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".)
- 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