Clinical assessment of patients with hepatitis B virus infection


KEY POINTS

  • Determining the phase of hepatitis B virus (HBV) infection is essential to the clinical assessment of the patient with HBV.
  • HBV DNA, HBeAg status and liver function testing are all vital components of this assessment.
  • HBV DNA is an important parameter in informing treatment decision. Testing is Medicare rebatable for one test annually for monitoring and up to four tests annually for those on treatment.
  • Fibrosis assessment to determine the stage of liver disease is also important (non-invasive tests, imaging with or without biopsy)
  • Non-invasive methods of assessing hepatic fibrosis such as transient elastography (FibroScan®) are becoming available.
  • Normal alanine aminotransferase (ALT) ranges are being revised downwards (< 19 U/L for females and < 30 U/L for males), and normal liver function tests (LFTs) do not rule out significant hepatic disease.
  • Transmission risks, lifestyle modification, cultural factors and long-term complications associated with chronic hepatitis B (CHB) infection are important components of patient education.
  • When people are diagnosed with hepatitis B, testing, assessment and vaccination should be offered to their household and sexual contacts.
  • All patients with CHB require regular monitoring for liver damage and disease progression.

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