Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

686 Hepatitis B

Imaging

■Ultrasound or CT: nondiagnostic; abnormal with advanced disease–

revealing cirrhosis and portal hypertension

Liver Biopsy

■May be used for staging, or to exclude co-existing liver disease

differential diagnosis

■Other viral infections (e.g., HAV, HCV, EBV, etc.), gallstone disease

■Other chronic liver diseases: alcohol, HCV, autoimmune, genetic

diseases

management

What to Do First

■Evaluate the virological status and severity of the liver disease,

including complications and suitability for therapies.

General Measures

■Minimize hepatotoxins (alcohol, potentially hepatotoxic medica-

tions)

■Care of acute infection mainly supportive

■HAV vaccination if susceptible

specific therapy

Indications

■Positive HBeAg, elevated HBV DNA, elevated ALT

Treatment Options

■Interferon (alpha-2b or pegylated alpha-2a)

➣Favorable factors: high ALT and low HBV DNA

➣Loss of viral markers of replication and ALT normalization 20%

more often in treated vs. controls.

■Lamivudine (Epvirir-HBV)

➣Rapid suppression of serum viral DNA, but no clearance of HBsAg

➣May have favorable outcome on progression of fibrosis

➣Viral resistance mutants emerge by first year of therapy in 20%

of patients

➣Optimal duration of therapy currently uncertain

■Adefovir dipivoxil

➣Optimal duration of therapy currently uncertain; generally until

HBeAg seroconversion

➣initial resistance rate lower than lamivudine, but rising