O98.0
DESCRIPTION
Hepatitis B virus (HBV) is transmitted sexually or by percutaneous exposure to infectious body fluids, i.e. blood, saliva, vaginal fluid & semen. Diagnosis is confirmed serologically by a positive hepatitis B surface antigen (HBsAg).
Screening in pregnancy for HBsAg should ideally be performed in the first trimester. HBeAg positive pregnant women are more infectious than HBsAg positive women, as they have higher rates of HBV replication and perinatal transmission.
GENERAL MEASURES
Screen sexual contact(s); if they are sero-negative, give hepatitis B vaccination.
All infected patients should be counselled with regard to lifestyle modifications to reduce hepatotoxicity, including alcohol, substance abuse, and co-prescription of herbal and traditional medicines.
MEDICINE TREATMENT
Indications for medical therapy in HIV-uninfected pregnant women are the same as for non-pregnant adults.
- For management of chronic hepatitis B, without chronic HIV infection, see Hepatitis B, chronic (non-HIV coinfection).
- For management of chronic hepatitis B with chronic HIV infection, see chapter 10: HIV and AIDS. (ART should include ARV active against hepatitis B).
Note:
- Ensure normal renal function before starting treatment with tenofovir (serum creatinine <85 micromol/L or creatinine clearance >60 mL/minute).
- Monitor ALT and HBV DNA viral load at 6 months after commencing treatment.
- An adequate virological response is an HBV DNA VL<2000 IU/mL.
Prevention of perinatal transmission
- Caesarean delivery is reserved for obstetric indications only.
- Babies born to mothers with acute hepatitis B infection at the time of delivery or to mothers who are HBsAg-positive or HBeAg-positive, see PHC STGs and EML, Hepatitis B exposed infant.
REFERRAL
- Cirrhosis.
- Liver failure.
- Renal dysfunction (eGFR <60 mL/minute).
- Treatment failure.
- Refer all infected babies to a specialist paediatrician for further management.