Hepatitis B Questions & Answers

Updated: Aug 01, 2018
  • Author: Nikolaos T Pyrsopoulos, MD, PhD, MBA, FACP, AGAF; Chief Editor: BS Anand, MD  more...
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Questions & Answers

Overview

What is hepatitis B (HBV) (Hep B)?

What is the pathogenesis of hepatitis B (HBV) (Hep B)?

What are the signs and symptoms of icteric hepatitis in patients with hepatitis B (HBV) (Hep B)?

What are the signs and symptoms of fulminant and subfulminant hepatitis in patients with hepatitis B (HBV) (Hep B)?

What is the clinical presentation of chronic hepatitis B (HBV) (Hep B) infection?

What are the physical findings suggestive of hepatitis B (HBV) (Hep B)?

What are the physical findings that suggest acute hepatitis B (HBV) (Hep B)?

What are the signs of chronic liver disease in patients with hepatitis B (HBV) (Hep B)?

What are the physical findings of cirrhosis in hepatitis B (HBV) (Hep B)?

Which lab tests may be used to assess the stages of hepatitis B (HBV) (Hep B)?

Which imaging studies are used to evaluate patients with hepatitis B (HBV) (Hep B) disease?

What procedure is performed to assess the severity of disease in patients with hepatitis B (HBV) (Hep B)?

What are the treatment goals for patients with hepatitis B (HBV) (Hep B) infection?

Which medications are used in the treatment of hepatitis B (HBV) (Hep B)?

What dietary limitations are indicated for patients with hepatitis B (HBV) (Hep B)?

What is the treatment of choice for fulminant hepatic failure and end-stage liver disease from hepatitis B (HBV) (Hep B) disease?

What is the global prevalence of hepatitis B (HBV) (Hep B)?

What are the possible complications of hepatitis B (HBV) (Hep B)?

What progress has been made in decreasing the prevalence of hepatitis B (HBV) (Hep B)?

How is hepatitis B (HBV) (Hep B) transmitted and what is the outcome of infection?

How common is chronic hepatitis B (HBV) (Hep B) in children and adults?

What is the efficacy of hepatitis B (HBV) (Hep B) vaccination in children?

What is the efficacy of antiviral treatment for hepatitis B (HBV) (Hep B)?

What is the pathophysiology of hepatitis B (HBV) (Hep B) infection?

What is encoded in the pathogenesis of hepatitis B (HBV) (Hep B) infection?

What is the role of S gene (surface gene) in the pathophysiology of hepatitis B (HBV) (Hep B) infection?

What is the role of the C gene (core gene) in the pathophysiology of hepatitis B (HBV) (Hep B) infection?

What is the role of the e antigen, (HBeAg) in the pathophysiology of hepatitis B (HBV) (Hep B) infection?

What is the role of the X gene in the pathophysiology of hepatitis B (HBV) (Hep B) infection?

What does the presence of antibodies against HBsAG (anti-HBs) indicate in the pathogenesis of hepatitis B (HBV) (Hep B) infection?

What does the presence of anti-HBc subtype IgM or IgG suggest in the pathogenesis of hepatitis B (HBV) (Hep B) infection?

What does the presence of antibodies to the e antigen (HBeAg) suggest in the pathogenesis of hepatitis B (HBV) (Hep B)?

How are hepatitis B (HBV) (Hep B) genome variants identified?

How does the global prevalence of the HBeAg-negative strain of hepatitis B (HBV) (Hep B) vary among regions?

What is the pathogenesis of hepatitis B (HBV) (Hep B) infection?

What is the final state of hepatitis B (HBV) (Hep B) disease?

What are the five stages in the life cycle of hepatitis B virus (HBV) (Hep B)?

What are the genotypes hepatitis B (HBV) (Hep B)?

Which factors increase the risk for hepatocellular carcinoma (HCC) in patients with hepatitis B (HBV) (Hep B)?

What is the prevalence of hepatocellular carcinoma (HCC) among patients with hepatitis B (HBV) (Hep B) and hepatitis C virus (HCV) coinfection?

What is the prevalence of hepatocellular carcinoma (HCC) among patients with hepatitis B (HBV) (Hep B) and hepatitis D (delta) virus (HDV) coinfection?

