Chronic Hepatitis B & C

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Chronic Hepatitis B

Patients with a positive HBsAg and cirrhosis

All patients with a positive HBsAg and cirrhosis should be offered treatment for chronic hepatitis B. Patients with bleeding oesophageal varices or ascites and a positive HBsAg should be considered cirrhotic. Test for HIV infection. If HIV positive initiate cART using a tenofovir based regimen.

If HIV negative, manage as follows.

Medicine	Dose	Frequency	Duration
Tenofovir po	300mg	once daily	for life

 

In absence of single formulation

Medicine	Dose	Frequency	Duration
Tenofovir/lamivudine	300mg/300mg	once daily	for life

Do not start treatment if renal function is abnormal - refer for specialist care. Do not treat if patient already has a hepatoma.

All persons with cirrhosis require lifelong treatment and should not discontinue antiviral therapy because of the risk of reactivation, which can cause severe acute-on-chronic liver injury.

Patients with a positive HBsAg and no cirrhosis

Some patients require treatment, but others can be observed. Refer for specialist assessment

Chronic Hepatitis C

Cure of hepatitis C is possible - refer patients with positive hepatitis C antibodies for specialist assessment. Hepatitis C infection should be confirmed in these patients by quantitative or qualitative PCR. Whenever possible, the genotype should be confirmed. The following regimen is effective against all the 6 hepatitis C genotypes.

	Medicine	Adult Dose	Frequency	Duration
	sofosbuvir po	400mg	once a day	12 weeks
and	velpatasvir po	100mg	once a day

Sofosbuvir 400mg and Ledipasvir 90mg once daily is an alternative regimen for genotype 1,4,5 and 6

Patients with decompensated cirrhosis, and those who are treatment experienced should be referred for specialist care. Weight based ribavirin should be added in these patients.