Clinical Care of Hepatitis B

Key points

  • Clinicians should work with patients to monitor and slow liver damage.
  • Although treatment is not considered curative, antiviral treatment, monitoring, and liver cancer surveillance can reduce morbidity and mortality.
  • People with chronic hepatitis B should be under the care of a clinician with expertise in managing hepatitis B.
A patient sitting on an exam table speaking with a healthcare professional

Treatment options

Clinicians should make supportive care treatment decisions based on the patient. Typically, rest and a balanced diet with healthy food and plenty of fluids are enough to treat symptoms. The decision to hospitalize patients should be individualized.

There are several antiviral medications available for patients with chronic hepatitis B virus (HBV) infection. However, not every person with chronic hepatitis needs medication, and the drugs may cause side effects in some patients.

Treatment recommendations

Clinicians typically use supportive care to treat patients with acute HBV infection, depending on the patient's symptoms. Treatment for chronic hepatitis B will depend on several factors.

Postexposure prophylaxis

If a person has been exposed to HBV, clinicians should give appropriate prophylaxis as soon as possible, preferably within 24 hours, to effectively prevent infection. The mainstay of postexposure immunoprophylaxis is hepatitis B vaccine, in certain circumstances, the addition of hepatitis B immune globulin (HBIG) provides increased protection.

For more information about treatment of HBV exposure and postexposure prophylaxis, see:

Treatment precautions

Treatment approaches will differ depending on several factors including the patient’s medical history, existing risk factors, pregnancy status, and the presence of comorbidities.

Pregnant patients

The AASLD recommends giving pregnant people with HBV DNA levels greater than 200,000 IU/ML antiviral therapy to reduce perinatal HBV transmission.

In addition, clinicians should advise pregnant patients with hepatitis B that their newborns should receive both hepatitis B vaccine and HBIG at the time of birth.

For more information on treating pregnant patients with HBV infection, visit Hepatitis B Perinatal Provider Clinical Overview.

Coinfected patients

Patients coinfected with HCV infection and HBV infection who are receiving direct-acting antiviral (DAA) therapy for HCV infection are at risk of HBV reactivation. Clinicians should test all patients starting hepatitis C treatment with DAA therapy for HBV infection with HBsAg, antibody to hepatitis B surface antigen (anti-HBs), and antibody to hepatitis B core antigen (anti-HBc). Monitor patients and consider HBV antiviral treatment for patients during HCV treatment if they have evidence of HBV infection.

For more information about reactivation risks, see long-term effects of HBV infection section on our hepatitis B clinical overview.

For more information about treating HBV/HCV coinfected patients, see:

Helping patients stay well

People with chronic hepatitis B should be under the care of a clinician with expertise in managing hepatitis B. To help patients stay healthy, clinicians should talk to their patients about:

  • Getting vaccinated against hepatitis A and tested for hepatitis C.
  • Limiting alcohol use.
  • Following a healthy diet.
  • Staying physically active, especially patients who are overweight (those with body mass index [BMI] ≥25kg/m2) or obese (BMI ≥30kg/m2).
  • Checking with a health care professional before taking any prescription pills, nutritional or herbal supplements, or over-the-counter medications, as these can potentially damage the liver.

For more information on counseling patients, visit the UW IDEA program's Hepatitis B Online — Initial Evaluation of Persons with Chronic Hepatitis B.

Resources

Clinicians can email questions about immunizations or vaccine-preventable diseases to NIPinfo@cdc.gov. A CDC immunization expert will typically answer within 24 hours.

CDC recommends the following resources:


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Content Source:
Division of Viral Hepatitis