HBV

Questions and Answers

What percentage of patients with adult-acquired hepatitis B infection are at risk of developing chronicity?

1-5% (correct)

50%

90%

10-30%

In chronic HBV infection, which symptom is most frequently reported?

Nausea

Jaundice

Fatigue (correct)

Abdominal pain

Which condition is characterized by severe cholestatic jaundice and deterioration of graft functions in liver transplant recipients?

Acute hepatitis

Hepatocellular carcinoma

Fibrosing cholestatic hepatitis (correct)

Chronic hepatitis

What is the defining criterion for chronic HBV infection diagnosis?

Persistent HBsAg and high titers of HBV DNA for more than 6 months Signup and view all the answers

Which of the following extrahepatic manifestations is associated with chronic hepatitis B infection?

Polyarteritis nodosa Signup and view all the answers

What percentage of patients with chronic hepatitis B may experience symptoms?

10-30% Signup and view all the answers

Which of the following is NOT a common symptom of chronic hepatitis B infection?

Severe abdominal cramps Signup and view all the answers

What is a rare but severe form of liver injury associated with HBV reactivation in immunosuppressed patients?

Fibrosing cholestatic hepatitis Signup and view all the answers

What does the presence of HBsAg in serum initially indicate in relation to hepatitis B?

Early stages of acute infection Signup and view all the answers

Which marker signifies diminished viral replication and decreased infectivity in hepatitis B infections?

Anti-HBe Signup and view all the answers

What is the significance of the quantitative HBsAg (qHBsAg) level in hepatitis B treatment?

Reflects the level of viral secretion Signup and view all the answers

How long after acute illness does HBsAg commonly persist in chronic hepatitis B infection?

More than 6 months Signup and view all the answers

Which phase of chronic hepatitis B infection is associated with the presence of HBeAg?

Phase 2 and 4 Signup and view all the answers

What is the typical recovery time for acute hepatitis B in most adults?

3 to 6 months Signup and view all the answers

Which test result indicates a diagnosis of acute hepatitis B during the window period?

Anti-HBc IgM Signup and view all the answers

What percentage of patients with chronic hepatitis B may develop cirrhosis?

Up to 40% Signup and view all the answers

Who should receive screening for HBV infection?

High-risk groups and all pregnant women Signup and view all the answers

What characteristic defines a protective immune response from the HBV vaccine?

Anti-HBs titer >10 mIU/mL Signup and view all the answers

What should be done for unvaccinated persons after exposure to HBsAg-contaminated material?

Administer post-exposure hepatitis B immune globulin (HBIG) Signup and view all the answers

What is the optimal goal of therapy for chronic hepatitis B?

Functional cure defined as loss of HBsAg and HBV DNA Signup and view all the answers

In which patients is post-vaccination anti-HBs titer testing necessary?

Healthcare workers and immunocompromised patients Signup and view all the answers

What is the recommended site for the administration of the HBV vaccine for best absorption?

Deltoid muscle via intramuscular injection Signup and view all the answers

Which group is most likely to exhibit low vaccination response rates to HBV vaccine?

People with advanced age and obesity Signup and view all the answers

What measure is unnecessary for patients infected with HBV who are under treatment?

Strict isolation protocols Signup and view all the answers

What is a common side effect associated with telbivudine treatment?

Elevated creatine kinase levels Signup and view all the answers

In which scenario can NUCs be discontinued?

HBeAg-positive chronic hepatitis patients achieving stable seroconversion Signup and view all the answers

What is the typical dosing schedule for pegylated interferon alpha (PEG-IFNα)?

180 mcg subcutaneously once weekly Signup and view all the answers

What is one of the contraindications for pegylated interferon alpha treatment?

Major psychiatric illness Signup and view all the answers

What percentage of patients treated with PEG-IFNα may maintain virological response after drug withdrawal?

40-45% Signup and view all the answers

What is a potential adverse effect of PEG-IFNα treatment?

Neuropsychiatric symptoms Signup and view all the answers

What is the reported rate of HBsAg seroclearance after a 3-year post-treatment follow-up of PEG-IFNα?

3-8% Signup and view all the answers

Which patient demographic is pegylated interferon alpha particularly recommended for?

Young women planning for pregnancy Signup and view all the answers

What is the primary goal of antiviral therapy for HBV?

Long-term viral suppression Signup and view all the answers

Which type of antiviral therapy is preferred for patients with decompensated cirrhosis?

Oral nucleoside and nucleotide analogs (NUCs) Signup and view all the answers

Which of the following NUCs has been noted to cause lactic acidosis in patients with decompensated cirrhosis?

