Hepatitis B

Deeper Dive

Investigation Patterns

• Nil infection/ vaccination: negative throughout

• Immune due to vaccination: antiHBsAg only 

• Cleared infection:  AntiHBsAg, AntiHBcAg IgG (if > 6m nil anti-HBcAg IgM)

• Active infection: antiHBcAg (IgM & IgG), HBcAg & HBsAg; nil antiHBsAg (B cell dysfunction)

• Chronic infection: AntiHBcAg & HBsAg

Tenofovir

Tenofovir is usually continued for life once started. Started once benefits > risks. Usually in late to middle age once immune system weakens with age and viral load increases. 

• Benefits: reduces the progression to cirrhosis & rates of HCC

• Indications to treat: high viral load, raised AST/ cirrhosis

• Side effects: nausea, headaches, lethargy

• Complications: Renal Impairment, Osteoporosis

• Monitoring: bloods with urine P:Cr

• Breast feeding: safe

HCC Surveillance

Indications similiar to tenofovir treatment. Because of effective screening tests and treatments (TACE), low threshold for 

• Indications: 

  • Tenofovir treatment, 

  • Cirrhosis, 

  • High viral load, 

  • > 20 year & african ethnicity or > 50 years & asian ethnicity

• 6 monthly AUSS and AFP

Pregnancy

• All Babies in UK will get routine HBV vaccination. 

• Vertical transmission considered a never event

• If HBV copies > 100,000: treatment with tenofovir, HBV vaccination & Immunoglobulin booster

Sexual Partners

• Legal responsibility of individual to inform partner

• Healthcare worker can break confidentiality to inform partner or workplace if significant risk of harm

• Advice partner to be vaccinated & wear condoms

Needle stick injuries

• HBV: 0.3% risk per needle stick 

• High risk events (needlestick in known or high risk HBV)

  • Give HBV immunoglobulin within first 12 hours, nil value > 7d

  • Test for HBV

  • Consider PEP

• Low risk events- minimal needlestick in low risk individual: 

  • Test for HBV

  • Await PEP till after tests

Clinical Cycle

Summary

Diagnosis: 

• Asymptomatic screening 

• Acute Hepatitis- may require admission

Monitoring in clinic: as there is no cure, these individuals often require long periods of monitoring in clinics. 

Clinic Checklist

• Investigations

  • LFTs- AST

  • Hepatitis B surface antigen & viral load

  • Hepatitis D co-infection

  • Fibroscan ? cirrhosis, AUSS ? HCC

• Management

  • Support / job- vaccination self / partner

  • Decision to treat / referral for transplant

Links

Body Systems: Gastrointestinal

Pathology: Infectious

Examinations: Gastrointestinal & Liver Exam 

Specialties: Gastroenterology, Infectious Diseases, Sexual Health

References

Written in 2026.