What is the role chronic hepatitis B (HBV) (Hep B) infection in the pathogenesis of hepatocellular carcinoma (HCC)?

What is the role of oval cells proliferation in the pathogenesis of hepatocellular carcinoma (HCC)?

Is cirrhosis suggestive of hepatocellular carcinoma (HCC) in patients with hepatitis B (HBV) (Hep B) infection?

What is the intrinsic hepatocarcinogenic activity in hepatitis B (HBV) (Hep B) infection?

What is the role of the HBxAg (antigen for the X gene of HBV) in the hepatocarcinogenic activity of hepatitis B (HBV) (Hep B) infection?

Which types of glomerulonephritis are caused by hepatitis B (HBV) (Hep B) infection?

What is the prevalence of glomerulonephritis among patients with chronic hepatitis B (HBV) (Hep B)?

What is the presentation of glomerulonephritis in patients with chronic hepatitis B (HBV) (Hep B)?

What is the pathogenesis of glomerulonephritis in patients with chronic hepatitis B (HBV) (Hep B)?

Can hepatitis B (HBV) (Hep B) cause arteritis?

What is the pathogenesis of polyarteritis nodosa (PAN) in patients with hepatitis B (HBV) (Hep B)?

What are the signs and symptoms of polyarteritis nodosa (PAN) in patients with hepatitis B (HBV) (Hep B)?

Which factors increase the risk of mortality from polyarteritis nodosa (PAN) in patients with hepatitis B (HBV) (Hep B)?

What is the prognosis of polyarteritis nodosa (PAN) in patients with hepatitis B (HBV) (Hep B)?

How is hepatitis B (HBV) (Hep B) transmitted?

Which genes increase the risk for developing chronic hepatitis B (HBV) (Hep B)?

What is the role of the IFNGR1 gene in hepatitis B (HBV) (Hep B) infection?

What is the role of the genes IFNAR2 and IL10R2 (CRFB4) in hepatitis B (HBV) (Hep B) infection?

Which genes may reduce hepatitis B (HBV) (Hep B) vaccine response?

What is the incidence of hepatitis B (HBV) (Hep B) in the US?

What are the risk factors for hepatitis B (HBV) (Hep B) infection in the US?

How has routine vaccination of infants for hepatitis B (HBV) (Hep B) infection affected the prevalence in the US?

What is the global prevalence of hepatitis B (HBV) (Hep B) infection?

How does the mode of transmission of hepatitis B (HBV) (Hep B) vary among global regions?

Which measures have reduced the global prevalence of hepatitis B (HBV) (Hep B)?

What is the geographic distribution of the 10 genotypes of hepatitis B (HBV) (Hep B)?

What are the race- and sex-related demographics of hepatitis B (HBV) (Hep B) disease?

How does the risk of developing chronic hepatitis B (HBV) (Hep B) vary among age groups?

How many deaths in the US are attributed to chronic hepatitis B (HBV) (Hep B) annually?

Which factors improve the prognosis in hepatitis B (HBV) (Hep B) infection?

Does chronic hepatitis B (HBV) (Hep B) increase the risk of hepatocellular carcinoma (HCC)?

What are risk factors for hepatocellular carcinoma (HCC) in patients with hepatitis B (HBV) (Hep B)?

What is the incidence of hepatocellular carcinoma (HCC) in patients with hepatitis B (HBV) (Hep B) infection and cirrhosis?

Which hepatitis B (HBV) (Hep B) mutations increase the risk of developing hepatocellular carcinoma (HCC)?

What are the mortality rates of hepatocellular carcinoma (HCC) among families with hepatitis B (HBV) (Hep B) infection?

What are variables that correlate with overall survival for individuals with cirrhosis or hepatocellular carcinoma (HCC) and hepatitis B (HBV) (Hep B) infection?

What is a poor prognostic factor for patients with hepatocellular carcinoma (HCC) and hepatitis B (HBV) (Hep B) infection?

What is the prognosis of renal disease in hepatitis B (HBV) (Hep B) related to?

