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Hepatitis B - Management
What further management for chronic hepatitis B is available in secondary care?

  • Refer all people with hepatitis B to a specialist, for consideration of the need for further treatment.
  • Most specialists offer antiviral treatment when there is evidence of at least moderate disease; this is indicated by higher levels of hepatitis B virus-DNA (HBV-DNA) and serum ALT (alanine transaminase), and the findings of non-invasive tests for liver fibrosis or liver biopsy.
    • People with severe, advanced liver disease require rapid treatment.
  • Only rarely do people with chronic hepatitis B clear the hepatitis B surface antigen (HBsAg) by developing antibodies (anti-HBs). Therefore, the goal of treatment is to:
    • Prevent progression of the disease to cirrhosis, end stage liver disease, and hepatocellular cancer.
    • Reduce the viral load to stabilize the disease. However, it is not clear whether suppression of viral replication reduces the incidence of hepatocellular cancer.
  • Specific treatment from two major groups of antiviral drugs may be initiated:
    • Supporting the immune system using interferon therapy.
      • Interferon is given as a defined (finite) course of treatment. It causes no virological resistance, but response rates may be low.
    • Long-term viral suppression with oral nucleosides or nucleotides.
      • Drugs such as tenofovir, entecavir, lamivudine, adefovir, or telbivudine are used.
  • Liver transplantation may be required for end-stage disease.
  • Follow up is important, even if specific antiviral treatment is not initiated.

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