Today in 5-minute refresher lectures I will be discussing hepatitis B. Always follow your local guidelines and seek specialist advice. This lecture is only intended as a brief overview.



 Hepatitis B is a virus that affects millions of people around the world. It is vertically transmitted during childbirth, with blood to blood contact as well as sexual transmission. When exposed as a child 90% develop chronic infection, whereas adult develop chronic infection in less than 10%. Interpreting serology is easy if you follow these simple steps. First determine if there is active infection with a positive surface antigen. Then determine if there was past infection due to the presence of the core antibody. Lastly check the surface antibody which becomes positive after vaccination.

Hepb Serology

To determine the management, one must first understand the natural history of hepatitis B. In childhood there is a very high viral load, but the virus does not cause any liver inflammation with a normal ALT. Usually around a patient 2nd decade the patients immune system creates an extra antibody against the hepatitis E antigen, which causes liver inflammation with an elevated ALT due to the immune system attacking infected liver cells. With these extra e antibodies, the patient then goes into the immune control phase where these is low viral load and no liver inflammation with a normal ALT. However, the viral can develop a mutation in the promoter region of the e antigen gene.  This stops production of e antigen by the virus and therefore allows it to escape the immune system. The immune escape phase is characterised by high ALT, high viral load, but negative e antigen.

Hepb Serology2

Treatment of hepatitis B should be initiated by a gastroenterologist. In general, we treat people with antiviral treatment such as tenofovir or entecavir when people are in the immune-clearance or immune escape phase. We also treat people with cirrhosis regardless of viral load. A Chinese study randomised pregnant women to placebo vs tenofovir and found that vertical transmission risk increased when viral load > 6 log 10. Pregnant women with high viral load should be started on tenofovir during 3rd trimester and continued for 6 months post-partum.

Some patient remain the immune-tolerance phase and we know that the risk of liver cancer has a linear relationship to the viral load. The special authority requirement has been removed in New Zealand for anti-viral treatment, allowing us to also treat these patients that are at higher risk for the development of cirrhosis and liver cancer.

I hope you enjoyed this brief overview of hepatitis B. In New Zealand there is the hepatitis foundation who offers a fantastic service to monitor hepatitis B patients with regular blood tests. Please consult a gastroenterologist for any specific patient questions.


5 out of 5 stars
posted 3 weeks ago

Dr. Van Rijnsoever is an excellent Gastroenterologist and Highly recommended. He was very helpful and provided me all with all the information I needed as well referrals, the procedure and reports for immigration. I would definitely refer anyone to him. 5 STARS!

5 out of 5 stars
posted 11 months ago

Dr Marius. I am writing to express my appreciation for all that Dr Marius has been able to do so i have been able to avoid major surgery. I have adenocarcinoma,(cancer in the duodenum). I was offered an extremely invasive operation called Whipple. This involves extensive cutting and rejoining of the liver pancreas and gall bladder with all its aftermath and infection risks. I chose not to have this as i preferred to have quality of life rather than longevity. Sadly i have been up close to...

5 out of 5 stars
posted 3 months ago

Dr Marius was very attentive and responded fully to my description of my state of health (physically and psychologically/emotionally). He was able to provide me with relevant information to assist me in moving forward, and made referrals to ensure that anything needing to be checked could be checked. Matthew Connolly

5 out of 5 stars
posted a month ago

I suffer from Eosinophilic esophagitis, & Marius has been the most qualified surgeon that I have ever had doing the procedure of GI endoscopy. He is very informative. About the only person I would trust to do a Endoscopy procedure correctly & safely. I very much recommend, hence 5 stars.

5 out of 5 stars
posted 10 months ago

Marius was the first person to take my condition seriously, and do everything in his power to help me. Even when my issues went outside of his scope of work. He is empathetic and diligent, and has been an heavy weight in my corner and my ace up my sleeve. I’m so grateful for him, and would highly recommend.