How frequently does membranous glomerulonephritis (MGN) undergo spontaneous remission in patients with hepatitis B (HBV) (Hep B) infection?

What education should be given to patients with acute or chronic hepatitis B (HBV) (Hep B)?

Presentation

What is the spectrum of symptoms of hepatitis B (HBV) (Hep B) infection?

What are the multisystem manifestations of hepatitis B virus (HBV) (Hep B) infection?

What are the cutaneous symptoms of the early course hepatitis B (HBV) (Hep B) infection?

What is the incubation period in the acute phase of hepatitis B (HBV) (Hep B) infection?

What is icteric hepatitis?

What is the presentation of fulminant and subfulminant hepatitis B (HBV) (Hep B)?

What are the signs and symptoms of chronic hepatitis B (HBV) (Hep B)?

Which symptoms may be present in chronic hepatitis B (HBV) (Hep B) with progressive liver disease?

What is the variance in severity of physical findings in hepatitis B (HBV) (Hep B)?

Which physical findings suggest acute hepatitis B (HBV) (Hep B)?

Which physical findings suggest chronic hepatitis B (HBV) (Hep B)?

Which physical findings suggest cirrhosis and hepatitis B (HBV) (Hep B)?

DDX

Which conditions should be included in the differential diagnoses of hepatitis B virus (HBV) (Hep B) infection?

What are the differential diagnoses for Hepatitis B?

Workup

What is the role of lab testing in the workup of hepatitis B (HBV) (Hep B)?

How is severity determined in hepatitis B virus (HBV) (Hep B)?

How is a patient’s level of infectivity determined in hepatitis B (HBV) (Hep B) infection?

What is the role of DNA testing in the evaluation of hepatitis B (HBV) (Hep B)?

What are the AASLD recommendations for the initial evaluation of HBsAg-positive patients with hepatitis B (HBV) (Hep B)?

What are the AASLD recommendations for evaluation of hepatitis B (HBV) (Hep B) in HBsAg-positive patients with elevated LFTs?

What are the USPSTF recommendations for screening asymptomatic adolescents and adults at high risk for hepatitis B (HBV) (Hep B) infection?

When are foreign-born residents of the US screened for hepatitis B (HBV) (Hep B)?

Among which patients with hepatitis B (HBV) (Hep B) is hepatocellular carcinoma (HCC) more prevalent?

What are the CDC recommendations on screening for hepatitis C virus (HCV) infections in adults?

Which diagnostic test findings suggest acute hepatitis B (HBV) (Hep B)?

Which diagnostic findings are less common for acute hepatitis B (HBV) (Hep B) disease?

Which viral markers may be identified in the serum and the liver for acute hepatitis B (HBV) (Hep B)?

Which findings are diagnostic for chronic hepatitis B (HBV) (Hep B)?

Which diagnostic test findings are expected in patients with inactive hepatitis B (HBV) (Hep B) disease?

How is chronic hepatitis B (HBV) (Hep B) disease categorized?

What are diagnostic test findings of the HBeAg-positive subtype of chronic hepatitis B (HBV) (Hep B) disease?

What are the increased risks of HBeAg-negative of chronic hepatitis B (HBV) (Hep B)?

What are the expected diagnostic test findings for cirrhosis in patients with hepatitis B (HBV) (Hep B) infection?

What is the role of imaging studies in the diagnosis of hepatitis B (HBV) (Hep B) infection?

What are the likely imaging findings of cirrhosis in patients with hepatitis B (HBV) (Hep B) infection?

Is ultrasonographic surveillance for the detection of hepatocellular carcinoma (HCC) effective in patients with cirrhosis due to hepatitis B (HBV) (Hep B) infection?

What is the role of the Hepatiq radiologic image processing system in the evaluation for hepatitis B (HBV) (Hep B) infection?

What is the role of liver biopsy in the evaluation of hepatitis B (HBV) (Hep B) infection?

Which histologic findings suggest acute hepatitis B (HBV) (Hep B)?

Which histologic findings suggest chronic hepatitis B (HBV) (Hep B)?

How is liver damage graded in hepatitis B (HBV) (Hep B)?

How is liver damage staged in hepatitis B (HBV) (Hep B)?

