Expert Opinions - Clinical Challenges

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HBV Epidemiology

HBV Epidemiology

Background

HBV Incidence in the United States

HBV Prevalence in the United States

Awareness of HBV Infection Status

Global HBV Epidemiology

Risks Associated with HBV Acquisition

CDC Case Definition and Reporting

HBV Disease Burden and HBV-Related Deaths

Summary Points

HBV Screening, Testing, and Diagnosis

HBV Screening, Testing, and Diagnosis

HBV Screening Recommendations

Rationale for Universal HBV Screening in Adults

HBV Tests

Recommended Screening Tests

Incorporation of HBV Screening into Clinical Workflows

Evolution of Serologic Tests after Infection and Vaccination

Interpretation of HBV Serologic Tests

Summary Points

HBV Immunizations

HBV Immunizations

Background

Vaccine Uptake

Indications for Hepatitis B Vaccination

Prevaccination Serologic Testing

HBV Vaccines and Schedules

Response to HBV Vaccines

Postvaccination Serologic Testing

Management of HBV Vaccine Nonresponders

Summary Points

Initial Evaluation of Persons with Chronic Hepatitis B

Initial Evaluation of Persons with Chronic Hepatitis B

Background

Key Aspects of Medical History

Key Aspects of the Physical Examination

Initial Laboratory Evaluation

Screening for Other Causes of Liver Disease

Evaluation of Fibrosis Stage

Immunizations for Persons with Chronic HBV and Cirrhosis

Counseling Persons with Chronic HBV Following Diagnosis

Summary Points

When to Initiate HBV Treatment

When to Initiate HBV Treatment

Background

Goals of Therapy with Treatment of Chronic HBV

Factors Used to Determine Whether to Initiate Treatment

Hepatitis B Treatment Guidance Recommendations

Special Indications for Initiating Treatment

Summary Points

Choosing an Initial HBV Treatment Regimen

Choosing an Initial HBV Treatment Regimen

Background

Oral Antiviral Therapy Options for HBV

Peginterferon-Based Therapy for HBV

Recommendations for Initial HBV Therapy

Summary Points

Monitoring Persons On and Off HBV Therapy

Monitoring Persons On and Off HBV Therapy

Background

Monitoring Persons with Chronic HBV Who are Not on Treatment

Safety Monitoring in Persons with Chronic HBV on Treatment

Definitions Used for Monitoring Response to Therapy

Monitoring Treatment Response in Persons with Chronic HBV

Overview of Monitoring Persons on Hepatitis B Treatment

Discontinuing Antiviral Therapy Based on Treatment Response

Monitoring after Antiviral Therapy is Stopped

Summary Points

Hepatitis B Reactivation

Hepatitis B Reactivation

Background

Pathophysiology of HBV Reactivation

Clinical Features of HBV Reactivation

Risk Factors for HBV Reactivation

Assessing Risk for HBV Reactivation

Risk Categories for HBV Reactivation

HBV Screening Prior to Initiation of Immunosuppression

Data on Antiviral Therapy to Prevent HBV Reactivation

Recommendations for HBV Prophylactic Antiviral Therapy

Special Populations to Consider for HBV Reactivation

Summary Points

Screening for Hepatocellular Carcinoma

Screening for Hepatocellular Carcinoma

Epidemiology of HBV-Associated Hepatocellular Carcinoma (HCC)

Factors that Impact HBV-Associated HCC

Prognosis of Persons Diagnosed with HCC

Benefit of HCC Screening in Persons with HBV

HCC Surveillance Testing Methods

Guidelines for HCC Surveillance

Summary Points

Preventing HBV Perinatal Transmission

Preventing HBV Perinatal Transmission

Universal Screening for HBV Infection During Pregnancy

Risk of Perinatal HBV Transmission

Route and Timing of Perinatal HBV Transmission

Management of Women with Chronic HBV in Pregnancy

Management of Pregnant Women with Isolated Anti-HBc

Management of Acute HBV in Pregnancy

Safety of Antivirals During Pregnancy

Hepatitis B Flares During Pregnancy and in the Postpartum Period

Management of Neonates Born to HBsAg-Positive Mothers

Breastfeeding in HBsAg-Positive Mothers

Summary Points

Occupational HBV Postexposure Prophylaxis

Occupational HBV Postexposure Prophylaxis

Background

Risk of HBV with Occupational Exposures

Initial Approach to Postexposure Prophylaxis

Interventions for HBV Occupational Postexposure Prophylaxis

Management of Occupational Exposure to HBV

Monitoring of HCP after Occupational HBV Exposure

Efficacy of Occupational Postexposure Prophylaxis for HBV

Summary Points
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HBV Epidemiology

