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Hepatitis B: Part II. Updates on Diagnosis and Therapy
Richard Moore Ii1, Claire L Porter2, Jama M Darling3
1Department of Family Medicine at the University of North Carolina, Chapel Hill and North Carolina Department of Health and Human Services, Raleigh.
American Family Physician
|March 16, 2026
Summary
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.
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.
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