Treatment

What are the WHO guidelines on treatment priorities for chronic hepatitis B (HBV) (Hep B) infection?

What are the risk factors for progression of hepatitis B (HBV) (Hep B) infection?

How is hepatocellular carcinoma (HCC) prevented in patients with hepatitis B (HBV) (Hep B) infection?

What is the treatment for acute hepatitis B (HBV) (Hep B) infection?

When is therapy indicated for the treatment of hepatitis B (HBV) (Hep B)?

What are the NIH recommendations for nucleos(t)ide therapy for hepatitis B (HBV) (Hep B) infection?

When is treatment recommended by the NIH for chronic hepatitis B (HBV) (Hep B)?

When is treatment recommended by the NIH for hepatitis B e antigen (HBeAg)-negative patients with chronic hepatitis B (HBV) (Hep B)?

What are the NIH recommendations for treatment of patients with hepatitis B (HBV) (Hep B) and HIV?

According to the NIH, when is therapy for hepatitis B (HBV) (Hep B) not routinely indicated?

When is treatment recommended by the WHO for chronic hepatitis B (HBV) (Hep B) infection?

What are the AASLD recommendations for treatment of individuals with hepatitis B (HBV) (Hep B) and HIV infection?

What are the AASLD guidelines for the treatment of chronic hepatitis B (HBV) (Hep B)?

What are the AASLD guidelines for the treatment of adults with HBeAg-negative immune-active chronic hepatitis B (HBV) (Hep B) infection?

What are the AASLD guidelines for the treatment of children with chronic hepatitis B (HBV) (Hep B) infection?

When is inpatient care indicated for patients with hepatitis B (HBV) (Hep B)?

What are the dietary restrictions for patients with hepatitis B (HBV) (Hep B)?

Which agents are used as first-line treatment for hepatitis B (HBV) (Hep B)?

Which medications are approved for the treatment of chronic hepatitis B (HBV) (Hep B)?

What is the first-line antiviral treatment for hepatitis B (HBV) (Hep B) in patients aged 12 years or older?

What is the first-line antiviral treatment for patients with hepatitis B (HBV) (Hep B) and HIV infection?

What is the second-line antiviral treatment for antiviral-resistant patients with hepatitis B (HBV) (Hep B)?

What are the special considerations of antiviral therapy in select patients with hepatitis B (HBV) (Hep B)?

What is a possible adverse effect of entecavir (ETV) in the treatment of hepatitis B (HBV) (Hep B)?

How are treatment regimens simplified in patients with hepatitis B (HBV) (Hep B) and HIV infection?

What is the efficacy of interferon alfa (IFN-a) treatment of hepatitis B (HBV) (Hep B)?

What are good prognostic factors for response to interferon alfa (IFN-a) treatment in patients with hepatitis B (HBV) (Hep B)?

Which findings indicate resolution of the hepatitis B (HBV) (Hep B) infection?

What is the efficacy of interferon alfa (IFN-a) therapy in treating hepatitis B (HBV) (Hep B)-related glomerulonephritis?

What are the effects of corticosteroids and immunosuppressive agents for treating vasculitis in patients with hepatitis B (HBV) (Hep B)?

Which antiviral drug has been used for the treatment of polyarteritis nodosa (PAN) in patients with hepatitis B (HBV) (Hep B)?

What are the adverse effects of interferon alfa (IFN-a) for the treatment of hepatitis B (HBV) (Hep B)?

What are the benefits of pegylated IFN-a 2a (PEG-IFN-a 2a) in the treatment of hepatitis B (HBV) (Hep B)?

What is the dosage regimen of pegylated IFN-a 2a (PEG-IFN-a 2a) for treatment of hepatitis B (HBV) (Hep B)?

Which patients with hepatitis B (HBV) (Hep B) have a better response to pegylated IFN-a 2a (PEG-IFN-a 2a)?

What is the role of telbivudine in the treatment of hepatitis B (HBV) (Hep B)?

Is telbivudine effective for the treatment of HBeAg-positive hepatitis B (HBV) (Hep B)?

Is telbivudine effective for the treatment of HBeAg-negative hepatitis B (HBV) (Hep B)?

