HBV


Prognosis (risk of developing chronic hepatits):
- Adults < 5%
- Infants 90%

HBV graph

Serology Graph


Work-up:
  • HCV genotype, PCR
  • HBV surface Ab, Surface Ag, HBV Core Ab.
  • HAV total Ab
  • R/O autoimmune hepatitis or primary sclerosing Cholangitis:
    • Anti-smooth muscle Ab
    • Anti-mitochondrial Ab
  • CMP, INR for MELD score
  • Iron panel, TIBC, Ferritin
  • RUQ US
  • AFP level

HBV Testing

 
HBsAg (+)
IgM IgG
Acute Chronic
Management:  Supportive Care


 

Post-Exposure Testing
Needle stick from HBsAb (+) person
Is the pt vaccinated?
NO
YES
HBIG immediately (preferably within 24 hrs after exposure) followed by the
hepatitis B vaccine series
(injection in 1 week or less, followed by a second dose in 1 month and a third dose in 6 months)
Check Ab levels (titer)
> 10 < 10
Protective, No re-vacc. or HBIG on exposure Incomplete response to vaccine
hepatitis B vaccine booster dose
+
HBIG
on exposure


  HBsAg HBeAg HBcAb HBsAb
acute + + + -
chronic + + + -
Immune
(post-infection)
- - + +
Immune
(vaccinated)
- - - +
Prognosis (risk of developing chronic hepatits):
- Adults < 5%
- Infants 90%

HBV table

Serology Table
hbv

HBV in Pregnancy

Pregnancy (HBsAg+ Mom):

  • HB vaccine to infant @ birth, 1-2 months & 6 months.
  • HBIG w/ first dose vaccine within 12hr of birth
  • Test infant for immunity @ 9-18 months.
    • if HBsAb (+) = immune
    • HBsAg (+) = pedi GI consult