Chronic Viral Hepatitis

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CLINICAL DESCRIPTION

There are five types of Viral Hepatitis: A, B, C, D and E. Chronic Viral Hepatitis is usually caused by Hepatitis B, C and D. These three types are acquired either vertically through mother to child transmission perinatally, horizontally or parenterally.

The most common type is Hepatitis B and carries the highest disease burden globally. 

Chronicity is defined as persistence of Hepatitis B surface antigen for 6 months or more. It manifests either asymptomatically, with mild symptoms or with signs of severe liver damage.

CLINICAL FEATURES

Clinical features of Chronic liver damage from Hepatitis B depend on severity of liver damage and are the following:

SIGNS AND SYMPTOMS

  • Caput Medusae
  • Ascites
  • Hepatic encephalopathy
  • Spider nevi
  • Hematemesis

INVESTIGATIONS

  • Hepatitis B surface antigen test
  • HIV test                       
  • Full Blood Count
  • Liver Function Test 
  • Abdominal Ultrasound
  • Abdominal Fibroscan

TREATMENT 

Patients with a positive Hepatitis B surface antigen test need to be eligible for treatment prior to commencement.

Eligibility for ADULTS is calculated using ONE or more of the following:

  • Clinical assessment showing any signs and symptoms of chronic hepatitis B.
  • A calculated Aspartate Amino Transferase to Platelet Ratio Index (APRI) score of greater than 0.65

  • Abdominal Ultrasound signs suggestive of cirrhosis
  • Abdominal Fibroscan findings suggestive of fibrosis or cirrhosis
  • Persistently raised ALT over two consecutive visits (3 months apart)
  • Persistent positive Hepatitis B surface antigen tests (6 months apart)
  • Family history of Hepatocellular carcinoma or cirrhosis with extrahepatic manifestations

Eligibility for CHILDREN follows a conservative approach. However, any ONE of the following is an indication for treatment:

  • Persistently elevated ALT on 3 or more consecutive visits over a 12-month period
  • Necro inflammatory changes on a liver biopsy
  • HBV DNA PCR result of greater than 20,000IU/mL

Adults 30kg and above (without Renal complications)

  • Tenofovir (300mg) and Lamivudine (300mg) OD

Adults (with any Renal complications)

  • Entecavir 0.5mg OD

Paediatrics

  • Entecavir

Entecavir 0.5mg (SDF)

Preferred for children less than 30 Kg

Alternative/Second line for patients with renal disease

Recommended once daily dose for children

kg

mg

10 - 11

0.15

>11 - 14

0.2

>14 - 17

0.25

>17 - 20

0.3

>20 - 23

0.35

>23 - 26

0.4

>26 - 30

0.45

>30

0.5