Hepatitis B HBV

• Facts:
  Transmitted by sexual contact and percutaneous transmission (eg. IV drug use)
  
  HBsAg and anti-HBc best screening tools for acute HBV
  Only positive anti-HBsAg (rest negative) signals prior vaccination
• Diagnosis:
  Elevated ALT, AST (with ALT > AST)
  Increased bilirubin and alkaline phosphatase
  
• Treatment:
  Interferon alpha, lamivudine (3TC) (acute HBV)
  Adefovir (chronic HBV)
  Transplant (fulminant hepatic failure-defined as hepatic encephalopathy that develops within 8 wks of acute liver failure)
• Complications:
  Cirrhosis
  Liver failure
  Hepatocellualr carcinoma
• Notes:
  Serologic markers
  
  HBsAg (carrier state, first evidence of infection)
  HBsAb / anti-HBs (provides immunity)
  HBcAb (positive during window period; recent disease)
  **IgM anti-HBc (most specific marker for diagnosis)
  **IgG anti-HBc (signals recovery from disease)
  
  HBeAg (indicator of transmissibility, BE ware)
  HBeAb (indicator of low transmissibility)
• See Also:
  Hepatitis
• Associated With:
  Membranous glomerulonephritis (especially in children)
• Risk Factors:
  Multiple sexual partners
  Health care workers