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Posted on June 2, 2024 by Tom Wade MD
All that follows is from The Curbsiders‘ #440 Hepatitis B with Dr. Arthur Kim*.
May 20, 2024 | By Malini Gandhi.
*Gandhi MM, Kim A, Williams PN, Watto MF. “#440 Hepatitis B with Dr. Arthur Kim”. The Curbsiders Internal Medicine Podcast. thecurbsiders.com/category/curbsiders-podcast Final publishing date May 20, 2024.
Transcript available via YouTube
Become a pro in Hepatitis B! Dr. Arthur Kim teaches us how to approach Hepatitis B screening and vaccination in primary care, provides pearls on counseling patients with chronic Hepatitis B infection, and summarizes considerations for Hepatitis B antiviral treatment and monitoring.
Show Segments
- Intro
- Case from Kashlak
- Hepatitis B screening – who should be screened?
- Hepatitis B screening – interpreting test results
- Hepatitis B vaccination
- Stages of Chronic HBV infection
- Counseling patients with chronic HBV about preventing transmission and protecting liver health
- Treatment of chronic HBV infection
- Screening for hepatocellular carcinoma
- Outro
Hepatitis B Pearls
- Updated CDC guidelines recommend that all adults should be screened for Hepatitis B at least once in their lifetime. Several populations may need repeat testing after initial screening, including those without adequate immunity who have ongoing risk factors and those with a greater than average risk of reactivation (such as patients who are about to initiate immunosuppressive therapy).
- Hepatitis B screening consists of “triple testing” for Hepatitis B surface antigen, Hepatitis B surface antibody, and Hepatitis B core antibody. Keep an eye out for false HBV core antibody positivity in the setting of IVIG, and false HBV surface antigen positivity in the setting of patients tested immediately after same-day vaccination.
- Available Hepatitis B vaccination formulations include the traditional three vaccine series, a combination HBV / HAV vaccine, the new PreHevbrio vaccine, and the CpG-adjuvanted vaccine. The CpG-adjuvanted vaccine may offer a promising option for populations who are immunocompromised / have traditionally not responded well to the standard vaccine; it is also increasingly being used for a second vaccine series in patients who did not respond to their initial series.
- Patients with a new diagnosis of chronic Hepatitis B should be counseled on how to prevent transmission to others, as well as how to protect their liver health.
- Treatment for Hepatitis B is warranted in patients with cirrhosis, as well as non-cirrhotic patients with evidence of active disease (based on ALT levels and HBV DNA). The preferred treatment regimens for HBV are tenofovir (in the form of tenofovir alafenamide or tenofovir disoproxil fumarate), or entecavir.
- Hepatocellular carcinoma screening should be conducted every 6 months with abdominal ultrasound +/- alpha-fetoprotein in several subsets of patients with chronic HBV at elevated risk of HCC.