What is the role of entecavir (ETV) in the treatment of hepatitis B (HBV) (Hep B)?

Is entecavir (ETV) effective for the treatment of HBeAg-positive hepatitis B (HBV) (Hep B)?

Is entecavir (ETV) effective for the treatment of HBeAg-negative hepatitis B (HBV) (Hep B)?

What is the efficacy of long-term treatment of hepatitis B (HBV) (Hep B) with entecavir (ETV) therapy?

What is the role of lamivudine (3TC) in the treatment of hepatitis B (HBV) (Hep B)?

What are the outcomes associated with lamivudine (3TC) in the treatment of hepatitis B (HBV) (Hep B)?

How is the HBeAg seroconversion rate affected after lamivudine (3TC) treatment for hepatitis B (HBV) (Hep B)?

What improvements have been seen in patients given lamivudine (3TC) for the treatment of hepatitis B (HBV) (Hep B)?

How is polyarteritis nodosa (PAN) treated in patients with hepatitis B (HBV) (Hep B) infection?

What therapy regimens may be prophylactic for hepatitis B (HBV) (Hep B) infection in patients with HIV infection?

How do viral variants complicate lamivudine (3TC) treatment of hepatitis B (HBV) (Hep B)?

When is adefovir indicated for the treatment of chronic hepatitis B (HBV) (Hep B)?

What is the optimal dose for adefovir for the treatment of hepatitis B (HBV) (Hep B)?

What is the efficacy of adefovir for the treatment of hepatitis B (HBV) (Hep B)?

When is tenofovir indicated for the treatment of hepatitis B (HBV) (Hep B)?

What is the efficacy of tenofovir for the treatment of HBeAg-positive hepatitis B (HBV) (Hep B)?

What is the efficacy of tenofovir for the treatment of HBeAg-negative hepatitis B (HBV) (Hep B)?

What is the efficacy of tenofovir for the treatment of chronic hepatitis B (HBV) (Hep B)?

Is tenofovir effective as the first-line therapy for hepatitis B (HBV) (Hep B)?

Which agents may provide prophylaxis against hepatitis B (HBV) (Hep B) infection?

What are the indications for surgical treatment of hepatitis B (HBV) (Hep B)?

What are the ACOG and the USPSTF recommendations for routine prenatal screening for hepatitis B (HBV) (Hep B)?

How are neonates of mothers with chronic hepatitis B (HBV) (Hep B) treated?

Is breastfeeding contraindicated in mothers with chronic hepatitis B (HBV) (Hep B)?

What are the guidelines for reducing the risk of perinatal hepatitis B (HBV) (Hep B) transmission?

What therapy should pregnant women with immune-active hepatitis B (HBV) (Hep B) receive?

When is antiviral therapy not recommended for pregnant women with hepatitis B (HBV) (Hep B)?

What does the hepatitis B (HBV) (Hep B) vaccine consist of?

How effective is the hepatitis B (HBV) (Hep B) 3-dose vaccine series when administered in infancy?

What are the recommendations for hepatitis B (HBV) (Hep B) vaccination in children?

What are the hepatitis B (HBV) (Hep B) vaccine options for adults?

What are the ACIP recommendations for immunizing adults at risk for hepatitis B (HBV) (Hep B) infection?

Which factors are associated with low hepatitis B (HBV) (Hep B) vaccination response rates?

Should nonresponders be revaccinated against hepatitis B (HBV) (Hep B)?

Should pregnant patients be vaccinated against hepatitis B (HBV) (Hep B)?

What is the advantage of a combined hepatitis A virus (HAV)/hepatitis B (HBV) (Hep B) vaccine?

What long-term monitoring is needed for individuals with inactive chronic hepatitis B virus (HBV) (Hep B)?

What are the guidelines for monitoring of hepatitis B (HBV) (Hep B) DNA and alanine aminotransferase (ALT) levels?

What long-term monitoring is needed for patients with hepatitis B (HBV) (Hep B) and cirrhosis?

What are the monitoring considerations for patients with hepatitis B (HBV) (Hep B)?

How long does hepatitis B (HBV) (Hep B) persist in the blood and what factors increase the risk of infection flare or reactivation?

