Color pdf icon [PDF — 1 page]. Learn the latest guidance for screening diagnosing, monitoring, and managing hepatitis C virus infection. Free CME credits and C contact hours available.
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Viral Hepatitis. All infants born to mothers who are positive for hepatitis B surface antigen should receive hepatitis B immune globulin promptly and the hepatitis B vaccine by 24 hours of life.
Pegylated interferon alfa-2a Pegasys , entecavir Baraclude , and tenofovir are recommended as first-line treatment options for chronic hepatitis B. Existing drug targets NUCs and various other drug targets in the pipeline are shown in red in the illustration and are also described below in parentheses following the step in the HBV DNA lifecycle they are targeting. This figure may not include all potential targets of drugs under development. New viral and immunological targets for hepatitis B treatment and cure: a review.
Infect Dis Ther. Lewandowska M, Piekarska A. New directions in hepatitis B therapy research. Clin Exp Hepatol. The U. Preventive Services Task Force and American Academy of Family Physicians recommend screening for hepatitis B in pregnant women at the first prenatal visit and in adolescents and adults at high risk of chronic infection.
The CDC additionally recommends screening in: Donors of blood, plasma, organs, tissue, or semen Infants born to mothers positive for hepatitis B surface antigen Persons on hemodialysis, cytotoxic therapy, or immunosuppressive therapy Persons who are sources of blood or bodily fluids that may expose others, requiring postexposure prophylaxis Persons with elevated alanine or aspartate transaminase levels of unknown etiology.
Information from references 7 and 9. The presence of anti-HBc may also indicate chronic hepatitis B or a false-positive result. Prevention of hepatitis B virus infection in the United States. The Advisory Committee on Immunization Practices recommends hepatitis B vaccination for all medically stable infants weighing 2, g 4 lb, 6 oz or more within 24 hours of birth, unvaccinated infants and children, and unvaccinated adults requesting protection from hepatitis B or who are at increased risk of infection.
Postvaccination testing is recommended only in individuals who may not elicit a complete response to the vaccine based on risk factor assessment. In certain populations i. Revaccination can be completed using one of two approaches: 1 administration of a second complete hepatitis B vaccine series followed by anti-HBs testing one to two months later, or 2 administration of a single dose of hepatitis B vaccine followed by anti-HBs testing one to two months later.
If the anti-HBs level remains less than 10 mIU per mL after a single dose, completion of the series should be performed with anti-HBs testing one to two months after completing the series. The CDC does not recommend administration of more than two complete hepatitis B vaccine series, except for patients on hemodialysis, in whom anti-HBs testing should be conducted annually and a booster dose of the vaccine administered when the anti-HBs level declines to less than 10 mIU per mL.
Acute hepatitis B is defined as the discrete onset of symptoms e. The younger the age at the time of infection, the higher the probability of developing chronic infection. The presence of HBeAg in the serum correlates with high levels of infectivity. Anti-HBe usually remain detectable for years after recovery. Chronic hepatitis B, defined as the persistence of HBsAg for more than six months, has five distinct phases 19 Table 3 The initial evaluation of individuals with chronic hepatitis B includes a complete history and examination.
There should be a special emphasis on signs and symptoms of cirrhosis, evaluation of alcohol intake and metabolic risk factors, family history of HCC, and hepatitis A and B vaccination status. Low risk of progression to cirrhosis or hepatocellular carcinoma, if the patient remains in this phase. Usually with detectable antibodies to HBeAg; associated with low rates of spontaneous disease remission.
Information from reference Laboratory measurements include a complete blood count with platelets, aspartate transaminase, ALT, total bilirubin, alkaline phosphatase, albumin, and international normalized ratio. Annually, approximately 0. The risk of liver-related complications is variable and influenced by a variety of host, viral, and environmental factors.
It is unclear which patients might benefit from screening for HCC. Some experts recommend screening patients with chronic hepatitis B only if they have other risk factors for HCC, whereas others advocate screening all individuals with chronic hepatitis B.
A Cochrane review of three randomized controlled trials found insufficient evidence to support or refute the value of alpha fetoprotein testing, ultrasound screening, or both. Chronic hepatitis B accounts for approximately one-half of all HCC cases.
After exposure to blood or bodily fluids, the patient's hepatitis B vaccination status should be assessed to determine if he or she is a known responder to the vaccine based on an anti-HBs level of 10 mIU per mL or more.
