chronic hepatitis B
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Introduction
Laboratory
* criteria for treatment (see Management: below)
Diagnostic procedures
- screen for heptocellular carcinoma in at risk patients with ultrasound every six months[1]*
* screening with serum alpha-fetoprotein insufficient[1]
Complications
- chronic active hepatitis
- cirrhosis
- risk factors
- older age
- longer duration of infection
- high hepatitis B virus DNA
- long-term alcohol use
- HIV or hepatitis C virus coinfection
- smoking
- risk factors
- hepatocellular carcinoma
- cirrhosis
- HBV genotype C
- conversion from HBeAg(-) to HBeAg(+)
- male
- family history of hepatocellular carcinoma
- may develop in the absence of cirrhosis[1]
- lipophilic statins (atorvastatin, simvastatin) may reduce (risk 3% vs 8%)[4]
Management
- patients in the immune control (inactive) phase generally do not require treatment[1]
treatment indicated for HBeAg(-) patients with
- serum ALT > 2-fold upper limit of normal &
- hepatitis B virus DNA > 2000 IU/mL
- entecavir* or tenofovir 1st line for treatment[3]
- lamivudine & adefovir no longer 1st line due to lower potency & development of resistance
- pegylated interferon (avoid in patients with depression)
- most patients will require therapy indefinitely
- cure rates are low[3]
- bepirovirsen is an antisense oligonucleotide that targets all hepatitis B virus messenger RNAs & decreases levels of hepatitis B viral proteins (investigational)[5]
* insufficient evidence to assess the effect of entecavir versus no treatment or placebo on all-cause mortality, serious adverse events or health-related quality of life in patients with chronic hepatitis B[6]
More general terms
More specific terms
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Medical Knowledge Self Assessment Program (MKSAP) 17, 19 American College of Physicians, Philadelphia 2015, 2021
- ↑ Lok AS, McMahon BJ Chronic hepatitis B: update 2009. Hepatology. 2009 Sep;50(3):661-2. PMID: https://pubmed.ncbi.nlm.nih.gov/19714720 corresponding NGC AASLD guidelines updated June 2016
- ↑ 3.0 3.1 3.2 Tang LDY, Covert E, Wilson E et al Chronic Hepatitis B Infection. A Review. JAMA. 2018;319(17):1802-1813 PMID: https://pubmed.ncbi.nlm.nih.gov/29715359 https://jamanetwork.com/journals/jama/fullarticle/2679946
- ↑ 4.0 4.1 Simon TG, Duberg AS, Aleman S et al Lipophilic Statins and Risk for Hepatocellular Carcinoma and Death in Patients With Chronic Viral Hepatitis: Results From a Nationwide Swedish Population. Ann Intern Med. 2019 Aug 20. PMID: https://pubmed.ncbi.nlm.nih.gov/31426090 https://annals.org/aim/article-abstract/2748619/lipophilic-statins-risk-hepatocellular-carcinoma-death-patients-chronic-viral-hepatitis
- ↑ 5.0 5.1 Yuen M-F et al. Efficacy and safety of bepirovirsen in chronic hepatitis B infection. N Engl J Med 2022 Nov 8; [e-pub]. PMID: https://pubmed.ncbi.nlm.nih.gov/36346079 https://www.nejm.org/doi/10.1056/NEJMoa2210027
Hoofnagle JH. A modern therapy for an ancient disease. N Engl J Med 2022 Nov 8; [e-pub]. PMID: https://pubmed.ncbi.nlm.nih.gov/36346068 https://www.nejm.org/doi/10.1056/NEJMe2213449 - ↑ 6.0 6.1 Wu J, Xie S, Ma Y, et al. Entecavir for children and adults with chronic hepatitis B. Cochrane Database Syst Rev. 2025 Apr 22;4(4):CD015536. PMID: https://pubmed.ncbi.nlm.nih.gov/40260837 PMCID: PMC12012880 (available on 2026-04-22)