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 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 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 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 the X gene in the pathophysiology of hepatitis B (HBV) (Hep B) infection?
How are hepatitis B (HBV) (Hep B) genome variants identified?
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)?
What is the role of oval cells proliferation in the pathogenesis of hepatocellular carcinoma (HCC)?
What is the intrinsic hepatocarcinogenic activity in 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 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?
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 prognosis of renal disease in hepatitis B (HBV) (Hep B) related to?
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 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
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)?
When are foreign-born residents of the US screened for hepatitis B (HBV) (Hep B)?
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 findings are diagnostic for chronic hepatitis B (HBV) (Hep B)?
How is chronic hepatitis B (HBV) (Hep B) disease categorized?
What are the increased risks of HBeAg-negative of chronic hepatitis B (HBV) (Hep B)?
What is the role of imaging studies in the diagnosis of 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?
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)?
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 guidelines for the treatment of chronic hepatitis B (HBV) (Hep B)?
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 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)?
Which findings indicate resolution of the hepatitis B (HBV) (Hep B) infection?
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 role of lamivudine (3TC) in the treatment of hepatitis B (HBV) (Hep B)?
How is polyarteritis nodosa (PAN) treated in patients with hepatitis B (HBV) (Hep B) 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)?
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?
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 patients with hepatitis B (HBV) (Hep B) and cirrhosis?
What are the monitoring considerations for 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 monitoring for hepatitis B (HBV) (Hep B) progression?
What is the WHO recommendation for infant and neonatal hepatitis B (HBV) (Hep B) vaccination?
What is the goal of 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 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 Interferons are used in the treatment of Hepatitis B?
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Hepatitis B. Under higher-power magnification, ground-glass cells may be visible in chronic hepatitis B virus (HBV) infection. Ground-glass cells are present in 50% to 75% of livers with chronic HBV infection. Immunohistochemical staining is positive for hepatitis B surface antigen (HBsAg.)
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Hepatitis B. Liver biopsy with hematoxylin stain showing stage 4 fibrosis (ie, cirrhosis) in a patient with hepatitis B.
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Hepatitis B. Hepatitis B virus (HBV) is a hepadnavirus, highly resistant to extremes of temperature and humidity, that invades the hepatocytes. The viral genome is a partially double-stranded, circular DNA linked to a DNA polymerase that is surrounded by an icosahedral nucleocapsid and then by a lipid envelope. Embedded within these layers are numerous antigens that are important in disease identification and progression. Within the nucleocapsid are the hepatitis B core antigen (HBcAg) and precore hepatitis B e antigen (HBeAg), and on the envelope is the hepatitis B surface antigen (HBsAg). Transmission electron micrograph (TEM) from Graham Colm and Wikipedia, licensed under the Creative Commons Attribution 3.0 Unported license.
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Hepatitis B. Serologic course of hepatitis B virus (HBV) infection. The flat bars show the duration of seropositivity in self-limited acute HBV infection. The pointed bars show that HBV DNA and e antigen (HBeAg) can become undetectable during chronic infection. Only immunoglobulin G (IgG) antibodies to the HBV core antigen (anti-HBc) are predictably detectable after resolution of acute hepatitis or during chronic infection. Antibody to hepatitis B surface antigen (anti-HBs) is generally detectable after resolution of acute HBV infection but may disappear with time. It is only rarely found in patients with chronic infection and does not indicate that immunologic recovery will occur or that the patient has a better prognosis. ALT = alanine transaminase. (Adapted from Liaw YF, Chu CM. Hepatitis B virus infection. Lancet. 2009;373(9663):582-92.)
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Hepatitis B. Radiologic studies may be useful in all stages of hepatitis B infection. Ultrasonography, computed tomography (CT) scanning, or magnetic resonance imaging (MRI) may exclude biliary obstruction in acute infection. In chronic disease, ultrasonograms may show nonspecific increased echogenicity of the liver parenchyma. In patients with long-standing disease, CT imaging may be used to detect cirrhosis or hepatocellular carcinoma (as shown).
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Hepatitis B. Long-standing cirrhosis leads to progressive replacement of liver parenchyma with fibrotic tissue. Over time, the liver contracts and develops a lobulated contour. These changes are readily apparent on cross-sectional imaging. This contrast-enhanced computed tomography (CT) scan demonstrates extensive cirrhosis, as well as malignant hepatocellular lesions (arrow).
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Hepatitis B. Liver biopsy with hematoxylin stain showing stage 4 fibrosis (ie, cirrhosis) in a patient with hepatitis B.