Entecavir Signup and view all the answers

Which of the following NUCs is least potent for treating HBV?

Adefovir dipivoxil Signup and view all the answers

What is a significant concern associated with long-term use of Tenofovir disoproxil fumarate?

Risk of renal toxicity and low bone density Signup and view all the answers

Which NUC therapy is associated with the lowest rates of HBsAg seroclearance?

Lamivudine Signup and view all the answers

What is a critical consideration when switching therapy for patients with HBV resistance?

Using TDF or TAF if no lamivudine-resistant mutants are present Signup and view all the answers

What is the desired endpoint for HBeAg-positive patients receiving antiviral therapy for HBV?

HBeAg loss with or without anti-HBe seroconversion Signup and view all the answers

Study Notes

Acute Hepatitis B

Clinical manifestations range from asymptomatic to icteric hepatitis; may rarely lead to fulminant hepatitis.
Acute illness typically resolves within 2-3 weeks; full clinical recovery by 16 weeks.
Perinatal or childhood infections have high chronicity (90%); adult infections exhibit low chronicity rates (1-5%).
Immunocompromised patients are at higher risk for chronic HBV infection.

Chronic Hepatitis B

Chronic HBV infection is diagnosed when HBsAg and high HBV DNA persist for over 6 months.
Symptoms include fatigue; physical exams reveal signs of chronic liver disease.
10-30% of patients with chronic hepatitis B may exhibit symptoms.
Serious complications include cirrhosis and hepatocellular carcinoma (HCC).
Acute disease flares can mimic acute hepatitis.

Diagnosis and Serological Markers

Elevated serum aminotransferase levels characterize acute hepatitis B; marked cholestasis is not present.
Key serological markers include:
- HBsAg: First indicator of acute infection; becomes undetectable in recovering patients.
- Anti-HBs: Signifies recovery and non-infectivity; may show a "window period" before detection.
- Anti-HBc IgM: Indicates active acute hepatitis B; appears shortly after HBsAg.
- Anti-HBc IgG: Indicates recovery; appears with anti-HBs.
- HBeAg: Indicates HBV replication; appears shortly after HBsAg.
- Anti-HBe: Signals diminished viral replication; appears after HBeAg.

Prognosis and Statistics

Acute hepatitis B resolves in 90-95% of adults within 3-6 months.
Acute liver failure occurs in <1% of cases with high mortality (up to 60%).
Risk of cirrhosis in chronic HBV is 40%; higher in co-infected patients (HCV/HIV).
Annual HCC risk in cirrhosis patients is 3-5%.

Prevention Strategies

Regular screening for high-risk groups and all pregnant women for HBsAg is essential.
Blood donation screening significantly reduces transfusion-related hepatitis risk.
Universal vaccination programs have shown promising results in endemic areas.

Immunoprophylaxis

HBV Vaccine: Recommended for infants, children, and high-risk adults. Safe in pregnancy, with various formulations available.
Hepatitis B Immune Globulin (HBIG): Provides post-exposure prophylaxis if given within 7 days after exposure. Critical for newborns from HBsAg-positive mothers.

Treatment of Hepatitis B

Acute Hepatitis B: Primarily supportive; may require antiviral treatment in severe cases.
Chronic Hepatitis B:
- No complete cure; aim for "functional cure" (loss of HBsAg and HBV DNA).
- Two primary antiviral therapy types: Nucleoside and Nucleotide analogs (NUCs) and Pegylated Interferon Alpha (PEG-IFNα).

Antiviral Therapy

Nucleoside and Nucleotide Analogs (NUCs):
- Include lamivudine, entecavir, adefovir, TDF, and TAF.
- High barrier to resistance; long-term therapy required.
- Entecavir and TDF are first-line treatments; TAF has less renal toxicity.
Pegylated Interferon Alpha (PEG-IFNα):
- Alternative to NUCs with both antiviral and immunomodulatory effects.
- Limited course; potential for sustained response post-treatment.
- Common side effects include flu-like symptoms and myelosuppression.

Monitoring and Follow-Up

Monitoring for HBsAg loss and virial suppression is crucial after antiviral therapy.
Close follow-up is necessary for patients at high risk of reactivation following NUC discontinuation.

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Description

This quiz delves into the clinical manifestations of acute hepatitis B, covering asymptomatic, icteric, and fulminant cases. It examines the recovery timeline and contrasts perinatal versus adult-acquired infections. Test your understanding of this important viral infection's characteristics and outcomes.

HBV