HBV Epidemiology

Background

HBV Incidence in the United States

HBV Prevalence in the United States

Awareness of HBV Infection Status

Global HBV Epidemiology

Risks Associated with HBV Acquisition

CDC Case Definition and Reporting

HBV Disease Burden and HBV-Related Deaths

Summary Points

HBV Screening, Testing, and Diagnosis

HBV Screening, Testing, and Diagnosis

HBV Screening Recommendations

Rationale for Universal HBV Screening in Adults

HBV Tests

Recommended Screening Tests

Incorporation of HBV Screening into Clinical Workflows

Evolution of Serologic Tests after Infection and Vaccination

Interpretation of HBV Serologic Tests

Summary Points

HBV Immunizations

HBV Immunizations

Background

Vaccine Uptake

Indications for Hepatitis B Vaccination

Prevaccination Serologic Testing

HBV Vaccines and Schedules

Response to HBV Vaccines

Postvaccination Serologic Testing

Management of HBV Vaccine Nonresponders

Summary Points

Initial Evaluation of Persons with Chronic Hepatitis B

Initial Evaluation of Persons with Chronic Hepatitis B

Background

Key Aspects of Medical History

Key Aspects of the Physical Examination

Initial Laboratory Evaluation

Screening for Other Causes of Liver Disease

Evaluation of Fibrosis Stage

Immunizations for Persons with Chronic HBV and Cirrhosis

Counseling Persons with Chronic HBV Following Diagnosis

Summary Points

When to Initiate HBV Treatment

When to Initiate HBV Treatment

Background

Goals of Therapy with Treatment of Chronic HBV

Factors Used to Determine Whether to Initiate Treatment

Hepatitis B Treatment Guidance Recommendations

Special Indications for Initiating Treatment

Summary Points

Choosing an Initial HBV Treatment Regimen

Choosing an Initial HBV Treatment Regimen

Background

Oral Antiviral Therapy Options for HBV

Peginterferon-Based Therapy for HBV

Recommendations for Initial HBV Therapy

Summary Points

Monitoring Persons On and Off HBV Therapy

Monitoring Persons On and Off HBV Therapy

Background

Monitoring Persons with Chronic HBV Who are Not on Treatment

Safety Monitoring in Persons with Chronic HBV on Treatment

Definitions Used for Monitoring Response to Therapy

Monitoring Treatment Response in Persons with Chronic HBV

Overview of Monitoring Persons on Hepatitis B Treatment

Discontinuing Antiviral Therapy Based on Treatment Response

Monitoring after Antiviral Therapy is Stopped

Summary Points

Hepatitis B Reactivation

Hepatitis B Reactivation

Background

Pathophysiology of HBV Reactivation

Clinical Features of HBV Reactivation

Risk Factors for HBV Reactivation

Assessing Risk for HBV Reactivation

Risk Categories for HBV Reactivation

HBV Screening Prior to Initiation of Immunosuppression

Data on Antiviral Therapy to Prevent HBV Reactivation

Recommendations for HBV Prophylactic Antiviral Therapy

Special Populations to Consider for HBV Reactivation

Summary Points

Screening for Hepatocellular Carcinoma

Screening for Hepatocellular Carcinoma

Epidemiology of HBV-Associated Hepatocellular Carcinoma (HCC)

Factors that Impact HBV-Associated HCC

Prognosis of Persons Diagnosed with HCC

Benefit of HCC Screening in Persons with HBV

HCC Surveillance Testing Methods

Guidelines for HCC Surveillance

Summary Points

Preventing HBV Perinatal Transmission

Preventing HBV Perinatal Transmission

Universal Screening for HBV Infection During Pregnancy

Risk of Perinatal HBV Transmission

Route and Timing of Perinatal HBV Transmission

Management of Women with Chronic HBV in Pregnancy

Management of Pregnant Women with Isolated Anti-HBc

Management of Acute HBV in Pregnancy

Safety of Antivirals During Pregnancy

Hepatitis B Flares During Pregnancy and in the Postpartum Period

Management of Neonates Born to HBsAg-Positive Mothers

Breastfeeding in HBsAg-Positive Mothers

Summary Points

Occupational HBV Postexposure Prophylaxis

Occupational HBV Postexposure Prophylaxis

Background

Risk of HBV with Occupational Exposures

Initial Approach to Postexposure Prophylaxis

Interventions for HBV Occupational Postexposure Prophylaxis

Management of Occupational Exposure to HBV

Monitoring of HCP after Occupational HBV Exposure

Efficacy of Occupational Postexposure Prophylaxis for HBV

Summary Points
HBV Primary
Care Guidance
HBV
Medications
Oral Antivirals

Adefovir

Tenofovir DF

Tenofovir alafenamide

Entecavir

Lamivudine

Immune Modulators

Peginterferon alfa-2a

Interferon alfa-2b

Vaccines

Engerix-B

Twinrix

Recombivax-HB

Heplisav-B
Tools &
Calculators
Clinical Calculators

AST to Platelet Ratio Index (APRI) Calculator

Body Mass Index (BMI) Calculator

Child-Turcotte-Pugh (CTP) Calculator

Creatinine Clearance (CrCl) Calculator

Fibrosis-4 (FIB-4) Calculator

2021 CKD-EPI Adult eGFR Calculator

Glasgow Coma Scale (GCS)

Model For End-Stage Liver Disease (MELD) for ages 12 and older

PAGE-B Risk Score

Serum-Ascites Albumin Gradient (SAAG) Calculator

Substance Use Screening Tools

CAGE Alcohol Questionnaire

Alcohol Use Disorders Identification Test (AUDIT-C)
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HBV Epidemiology

HBV Screening, Testing, and Diagnosis

HBV Immunizations

Initial Evaluation of Persons with Chronic Hepatitis B

When to Initiate HBV Treatment

Choosing an Initial HBV Treatment Regimen

Monitoring Persons On and Off HBV Therapy

Hepatitis B Reactivation

Screening for Hepatocellular Carcinoma

Preventing HBV Perinatal Transmission

Occupational HBV Postexposure Prophylaxis

HBV Epidemiology

HBV Screening, Testing, and Diagnosis

HBV Immunizations

Initial Evaluation of Persons with Chronic Hepatitis B

When to Initiate HBV Treatment

Choosing an Initial HBV Treatment Regimen

Monitoring Persons On and Off HBV Therapy

Hepatitis B Reactivation

Screening for Hepatocellular Carcinoma

Preventing HBV Perinatal Transmission

Occupational HBV Postexposure Prophylaxis