Hepatitis B Flashcards
What does a positive hepatitis B surface antigen indicate?
Acute or chronic hepatitis (15% after acute infection)
What is your initial work-up for a patient with a positive hepatitis B surface antigen?
HepB e Ag
anti-HBe
anti-HBc IgM
hepatitis B virus DNA
Routine chemistry panel
Complete blood count
Prothrombin time
Quantitative immunoglobulin levels
Alpha-fetoprotein
Antibody to hepatitis C virus (anti-HCV)
Antibody to hepatitis A virus (anti-HAV)
Antibody to hepatitis D virus (anti-HDV)
Antibody to human immunodeficiency virus (anti-HIV)
What does a positive hepatitis B surface antigen result indicate?
Indicates you are infected and can spread the hepatitis B virus to others through your blood
How do you interpret these results: positive hepatitis B surface antibody with negative hepatitis B surface antigen?
Immunity (through vaccination or resolved infection)
Can also be:
Inactive HBsAg carrier
Chronic hepatitis B
How do you interpret these results: positive hepatitis B surface antigen, negative hepatitis B surface antibody, positive hepatitis B core antibody?
Acute infection
What is the significance of the hepatitis B antigen?
Patient is infectious
How is hepatitis B transmitted?
Spread through blood, semen, or other body fluids
Who is a candidate for the hepatitis B vaccine?
Persons at risk for infection by sexual exposure
- Sex partners of hepatitis B surface antigen (HBsAg)–positive persons
- Sexually active persons who are not in a long-term, mutually monogamous relationship (e.g., persons with more than one sex partner during the previous 6 months)
- Persons seeking evaluation or treatment for a sexually transmitted infection
- Men who have sex with men
Persons at risk for infection by percutaneous or mucosal exposure to blood
- Current or recent injection-drug users
- Household contacts of HBsAg-positive persons
- Residents and staff of facilities for developmentally disabled persons
- Health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids
- Hemodialysis patients and predialysis, peritoneal dialysis, and home dialysis patients
- Persons with diabetes aged 19–59 years; persons with diabetes aged ≥60 years at the discretion of the treating clinician
Others
- International travelers to countries with high or intermediate levels of endemic hepatitis B virus (HBV) infection (HBsAg prevalence of ≥2%)
- Persons with hepatitis C virus infection
- Persons with chronic liver disease (including, but not limited to, persons with cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, or an alanine aminotransferase [ALT] or aspartate aminotransferase [AST] level greater than twice the upper limit of normal)
- Persons with HIV infection
- Incarcerated persons
- All other persons seeking protection from HBV infection
What is the likelihood of vertical transmission in a patient with acute hepatitis B infection?
The risk is highest in HBsAg- and HBeAg-positive mothers (transmission rate: 70%–90%), and low for HBsAg-positive HBeAg-negative mothers (transmission rate: 10%–40%)
What is the role of hepatitis B viral load and risk of vertical transmission?
<10^6 not associated
10^6–10^7 3% - start tenovovir 300mg daily
10^7-10^8 7%
>10^8 8%
Can a patient with hepatitis B infection breastfeed?
Yes
How should a neonate born to a hepatitis B infected mother be managed?
All infants born to HBV-infected mothers should receive hepatitis B immune globulin (HBIG) and the first dose of hepatitis B vaccine within 12 hours of birth.
Is cesarean delivery recommended for patients with high hepatitis B viral load?
No
Who is candidate for antiretroviral therapy for hepatitis B infection in pregnancy?
An HBV DNA level greater than 200,000 IU/mL or 1 million cp/ml
What are maternal risks of chronic hepatitis B infection?
GDM
preterm birth
antepartum hemorrhage
caesarean section