What are the recommendations for prophylactic antiviral therapy in patients with hepatitis B (HBV) (Hep B)?

What medications may increase the risk for hepatitis B (HBV) (Hep B) reactivation?

Guidelines

What are the WHO guidelines for follow-up assessment of liver disease in hepatitis B (HBV) (Hep B)?

What are the WHO guidelines for treatment priority in chronic hepatitis B (HBV) (Hep B)?

What are the WHO guidelines for when hepatitis B (HBV) (Hep B) should be treated?

What are the WHO guidelines for when hepatitis B (HBV) (Hep B) should be monitored but not treated?

What are the WHO recommendations for first-line antiviral therapy in hepatitis B (HBV) (Hep B)?

What are the WHO recommendations for first-line antiviral therapy in patients with hepatitis B (HBV) (Hep B) and HIV infection?

What is the WHO recommendation for second-line antiviral therapy in antiviral-resistant hepatitis B (HBV) (Hep B)?

According to the WHO recommendations, which patients with hepatitis B (HBV) (Hep B) require lifelong nucleos(t)ide analog (NA) therapy?

According to the WHO recommendations, which patients may be considered for discontinuation of nucleos(t)ide analogs (NAs) for the treatment of hepatitis B (HBV) (Hep B)?

When is retreatment of nucleos(t)ide analog (NA) for hepatitis B (HBV) (Hep B) recommended by the WHO?

What are the WHO recommendations for monitoring for hepatitis B (HBV) (Hep B) progression?

According to the WHO, which individuals with hepatitis B (HBV) (Hep B) infection do not meet the criteria for antiviral therapy?

What is the WHO recommended monitoring for patients with hepatitis B (HBV) (Hep B) during treatment or following treatment discontinuation?

What is the WHO recommended monitoring of tenofovir and entecavir toxicity in patients with hepatitis B (HBV) (Hep B) infection?

What is the WHO recommendation for monitoring for hepatocellular carcinoma (HCC) and in which patients with hepatitis B (HBV) (Hep B) infection?

What is the WHO recommendation for infant and neonatal hepatitis B (HBV) (Hep B) vaccination?

What is the WHO recommendation for use of antiviral therapy to prevent vertical transmission of hepatitis B (HBV) (Hep B)?

What are the AASLD guidelines for the initial evaluation of hepatitis B surface antigen (HBsAg)-positive patients?

What is the goal of antiviral treatment for hepatitis B (HBV) (Hep B)?

What are the AASLD recommendations for medications for the treatment of chronic hepatitis B (HBV) (Hep B)?

What are the AASLD guidelines for treatment of adults with immune-active chronic hepatitis B (HBV) (Hep B) infection?

What are the AASLD guidelines for the treatment of adults with immune-tolerant chronic hepatitis B (HBV) (Hep B) infection?

What are the AASLD guidelines for the treatment of adults with HBeAg-positive immune-active chronic hepatitis B (HBV) (Hep B)?

What are the AASLD guidelines for the treatment of adults with HBeAg-negative immune-active chronic hepatitis B (HBV) (Hep B) infection?

What are the AASLD guidelines for monitoring renal disease in patients with hepatitis B (HBV) (Hep B)?

What are the AASLD guidelines for patients with poor response to antiviral treatment for hepatitis B (HBV) (Hep B)?

What are the AASLD guidelines for the treatment of cirrhosis and hepatitis B (HBV) (Hep B)?

What are the AASLD guidelines for the treatment of pregnant patients with chronic hepatitis B (HBV) (Hep B)?

What are the AASLD guidelines for the treatment of children with chronic hepatitis B (HBV) (Hep B)?

Medications

What are the goals of pharmacotherapy in the treatment of hepatitis B (HBV) (Hep B) disease?

Which first-line agents are used to treat hepatitis B (HBV) (Hep B)?

Which medications in the drug class Vaccines, Inactivated, Viral are used in the treatment of Hepatitis B?

Which medications in the drug class Antihepadnaviral, Reverse Transcriptase inhibitors are used in the treatment of Hepatitis B?

Which medications in the drug class Interferons are used in the treatment of Hepatitis B?