Management of Acute Hepatitis B Virus Infection
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HEPATITIS B (JK LIM, SECTION EDITOR)
Management of Acute Hepatitis B Virus Infection Mitchell L. Shiffman 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of the Review This review will summarize the sequence of events which occur when patients develop acute HBV, how flares in chronic HBV can be identified and prevented, and when treatment of acute HBV with antiviral therapy is appropriate. Recent Findings Severe forms of acute HBV may be due to coinfection and superinfection with hepatitis D, and this may be more prevalent than previously thought. Patients with chronic HBV, who develop diseases and require medications that alter the immune response, are at risk to develop flares in HBV. If the patient is not known to have chronic HBV, these flares may be mistaken for acute HBV. Only patients with acute liver failure (ALF) from severe acute HBV should be treated with antiviral therapy. Summary The primary treatment for acute HBV is prevention through vaccination. Patients with chronic HBV at risk for flare and those with ALF from acute HBV should be treated with antiviral therapy. Keywords Acute hepatitis B virus . HBV flare . Hepatitis D virus . HBV vaccination . Acute liver failure
Introduction Hepatitis B virus (HBV) is one of the most common causes of chronic liver disease worldwide. Approximately one-third of the world’s population has serologic markers of previous or current infection [1]. Persons living in China and its bordering countries, Southeast Asia and the Pacific Islands, have the highest prevalence of chronic HBV. Approximately half the populations of these countries have serologic markers of current or previous HBV infection [2]. Chronic HBV is also common in the countries of sub-Saharan Africa, several island countries of the Caribbean, and South America where the prevalence of serologic markers for infection ranges from 8 to 20% [3, 4]. In contrast, less than 2% of the population of the United States of American (USA), Canada, and most countries of the European Union (EU) have serologic markers of exposure to HBV. In these countries, nearly half of all persons with chronic HBV are immigrants from areas of the world with higher prevalence [5]. This article is part of the Topical Collection on Hepatitis B * Mitchell L. Shiffman [email protected] 1
Liver Institute of Virginia, Bon Secours Mercy Health, 5855 Bremo Road, Suite 509, Richmond, VA 23226, USA
Acute HBV occurs when naive individuals interact with persons who have chronic HBV infection. In areas of the world with high prevalence, this most commonly occurs via vertical transmission when children are born to mothers with chronic HBV, or via horizontal transmission by exposure to siblings and other family members with chronic HBV infection [6]. In areas of the world with low prevalence, acute HBV most commonly occurs in non-vaccinated teenagers or young adults who have sexual interactions, share items of personal hygiene, or administer illicit narcotics with a person who has chronic HBV in
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