Informed consent should be obtained from the source person in accordance with state laws, and his or her blood should be obtained and tested for HBsAg. If it is not possible to test the source person's blood, the exposed patient should be managed as if the source person is positive for HBsAg. Patients who are known responders to the hepatitis B vaccine require no further action. Management recommendations for health care personnel exposed to the HBV are summarized in Table 4.
Response unknown after three vaccine doses. Unvaccinated, incompletely vaccinated. The effectiveness is unknown when administered more than seven days after percutaneous mucosal or nonintact skin exposure. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management.
Additional vaccine doses should be administered if the infant is determined to be a nonresponder. However, because current treatments cannot eradicate the virus, including the covalently closed circular DNA, reactivation may occur. Lifelong monitoring is required for individuals with chronic hepatitis B who are not currently candidates for treatment, because they may become candidates in the future. Table 5 includes treatment recommendations for patients with chronic hepatitis B.
Specific strategies for speaking with clients include:. Once clients are comfortable talking about viral hepatitis , they might be more willing to undergo screening. However, clients might be anxious about the test itself; a reassurance that testing is a simple procedure can help allay these concerns.
Many substance use treatment facilities do not offer screening, and clients might need to be referred elsewhere. The following strategies can enhance the discussion of the hepatitis screening process and hepatitis prevention:.
The medical personnel who ordered or arranged the screening test, not counselors, usually explain the results. Hepatitis screening should be part of the intake physical examination in an opioid treatment program, and medical personnel may report the results. However, the client may want to discuss the results with the counselor or ask the counselor questions.
Suggestions for conversations with clients when the test results are negative include the following:. Clients whose screening test results are positive for chronic hepatitis will need additional tests and examinations—usually with doctors who specialize in diseases of the liver i.
These tests are described in Chapter 3. The following guidelines can help prepare clients for the next steps in evaluating their chronic hepatitis :. Clients will react in a variety of ways to news of a positive result.
Some clients might be worried about spreading the virus to others or about the reaction of family, friends, and others. For others, a positive test might be of little concern because they are more concerned with treatment for a substance use disorder SUD and stressors in their life other than an asymptomatic viral infection. HCV is easily spread through exposure to infected blood by sharing drug use paraphernalia or equipment or any item that can have minute bits of blood on it, including toothbrushes and razors.
HCV is not spread by sneezing, coughing, hugging, or sharing eating utensils or drinking glasses; it is not spread through casual contact. The risk of spreading HCV by sexual contact is very low, but HBV can be spread by sexual contact and any close personal contact. Open sores or wounds should be treated and covered with a bandage.
Having hepatitis C does not exclude clients from work, school, or other settings. Clients who are infected with HCV cannot donate blood, body organs, or semen. In the event of a relapse, clients should not share any drug paraphernalia or equipment and should return to treatment. Screening for hepatitis B involves blood tests that measure HBV antigens and antibodies. Screening for hepatitis C involves a blood test to detect antibodies, but the results are not clear cut and should be interpreted carefully.
Turn recording back on. National Center for Biotechnology Information , U. Search term. Antigens and Antibodies Hepatitis screening involves testing a small sample of blood for antigens and antibodies to determine whether the individual has been infected with viral hepatitis. Counseling Practices That Educate, Support, and Motivate Clients Undergoing Screening Clients might need help deciding whether to get screened, understanding the test results, and determining their next steps.
It is an opportunity to educate the client about hepatitis , its effects on health, and prevention strategies. It is an opportunity for clients to identify their risk factors and learn how they can reduce the risk of contracting or transmitting viruses. Be aware that many clients may not know whether they have been screened for hepatitis in the past or they might not know the results.
They might confuse HIV screening or any blood test with hepatitis screening, and they might erroneously believe that they are—or are not—infected. Clearly explain that the hepatitis test is optional. Clients may not understand what disease the test will detect or that they have the option not to give consent Munoz-Plaza et al.
Follow up with clients regardless of the results. Failure to follow up is a missed opportunity to deliver or reinforce prevention messages Munoz-Plaza et al. Discussing Screening for Viral Hepatitis Many clients entering substance abuse treatment do not know their hepatitis status.
Today, I wondered if it would be okay to talk about how your use has generally affected your health. Is that okay? And please remember that not everyone who tests positive for hepatitis needs treatment. So, what do you think? Addressing Hepatitis for the First Time It is crucial that a treatment counselor or health professional use a nonjudgmental and compassionate tone.
