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Hepatitis B - Management
What follow up and monitoring should occur for people with hepatitis B?
- For people with acute hepatitis B, repeat hepatitis serology after 6 months to exclude or detect chronic infection, even if liver function tests are normal.
- Persistence of hepatitis B surface antigen (HBsAg) in the serum for 6 months or longer indicates chronic hepatitis.
- All people with chronic hepatitis B should be reviewed at intervals of 1 year (or less) by a physician with appropriate expertise. This is to:
- Monitor progress. Various indicators are used, including:
- ALT (alanine transaminase) and/or AST (aspartate transaminase) levels, in conjunction with trends in hepatitis B virus-DNA (HBV-DNA).
- Loss of positivity to HBsAg qualifies as remission (but is rare).
- Seroconversion (from positive to negative) for hepatitis B e-antigen (HBeAg, an indicator of viral replication) or positivity for antibodies to HBeAg (anti-HBe).
- Screen for hepatocellular cancer in people with cirrhosis.
- Ultrasound examinations and regular determinations of alpha fetoprotein are used to screen people at high risk. This is particularly important for those older than 40 years of age who acquired hepatitis B during childhood and who have cirrhosis.
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