TREATMENT
■ Acute exposure/needlestick prophylaxis: The CDC recommends that
hepatitis B immune globulin (HBIG) be given within 24 hours along
with vaccine if the patient was not previously immunized.
■ Pegylated interferon-α2a:Given SQ; associated with many side effects (eg,
constitutional, psychiatric, bone marrow toxicity, flare of autoimmune dis-
ease, hepatic decompensation); contraindicated in cirrhosis; the best
responses to treatment obtained with active hepatic inflammation (high
ALT) and low-HBV DNA levels
■ Lamivudine: Given PO; well tolerated but resistance may develop
■ Adefovir:Given PO; well tolerated and may be used to treat lamivudine-
resistant virus; has lower rates of resistance than lamivudine; associated
with renal insufficiency
■ Newer antivirals:Entecavir, telbivudine, and emtricitabine/tenofovir (used
for HIV coinfection)
HEPATITISC
TRANSMISSION
IVDA, intranasal drug use, hemodialysis, blood transfusions before 1992
SYMPTOMS/EXAM
■ Acute HCV: Presents with flulike illness, malaise, weakness, low-grade
fever, myalgias, and RUQ pain followed by jaundice; only 30% of patients
symptomatic in acute disease
■ Chronic HCV:Often asymptomatic or may present with cryoglobuline-
mia associated with a vasculitis skin rash (leukocytoclastic vasculitis),
arthralgias, sicca syndrome, and glomerulonephritis;in the setting of cir-
rhosis, presents with fatigue, muscle wasting, dependent edema, and easy
bruising
ABDOMINAL AND GASTROINTESTINALEMERGENCIESTABLE 11.12. Serologic Patterns for Hepatitis B Infection
HBSAg ANTI-HBS ANTI-HBC HBeAg ANTI-HBe INTERPRETATION+ – IgM + – Acute hepatitis B+ – IgG + – Chronic hepatitis B with active viral replication+ – IgG – + Chronic hepatitis B with low viral replication+ + IgG + or – + or – Chronic hepatitis B with heterotypic anti-HBs (about
10% of cases)- – IgM + or – – Acute hepatitis B
- IgG – + or – Recovery from hepatitis B (immunity)
- – – – Vaccination (immunity)
- – IgG – – False-positive; less commonly, infection in remote past