Internal Medicine

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

688 Hepatitis B Hepatitis C

■During chemotherapy

➣Risk of HBV flare; consider pre-emptive lamivudine for expected

limited (through 3–6 months post chemotherapy) course

Prevention

■Passive immunization: with HBIG (used alone only in post-OLT set-

ting)

■Active immunization: recombinant vaccine (required component of

all other immunization protocols)

follow-up

During Treatment

■Monitor for potential complications (check CBC, TSH during inter-

feron), and efficacy (ALT, HBeAg, HBV quantitative DNA)

Routine

■Monitor ALT, albumin, prothrombin time, bilirubin, CBC

■Screen for HCC with ultrasound and AFP every 6 months

complications and prognosis

■if adult:

➣90–95% uneventful recovery

➣∼1% fulminant hepatic failure

➣5–10% become chronic carriers

■if child <5 yr:

➣25–50% develop chronic infection

■if acquired perinatally:

➣70–90% become chronically infected

■All chronic carriers at risk for:

➣cirrhosis

➣HCC (∼200-fold relative risk)

Hepatitis C.........................................

BRUCE F. SCHARSCHMIDT, MD

history & physical

History of Exposure

■IV drug use, body piercing, hemodialysis, hemophiliacs, high-risk

sexual exposure