Hepatitis B
Overview
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- Diagnosis - cause (if known), when diagnosed
- Manifestations - cirrhosis, polyarteritis nodosa, membranous glomerulonephropathy
- Management - antivirals, surveillance
Risk Factors for Hepatitis B Infection
- Certain ethnic groups
- Children of hepatitis B positive mothers
- Iatrogenic exposure - surgery, colonoscopy, haemodialysis, blood transfusion prior to 1990
- High risk sexual behaviour
- Healthcare workers
- IV drug use
- Prisoners
- Tattoos
Manifestations
Manifestations of Hepatitis B Infection
Hepatic
- Acute hepatitis
- Chronic hepatitis
- Cirrhosis
- Hepatitis D infection
Extrahepatic
- Polyarteritis nodosa
- Membranous glomerulonephropathy
- Serum sickness-like syndrome (fevers, rash, myalgias, arthralgias)
Phases of Hepatitis B Infection
- Immune tolerant - very early infection, prior to significant hepatitis
- Immune active - attempted clearance of the virus by the immune system
- Immune control - low viraemia due to clearance
- Immune escape - recrudescence of viral replication and hepatitis
Management
Management of Hepatitis B
Non-Pharmacologic
- Cirrhosis surveillance
- HCC surveillance
Pharmacologic
- Nucleoside analogues - entecavir, lamivudine
- Nucleotide analogues - tenofovir
- Pegylated interferon
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