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Hepatitis B (HBV)

SOURCE

Source: Deming P. Viral hepatitis. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=132516044. Accessed April 10, 2017.

DEFINITION

  • Acute or chronic viral infection of liver.

  • Associated with development of:

    • Chronic cirrhosis.

    • Hepatocellular carcinoma (HCC)

ETIOLOGY

  • DNA virus, Hepadnaviridae family.

PATHOPHYSIOLOGY

  • Virion attaches to hepatocyte cell surface receptors and replicates.

  • HBV is not pathogenic to cells.

    • Immune response to virus cytotoxic to hepatocytes.

    • Destruction of heptocytes releases alanine transaminase (ALT), thus increasing levels.

  • Liver attempts to regenerate in environment of persistent inflammation, resulting in cirrhosis.

  • HCC develops after years of inflammatory processes provoked by ongoing HBV infection.

EPIDEMIOLOGY

  • Infection transmitted through activities that involve percutaneous or mucosal contact with infectious blood or body fluids.1

    • Parenterally (injection drug use; needle sticks, or sharp instrument exposures)

    • Perinatally.

    • Sexually.

PREVENTION AND SCREENING

  • Prophylaxis with:

    • HBV vaccine for active immunity (Tables 1 and 2)

    • Hepatitis B immune globulin (HBIG) for temporary passive immunity in postexposure cases2

  • Common vaccine side effects include (lasting ~1–2 days)3

    • Soreness at injection site (3–29% most common)4

    • Fever (1–6% most common)4

    • Headache.

    • Fatigue.

    • Irritability.

  • Immunization goals:

    • Prevention of short-term viremia to limit:

      • Transmission of infection.

      • Clinical disease.

      • Chronic HBV infection.

TABLE 1.Recommendations for Hepatitis B Virus (HBV) Vaccination
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TABLE 1. Recommendations for Hepatitis B Virus (HBV) Vaccination

Infants—within 24 hours of birth.

Adolescents, including all previously unvaccinated children <19 years old.

All unvaccinated adults at risk for infection:

  • Sexual exposure.

    • Sex partners of HBsAg-positive persons.

    • Sexually active persons not in mutually monogamous relationship.

    • Persons seeking evaluation/treatment for STI

    • MSM

  • Percutaneous or mucosal exposure to blood.

    • Recent/current uses of injection drugs.

    • Household contacts of HBsAg-positive persons.

    • Residents and staff of facilities for developmentally disabled persons.

    • Incarcerated.

    • Healthcare and public safety workers.

    • Age <60 with diabetes mellitus.

    • Age ≥60 with diabetes mellitus at discretion of treating clinician.

  • Chronic liver disease, including but not limited to.

    • Hepatitis C virus infection.

    • Cirrhosis.

    • Fatty liver disease.

    • Alcoholic liver disease.

    • Autoimmune hepatitis.

    • ALT or AST level >2x upper limit of normal.

  • Adults with ESRD, including those in predialysis care, with hemodialysis, peritoneal dialysis, or home dialysis.

  • Adults with HIV infection.

  • Pregnant women at risk for HBV infection.

    • More than one sex partner in previous 6 months.

    • Previously evaluated for STI

    • Recent or current injection drug use.

    • HBsAg-positive sex partner.

  • International travelers to regions with high or intermediate levels of endemic HBV infection.

  • Adults in following settings:

    • STI treatment facilities.

    • HIV testing and treatment facilities.

    • Drug-abuse treatment and prevention facilities.

    • Healthcare settings targeting services to persons who ...

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