Hepatitis B virus: Case studies
- Anna SF Lok, MD
Anna SF Lok, MD
- Professor of Medicine
- University of Michigan Medical School
The management of hepatitis B virus (HBV) infection is complex and depends upon multiple factors including clinical variables (eg, the presence or absence of liver inflammation and/or cirrhosis), the patient's immunologic response to infection (eg, hepatitis B e antigen status), virologic factors (eg, the HBV viral load and genotype), and risk factors for disease progression (eg, age >40 and family history of hepatocellular carcinoma).
The following topic will outline issues related to the management of hepatitis B through the use of cases studies that incorporate patient-specific clinical information and test results. Our approach to treatment is generally consistent with guidelines from the European consensus statement, Asian-Pacific consensus statement, and American Association for the Study of Liver Diseases Practice Guidelines [1-4].
Additional topic reviews that address the diagnosis and management of HBV include:
●(See "Hepatitis B and pregnancy".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology 2009; 50:661.
- Terrault NA, Bzowej NH, Chang KM, et al. AASLD guidelines for treatment of chronic hepatitis B. Hepatology 2016; 63:261.
- European Association For The Study Of The Liver. EASL clinical practice guidelines: Management of chronic hepatitis B virus infection. J Hepatol 2012; 57:167.
- Sarin SK, Kumar M, Lau GK, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int 2016; 10:1.
- Chien RN, Liaw YF, Atkins M. Pretherapy alanine transaminase level as a determinant for hepatitis B e antigen seroconversion during lamivudine therapy in patients with chronic hepatitis B. Asian Hepatitis Lamivudine Trial Group. Hepatology 1999; 30:770.
- Chan HL, Chan CK, Hui AJ, et al. Effects of tenofovir disoproxil fumarate in hepatitis B e antigen-positive patients with normal levels of alanine aminotransferase and high levels of hepatitis B virus DNA. Gastroenterology 2014; 146:1240.
- Centers for Disease Control and Prevention (CDC). Updated CDC recommendations for the management of hepatitis B virus-infected health-care providers and students. MMWR Recomm Rep 2012; 61:1.
- Lok AS, Trinh H, Carosi G, et al. Efficacy of entecavir with or without tenofovir disoproxil fumarate for nucleos(t)ide-naïve patients with chronic hepatitis B. Gastroenterology 2012; 143:619.
- Kumar M, Satapathy S, Monga R, et al. A randomized controlled trial of lamivudine to treat acute hepatitis B. Hepatology 2007; 45:97.
- YOUNG MAN WITH ACTIVE REPLICATION
- PRESUMED PRECORE VARIANT
- HBeAg-POSITIVE, HIGH HBV DNA, NORMAL ALT
- DENTAL STUDENT WITH ACTIVE REPLICATION
- CHRONIC CARRIER, ADVANCED HISTOLOGIC FEATURES
- DECOMPENSATED CIRRHOSIS
- PATIENT REMAINS HBeAg-POSITIVE DESPITE LAMIVUDINE FOR ONE YEAR
- BREAKTHROUGH INFECTION WHILE ON LAMIVUDINE
- ACUTE INFECTION