Results: Patient with chronic hepatitis B

A 42-year-old man, of eastern European origin, attends an emergency department and is diagnosed with chronic hepatitis B. He consumes 10 units of alcohol per week and has a BMI of 26. He is not known to have any medical issues. Laboratory testing returns serum alanine transaminase (ALT) of 54 IU/L (normal 30–50IU/L). He is hepatitis B surface antigen positive, e-antigen positive, IgM anti-HBc negative and with detectable viral load of 12,000IU/mL. Anti-HDV is negative.

• HBV genotyping is not necessary in the initial evaluation, although it may be useful for selecting patients to be treated with pegylated interferon-alpha (PegIFN-α) and offering prognostic information for the probability of response to PegIFN-α therapy and the risk of hepatocellular carcinoma (HCC). Only patients with mild to moderate fibrosis (and possibly those with compensated advanced chronic liver disease) should be considered for PegIFN-α therapy.
• HBV genotypes A and B are associated with higher rates of HBV surface antigen loss (rates of 35%–54% and 21%–27% respectively) than genotypes C and D in response to PegIFN-α therapy.
• PegIFN-α in HBV genotype C achieves a 19%–32% sustained virological response (SVR) rate.
• PegIFN-α is less effective in HBV genotypes D or E (7%–15% and 20% SVR rate respectively).

If it is felt that it would be beneficial to know which HBV genotype the patient has to guide treatment decisions (usually after discussion at the hepatitis operational delivery network multidisciplinary meeting), then you should complete HBV genotyping tests as per your local virology policy.

For clinicians

• British Association of Sexual Health and HIV: Management for Viral Hepatitides 2017
• NICE: Hepatitis B
• World Health Organisation: Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection

References:

• European Association for the Study of the Liver. ‘EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection‘. Journal of Hepatology 2017: volume 67, issue 2, pages 370–398. DOI: 10.1016/j.jhep.2017.03.021
• Terrault NA, Lok ASF, McMahon BJ and others. ‘Update on Prevention, Diagnosis, and Treatment of Chronic Hepatitis B: AASLD 2018 Hepatitis B Guidance‘. Clinical Liver Disease 2018: volume 12, issue 1, pages 33–34. DOI: 10.1002/cld.728

For patients

• British Liver Trust: Hepatitis B
• Bumps (Best Use of Medicines in Pregnancy): Hepatitis B vaccine (for pregnant women)
• NHS Health A to Z: Hepatitis B
• Patient.info: Hepatitis B
• World Health Organisation: Hepatitis B