Infectious Disease Compendium

Hepatitis B

Microbiology

A virus.

Epidemiologic Risks

Exposure to contaminated blood. So, if you are sharing needles as part of your heroin use, might I suggest it is a suboptimal idea. Sex. And maybe maybe maybe sweat (PubMed). Now whatcha gonna do at the gym with that sweaty barbell?

Reactivates with rituximab and ofatumumab (anti CD20); check before starting.

Syndromes

Hepatitis (acute and chronic), cirrhosis and hepatic cancer. Can get a 'flair' reaction with e seroconversion.

Treatment

(NEJM review 2008)

In head to head trials, telbivudine is superior to adefovir (PubMed) at suppressing Hepatitis B and telbivudine is superior to lamivudine (PubMed).

Adefovir will lead to a prolonged (on medication for 5 years) suppression in about 2/3 of e antigen negative chronic Hepatitis B, the remaining 1/3 will develop resistance (PubMed).

Lamuvudine 100 mg po qd to tid and famciclovir both suppress the disease but resistance occurs over time. Interferon also an option. Entecavir is approved for chronic Hepatitis B but it breeds resistance in HIV (PubMed).

Notes

There is a vaccine. It is very effective, good for at least 30 years . However in HCW's who do not respond to the initial series do not get a better response with more jabs.