Hepatitis B — Chronic

For patients HepB surface-antigen (HBsAg) positive, order:

• HepB “e” antigen  (HBeAg)
• HepB “e” antibody  (Anti-HBeAB)
• Hep B Viral Load  (HBV DNA)

Interpret Labs as follows:

HBeAg   NEG Anti-HBeAB   POS HBV DNA <20,000 copies/4,000 IU   HBeAg   POS Anti-HBeAB  NEG HBV DNA >100,000 copies/20,000 IU   HBeAg   POS Anti-HBeAB   POS HBV DNA >100,000 copies/20,000 IU   HBeAg   NEG Anti-HBeAB   NEG HBV DNA >10,000 copies/2,000 IU

Chronic Carrier Don’t Tx Infectious Probably will never develop disease    Chronic Active Hepatitis  —  Tx Very Infectious Eventual cirrhosis / hepatocellular carcinoma   Chronic Active Hepatitis  —  Tx Same as above Unusual for both “e” Ag & AB positive (occas. happens)   “e-Ag Negative” Chronic Active Pre-core mutant virus See Chronic Active above  —  Tx even low VL

In General (Hepatology usually manages Chronic Hep B)

TREAT  if  HBV DNA >100,000 copies (20,000 IU)

• Treat “e-Ag Negative” Chronic Hepatitis if >10,000 copies (2,000 IU)

DON’T TREAT

• Chronic Carriers (low viral loads)
• Vertically-Infected persons with normal ALT/AST

VACCINATE  —  contacts of HBsAg-positive patients

• Sexual partners & Household Members