavir, and tenofovir are recommended as first-line treatment options for chronic hepatitis B.

The Centers for Disease Control and Prevention (CDC) estimated that in 2015 there were 21,900 cases of acute hepatitis B, with an overall incidence of 1.1 cases per 100,000.1 There are an estimated 850,000 to 2.2 million individuals in the United States with chronic hepatitis B.1,2 Approximately 25% of children and 15% of adults with chronic hepatitis B die prematurely from hepatocellular carcinoma (HCC) or cirrhosis.3 However, treatment reduces morbidity and mortality from the disease.

WHAT IS NEW ON THIS TOPIC

Approximately 1,000 cases of perinatal hepatitis B occur annually in the United States, and nearly 90% of chronic hepatitis B cases in infants develop in the first year of life.

Hepatitis B vaccination is recommended for all medically stable infants weighing 2,000 g (4 lb, 6 oz) or more within 24 hours of birth, unvaccinated infants and children, and unvaccinated adults requesting protection from hepatitis B or who are at increased risk of hepatitis B.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Pregnant women should be screened for hepatitis B at the first prenatal visit.

A

6

Adolescents and adults at high risk of chronic infection should be screened for hepatitis B.

B

7

Hepatitis B vaccination is recommended for all medically stable infants weighing 2,000 g (4 lb, 6 oz) or more within 24 hours of birth, unvaccinated infants and children, and unvaccinated adults requesting protection from hepatitis B or who are at increased risk.

C

11

Acute hepatitis B should not be treated with antivirals.

B

17

All infants born to mothers who are positive for hepatitis B surface antigen should receive hepatitis B immune globulin promptly and the hepatitis B vaccine by 24 hours of life.

C

25

Pegylated interferon alfa-2a (Pegasys), entecavir (Baraclude), and tenofovir are recommended as first-line treatment options for chronic hepatitis B.

C

27


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expertopinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Pregnant women should be screened for hepatitis B at the first prenatal visit.

A

6

Adolescents and adults at high risk of chronic infection should be screened for hepatitis B.

B

7

Hepatitis B vaccination is recommended for all medically stable infants weighing 2,000 g (4 lb, 6 oz) or more within 24 hours of birth, unvaccinated infants and children, and unvaccinated adults requesting protection from hepatitis B or who are at increased risk.

C

11

Acute hepatitis B should not be treated with antivirals.

B

17

All infants born to mothers who are positive for hepatitis B surface antigen should receive hepatitis B immune globulin promptly and the hepatitis B vaccine by 24 hours of life.

C

25

Pegylated interferon alfa-2a (Pegasys), entecavir (Baraclude), and tenofovir are recommended as first-line treatment options for chronic hepatitis B.

C

27


A = consistent,

The Authors

show all author info

THAD WILKINS, MD, MBA, FAAFP, is director of academic development and a professor in the Department of Family Medicine at the Medical College of Georgia at Augusta University....

RICHARD SAMS, MD, MA, is an associate professor in the Department of Family Medicine at the Medical College of Georgia at Augusta University.

MARY CARPENTER, PharmD, is a clinical assistant professor in the Department of Family Medicine at the Medical College of Georgia at Augusta University.

Address correspondence to Thad Wilkins, MD, MBA, Medical College of Georgia at Augusta University, 1120 15th St., Augusta, GA 30912 (e-mail: jwilkins@augusta.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

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