22/04/2026
VTRH WEEKLY CME
*PRESENT* : TIEMA *PERPETUA*
*TOPIC* . : HEPATITIS B
*VENUE* . : CHAPEL
Hepatitis B is a viral infection caused by the Hepatitis B virus (DNA virus) that affects the liver. Highly infectious, 100 times more than HIV, it remains stable outside the body, increasing risk of transmission. Infection can be acute (short-term) or chronic (long-term, >6 months).
Transmission
Vertical -Perinatal (mother → baby) , Horizontal child-child- contact with open sores and wounds, Sexual contact, Parenteral -Blood exposure (needle sharing, transfusion with unscreened blood) , Occupational exposure (needle-stick injuries) , Certain traditional practices-scarification, tattooing, circumcision with unsterile equipment
Clinical Presentation
Acute infection -Often asymptomatic
Fever, fatigue , nausea, vomiting, right upper quadrant pain, Jaundice (late sign)
Chronic infection -Usually asymptomatic for years
Can progress to: Cirrhosis, Hepatocellular carcinoma (HCC)
Diagnosis
Key Tests:
1. HBsAg → indicates infection
2. Anti-HBs → immunity
3. HBeAg → high infectivity
4. Anti-HBe → lower replication
5. HBV DNA (viral load) → replication level
6. ALT → liver inflammation
Management
1. Acute Hepatitis B rarely needs anti-virals unless if its fulminant hepatitis
Usually supportive care and monitoring of LFTs and INR
2. Chronic Hepatitis B Indications for Treatment
Treat if:
HBV DNA > 2,000 IU/mL (or >20,000 depending on HBeAg)
Elevated ALT
Evidence of liver damage (fibrosis/cirrhosis) -use APRI Score and FIB-4
First-line Antivirals
Tenofovir (TDF or TAF) ,Entecavir
Tenofovir (TDF) is most commonly used (also part of HIV regimens like TDF/3TC/DTG).
Treatment Goals-Suppress HBV DNA , Normalize ALT , Prevent cirrhosis and HCC , Achieve HBsAg loss (rare but ideal)
Prevention
1. Vaccination -Highly effective, given at birth + routine immunization
2. Post-Exposure Prophylaxis -HBV vaccine ± HBIG (if high risk)
