Case 023: Hepatitis B

PATIENT PRESENTATION

Chief Complaint

“My siblings were diagnosed with hepatitis B recently.”

History of Present Illness

The patient is a 28-year-old Asian male with HBV and a strong family history of HBV. Mom had passed away recently due to HCC secondary to HBV. Patient is advised to be on HBV therapy to minimize chance of developing advance liver disease and hepatocellular carcinoma.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. What signs and symptoms of hepatitis B does this patient have?

   Hint: See Epidemiology and Etiology and Clinical Presentation and Diagnosis in PPP

2. What are the goals of therapy for the treatment of HBV?

   Hint: See Prevention and Treatment of Viral Hepatitis and Outcome Evaluation in PPP

3. What preventative measure can be taken to prevent the spread of hepatitis B and minimize the progression of the liver disease?

   Hint: See Prevention and Treatment of Viral Hepatitis in PPP

4. What are the adverse effects of hepatitis B therapy you would need to discuss with the patient prior to starting treatment?

   Hint: See Prevention and Treatment of Viral Hepatitis in PPP

5. On the basis of the patient’s laboratory results, what pharmacological recommendation would you make at this time?

   Hint: See Prevention and Treatment of Viral Hepatitis in PPP

FOLLOW-UP

How long should you treat this patient based on these laboratory results?

Hint: See Outcome Evaluation in PPP and reference below

CASE SUMMARY

Global Perspective

Despite having an effective vaccine to prevent the spread of hepatitis B infection, this disease continues to affect more than 2 billion people worldwide. Chronic hepatitis B affects close to 250 million people and about 887,000 may die due to complications associated with the liver disease. Approximately 75% of chronic HBV cases occur in Asia. The hepatitis B – related mortality rate in Asian immigrants to the United States is seven times greater than individuals who are Caucasian. Although the treatment armamentarium for hepatitis B has grown significantly over the past decade, at present, the agents available are only effective in suppressing HBV levels and delaying the progression of liver disease to cirrhosis. These agents may not be readily available to patients in developing countries. Since most of these HBV infections are acquired at birth from mothers infected with HBV, providing immunization to include the hepatitis B vaccine with or without immune globulin at birth is the most effective measure to prevent chronic hepatitis B disease.

Key References