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Hepatitis B management focuses on preventing cirrhosis and liver cancer. Antiviral therapy is recommended for chronic cases with high viral load or cirrhosis, though functional cure remains rare.

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Area of Science:

  • Hepatology
  • Virology
  • Gastroenterology

Background:

  • Acute hepatitis B presents with jaundice and elevated transaminases, typically resolving spontaneously in adults.
  • Chronic hepatitis B is defined by persistent hepatitis B surface antigen for over 6 months.
  • Management of chronic hepatitis B aims to prevent cirrhosis, hepatocellular carcinoma, and liver-related mortality.

Purpose of the Study:

  • To outline the diagnostic criteria for acute and chronic hepatitis B.
  • To detail the evaluation and risk assessment for chronic hepatitis B patients.
  • To define therapeutic goals and indications for antiviral treatment.

Main Methods:

  • Diagnosis relies on serological markers like hepatitis B surface antigen and antibodies.
  • Evaluation includes liver function tests, fibrosis risk assessment, and screening for viral coinfections.
  • Treatment decisions are guided by alanine transaminase levels, hepatitis B DNA, and presence of cirrhosis.

Main Results:

  • Most acute hepatitis B infections are cleared spontaneously by adults (>95%).
  • Oral nucleoside/nucleotide analogues are effective, well-tolerated, and have a high resistance barrier for long-term use.
  • Functional cure (loss of hepatitis B surface antigen) is infrequent with current therapies.

Conclusions:

  • Antiviral therapy is indicated for chronic hepatitis B with elevated ALT and HBV DNA >2,000 IU/mL, or cirrhosis.
  • Prophylactic viral suppression is recommended during immunosuppressive therapy.
  • Regular surveillance for hepatocellular carcinoma is crucial for patients with cirrhosis or at high risk.