The following strategies can help initiate the conversation: Display posters, literature, or other hepatitis -related items that could help prompt the client to ask questions about hepatitis. See Appendix C for hepatitis resources. Raise the subject in a way that avoids making clients feel defensive or afraid. Consider introducing the subject by making parallels with other conditions that have been discussed. Were you ever tested for viral hepatitis? Tell me about those tests.
Be patient and allow time for multiple, short conversations about the subject. The exclusion criteria were as follows: 1 with missing data in key variables; 2 with other liver diseases such as alcoholic hepatitis, hepatitis C, autoimmune hepatitis, hepatocellular carcinoma HCC and acute on chronic liver failure.
The following are the criteria for diagnosis of liver diseases. Cirrhosis was diagnosed by the typical changes in radiology or histology or the presence of clinical symptoms such as ascites, variceal bleeding, and hepatic encephalopathy. The diagnosis of autoimmune hepatitis was based on the diagnostic scoring system proposed in The required sample size is. The following variables were collected from all participants: age, sex, history of smoking and alcohol intake, medical history of diabetes and hypertension, Child—Pugh score, cirrhotic complications ascites, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, portal hypertension, hepatorenal syndrome , BMI weight in kilograms divided by height in meters squared , triceps skinfold thickness TSF , mid-arm circumference MAC , hand grip strength, hemoglobin, lymphocyte count, bilirubin, albumin, preprotein, cholesterol, creatinine, cholinesterase, prothrombin time PT , international normalised ratio INR.
Each measurement was repeated 3 times by two independent investigators and the mean of each variable was used for final analysis. The laboratory indicators were collected within 72 hours after admission.
Continuous data with normal distribution were compared using Student t -test and the rests were compared using Mann—Whitney rank sum test. Categorical data were analyzed using the Fisher exact test or chi-square test. Univariate and multivariate logistic regressions were used to select the risk factors of malnutrition for models. Nomogram and decision tree models were developed for predicting malnutrition. Receiver operating characteristic ROC curve was used to evaluate the performance of models.
This study was approved by the Ethics Committee of Mengchao Hepatobiliary Hospital of Fujian Medical University approval number: and was incompliance with the Declaration of Helsinki. All participants were informed about the purpose of the study and signed the informed consent.
Patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research. A total of patients with HBV-related cirrhosis were hospitalized during study period. Among them, 54 cases were excluded for alcoholic liver disease, for HCC, 60 for liver failure, 6 for hepatitis C, and 27 for refusing to participate.
Among the rest of patients, 46 patients were found to have cancer or liver failure during hospitalization and 24 patients did not have complete data and were then excluded. A total of cases were eligible for final analysis Figure 1. The average age of this cohort is Forty-five percent of them were Child—Pugh grade A. The BMI level was The baseline characteristics of malnourished patients identified by different nutritional assessment tools are displayed in Supplementary Table 1.
The comparison between malnourished and nourished group was shown in Table 1. Compared with nourished patients, malnourished patients were older The hemoglobin and albumin level were lower while the creatinine was higher in the malnourished group. The presence of liver-specific complications, including the ascites, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, portal hypertension, and the hepatorenal syndrome were similar between the two groups.
The comparison of the nutrition-specific index showed that, the malnourished group had lower MAC All patients were followed up for at least one year.
The four independent factors selected by multivariate regression were used to construct a nomogram model. Values and the points of each variable are illustrated on the top of nomogram plot Figure 2. The risk of malnutrition is plotted on the bottom. Draw a vertical line from the values of each prediction indicators to the corresponding point on the top and add up the points of four indicators to get a total point. Then, draw a vertical line from the total points to the risk axis to get the corresponding risk, which is the probability of malnutrition for this individual.
For example, if a patient is with a BMI of The corresponding risk for points is 0. The bootstrap calibration curve showed that the evaluation probability and the actual value were close to each other, indicating the nomogram model is accurate Figure 3. The nomogram for nutritional screening in patients with hepatitis B-related cirrhosis.
Calibration curve of malnutrition nomogram model. The evaluation accuracy is satisfactory if the solid line performance is close to the dotted line models.
The Gini index was used to select the optimal feature and the CART generation algorithm was used to develop the decision tree model.
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