Chronic Hepatitis B
A 45-year-old male Chinese university lecturer presented to his GP with malaise and dark urine. He was referred to the local infectious diseases clinic, and blood tests were as follows:
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Key Learning Points
• 240 million people worldwide are estimated to be infected with hepatitis B virus. • Infection occurs through exposure to infected blood or body fluids. • Complications of chronic infection include cirrhosis and hepatocellular carcinoma. • The hallmark of chronic infection is positivity of the hepatitis B surface (HBsAg) 6 months beyond the time of infection. • The formal implementation of a universal vaccination programme would have a profound effect on HBV related morbidity and mortality.
N. Hansi • U. Gill Clinical Research Fellow, Blizard Institute, Barts and The London SMD, QMUL, Newark St, London E1 2AT, UK P. Kennedy () Reader in Hepatology, Blizard Institute, Barts and The London SMD, QMUL, Newark St, London E1 2AT, UK e-mail: [email protected] T. Cross (ed.), Liver Disease in Clinical Practice, In Clinical Practice, DOI 10.1007/978-3-319-43126-0_10, © Springer International Publishing Switzerland 2017
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• Current treatments are pegylated interferon and nucleos(t)ide analogues. • Historically treatment has focused on normalisation of transaminases and viral suppression, but the gold standard of treatment is now considered to be loss of HBsAg.
Case Study A 45-year-old male Chinese university lecturer presented to his GP with malaise and dark urine. He was referred to the local infectious diseases clinic, and blood tests were as follows: Bilirubin 36 μmol/L, ALT 563 IU/L, ALP 149 IU/L, albumin 38 g/dL and PT 13 s HBsAg positive, HBeAg positive, HBeAb negative, antiHBc IgM negative, HBcAb positive, HDV IgM negative and HIV negative Answer true or false to all of the following questions. What further investigations should be requested? A. B. C. D. E.
A FibroScan or liver fibrosis determination method A liver autoimmune profile Immunoglobulins Hepatitis E IgM A liver ultrasound
A FibroScan shows a liver stiffness measurement of 8 KPa. The patient refuses to have a liver biopsy at this time. What treatments should you consider for this patient? A. B. C. D. E.
No treatment, the patient should be observed. Corticosteroids. Ledipasvir. Pegylated interferon. Entecavir.
Five years later the patient re-presents with the following blood results. He has become jaundiced over the last 2 weeks.
Chapter 10. Chronic Hepatitis B
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He feels tired and lethargic but otherwise well. Clinical examination is unremarkable, other than the presence of yellow sclerae. Bilirubin is 86 μmol/L, ALT 2437 IU/L, ALP 219 IU/L, albumin 36 g/dL and PT 19 s; HBsAg is positive, HBeAg negative, HBeAB positive, HB IgM negative, HBcAb positive, HDV IgM negative and HIV negative. Liver autoimmune and immunoglobulin profile is normal. Which of the following statements are true? A. A history should be taken to determine use of medications (including paracetamol) and traditional medicines. B. The patient needs to be referred immediately for assessment for emergency liver transplantation. C. He should be treated with pegylated interferon. D. He could be treated with an n-acetylcysteine infu
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