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

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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 2 months ago

Dr Marius has been my lifesaver in terms of some serious pain I was getting in my stomach. He diagnosed what was happening very quickly based on my symptoms and case and he organised treatment for me straight away resulting in instant pain relief. A doctor that genuinely cares with a lot of expertise and goes above and beyond! Thank you so much Marius.

5 out of 5 stars
posted 4 months ago

An absolutely awesome consultant, with an excellent and genuine concern for patient care. I consider myself extremely fortunately to have been referred under his professional care and his treatment, has genuinely improved my quality of life. By far the most supportive and expert gastroenterologist that I have ever had the pleasure of meeting. Thank you for your continued support.

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posted 7 months ago

Dr Maruis awesome and knowledgeable doctor very helpful and will do above and beyond for his patients. After dignoses he referred me to another specialist for operation and everything went smoothly and recovery. He also called me after to check on me. Highly recommend 100%

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posted a year ago

My son Liam has been under the care of Marius for most of this year with some complex issues which are now resolved. Marius was extremely knowledgeable and professional in his care throughout this process, while offering a kind and empathetic approach to both myself and Liam . I would thoroughly recommend him to anyone seeking the services of a Gastroenterologist.

5 out of 5 stars
posted 11 months ago

Doctor Marius, is an amazong prpfesional that make you feel confident and secure that everything will be fine. Super dedicated and look amazingly well after every patient!!! fully recommend him and his team to look after your health!