Management of Fulminant Hepatitis B

Area of Science:

• Hepatology
• Infectious Diseases
• Gastroenterology

Background:

• Acute Hepatitis B virus (HBV) infection and exacerbations of chronic HBV can cause acute liver injury (ALI) or fulminant hepatitis (FH).
• Spontaneous survival rates for HBV-ALI/FH are critically low, below 25%.

Purpose of the Study:

• To provide an overview of the specific management strategies for patients diagnosed with HBV-related ALI/FH.
• To highlight the urgency of differentiating between acute HBV infection and chronic HBV exacerbations for prompt antiviral therapy initiation.

Main Methods:

• Review of current literature and clinical guidelines for managing HBV-ALI/FH.
• Analysis of treatment protocols, including supportive care and liver transplantation.

Main Results:

• Distinguishing between acute HBV infection and chronic HBV exacerbations is crucial for rapid antiviral therapy.
• Management of HBV-related FH involves cardiorespiratory and neurological monitoring, acetylcysteine, organ support, and albumin dialysis.
• Liver transplantation is a viable option for patients meeting poor prognosis criteria, with post-transplant HBV recurrence preventable by HBIG and antiviral therapy.

Conclusions:

• Prompt diagnosis and management are essential for improving outcomes in HBV-ALI/FH.
• Standard FH management protocols apply, with liver transplantation as a last resort.
• Prophylaxis against HBV recurrence post-transplantation is critical.