Hep B ASHM

Question 1

What initial tests need to be requested after a diagnosis of Hep B?

Answer 1

eAg, eAb, viral load,
HIV, Hep A, C & D
LFT/chem 20, FBC
(?if just for HCC screening) upper abdo USS, PT/INR, AFP

Question 2

What percentage of HCC produce AFP?

Answer 2

60%

Question 3

What is the diagnostic imaging for HCC?

Answer 3

4-phase CT or contrast MRI

Question 4

What is dual first, and alternative lines of therapy?

Answer 4

First line: entecavir, tenofovir
alternative: pegylated interferon

Question 5

What is the incidence of HCC per year in patients with cirrhosis?

Answer 5

3-8% pa

Question 6

What is the screening and frequency tests for HCC?
WHich is better?

Answer 6

6 monthly AFP and USS
USS has higher spec and sens

Question 7

What is the rate of perinatal transmission of CHB if:
a) baby receives no vaccination
b) baby has active immunisation (birth dose + complete course)
c) passive Ig + full course

Answer 7

> 90%
28%
<5%

Question 8

What is the risk of a post-partum flare in a woman who is HBeAg positive?

Answer 8

30-50%

Question 9

How severe are post-partum flares usually?

Answer 9

usually asymptomatic and resolve spontaneously

Question 10

How often should LFT’s be monitored for post-partum?

Answer 10

Q1-2 months during postpartum period (how do they define the postpartum period?)

Question 11

What is the regimen for antiviral therapy for Hep b in pregnancy and post-partum?

Answer 11

tenofovir 300 mg daily from 30-32 weeks.
Continue for at least 2 weeks post partum, and upto 12 weeks post partum, with subsequent ongoing monitoring (?LFT monitoring)

Question 12

If a women is identified to ahve a flare of hep b, how often should she be monitored?

Answer 12

twice a week and be referred to a specialist

Question 13

How long can the anti-HBc last for, vertically transmitted?

Answer 13

for up to 2 years, so you don’t test this age group for the anti-HBc

Question 14

Children with CHB should have what monitoring?

Answer 14

q6 monthly:
- LFT
- clinical review
- HBV serology (HBeAg and anti-HBe)

(why so frequent…?)

Question 15

Which children with CHB should be prioritised for referral?

Answer 15

-abnormal LFT
- hep b acquried overseas
- evidence of chronic liver disease: splenomegaly, spider naevi

Question 16

HOw soon do the HBIG & hep b vaccine need to be given to the neonate after birth?

Answer 16

12 hrs for HBIG
24 hrs for vaccine

Question 17

What tests to order for babies/children of women with HBV?

Answer 17

sAg and sAb (if < 2 years)

It is recommended to test all children born to CHB positive women 3 months after they complete the vaccination schedule at 9-12 months. A child under 2 years you order HBsAg and anti-HBs only as a child might have persistent core antibody from their mother. Matthew can have all three tests due to his age.

Question 18

viral load cutoff for pregnant women for risk of transmission HBV

Answer 18

Mothers with HBV DNA above 200,000 IU/mL (> 6 log10 copies/mL) have a significant risk of vertical transmission even with vaccination and HBIg being administered to the infant at birth. International guidelines recommend that third-trimester antiviral therapy should be considered for these women.

Question 19

Hep B-related risk factors for hepatitis flare in post-partum period

Answer 19

Postpartum flares of hepatitis B have been observed in mothers who are HBeAg positive with a high viral load (30-50% risk), as well as those who are HBeAg negative. Flares are usually asymptomatic and settle spontaneously.

Question 20

frequency to monitor LFT in post-partum period to check for flare

Answer 20

Q1-2 monthly

Question 21

duration for tenofovir post-partum

Answer 21

In Australia, the optimal regimen is tenofovir 300mg daily, commencing at 32 weeks gestation, continuing for at least two weeks postpartum and up to 12 weeks postpartum, with subsequent ongoing monitoring and care of the mother.

Question 22

management of post-partum hep b flare

Answer 22

Most flares are self-limited. They require monitoring, but no specific intervention. Natalie should have liver enzymes monitored twice weekly initially and be referred to a specialist.

Question 23

% that HCC risk is reduced by treating hep B

Answer 23

Treatment can prevent cancer and reduce risk for an individual by up to 75%