Hepatitis B Treatment Singapore | STD

Hepatitis B Treatment in Singapore: Hepatitis B treatment Singapore: Treatment available for Hepatitis B.

Hepatitis B Treatment is usually done in collaboration with a hepatologist

 


 

TREATMENT

Patients should be advised to avoid unprotected sexual intercourse until they have become non-infectious or their partners have been successfully vaccinated [III,B]. Hepatitis B is a notifiable disease. Screen for other STIs in cases thought to have been sexually acquired or if otherwise appropriate.

General counselling:

Hepatitis B virus transmission is not transmissible through:

Acute Hepatitis as for hepatitis A.

Chronic Hepatitis B Infection

Management of patients with chronic hepatitis B should be tailored according to the clinical state of liver disease (compensated versus decompensated liver disease) as well as virologic and biochemical (i.e. the liver function test, in particular the serum transaminase levels) status.

  1. For patients with HBsAg positive > 6 months and well compensated liver disease:
    1. HBeAg–positive hepatitis B virus infection and:
      1. ALT < Upper limit of normal (ULN): no pharmacotherapy needed. Monitor ALT at least 6 monthly and HBeAg at least 12 monthly
      2. ALT 1-2 X ULN: monitor ALT 3 to 6 monthly and HBeAg 6 monthly. Refer to specialist if persistent evidence of early deterioration of liver function or age >40. Consider liver biopsy and treatment if biopsy shows significant liver damage
      3. ALT > 2X ULN: repeat ALT and HBeAg within 1 to 3 months. Refer to specialist if persistent. Treat immediately upon evidence of hepatic decompensation
    2. HBeAg–negative hepatitis B virus infection and:
      1. ALT < ULN: Monitor ALT 3 months later. If still normal, monitor ALT every 6 to 12 monthly
      2. ALT 1-2X ULN: Monitor ALT 3 to 6 monthly. Refer to specialist if persistent, evidence of early deterioration of liver function or age > 40. If HBV DNA is > 2000 IU/ml, consider liver biopsy and treat if biopsy shows significant liver damage
      3. ALT > 2X ULN: repeat ALT within 1 to 3 months. Refer to specialist if persistent. If HBV DNA > 2000 IU/ml, consider treatment if persistent. Note that common conditions, such as fatty liver and commonly consumed drugs may be confounding factors giving rise to mild to moderate elevation of serum transaminases
  2. For patients with decompensated hepatitis B virus–related cirrhosis: Refer to gastroenterologist or hepatologist for management [IV, D].

Surveillance of patients with chronic hepatitis B should be carried out regularly; frequency of surveillance will depend on the risk profile, which should be determined before the start of the surveillance programme (see below):

  1. Baseline assessment to stratify risk
    1. check serum ALT, AST, bilirubin, albumin, prothrombin time, alpha- fetoprotein, HBsAg, HBeAg, anti HBe and HBV DNA
    2. liver imaging
  2. Periodic reassessment is necessary
    Frequency of surveillance is dependent on patients’ risk profile:

    1. Low-risk group (patients who have seroconverted and have a nonreplicative hepatitis B virus infection): 6 monthly serum ALT and bilirubin – if abnormal, HBV DNA should be checked
    2. Medium-risk group (patients with replicative HBV infection who are beyond the immuno-tolerant window; chronic hepatitis B not on treatment; chronic hepatitis B which is resistant to treatment; patients who are expected to tolerate exacerbation of hepatitis B poorly, e.g. patients with liver cirrhosis): 4-6 monthly serum ALT and bilirubin assessment – if abnormal, HBV DNA should be checked
    3. High-risk group (patients who are subjected to immunosuppressive treatment either during immunosuppressive treatment or on withdrawal of immunosuppressive treatment with agents such as steroids, cytotoxics, monoclonal antibodies with imunomodulatory activity; patients withdrawn from nucleoside/tide analogue treatment for prior chronic hepatitis B; demonstrating resistance to their ongoing nucleoside/tide analogue treatment for their prior chronic hepatitis B; having reduced liver mass, e.g. post-hepatic resection): 2-4 monthly serum ALT, bilirubin, HBV DNA, appropriate to each set of circumstances. If abnormal the specialist will have to decide on further appropriate management [GPP]

Most patients in medium risk group and all patients in high risk group should be referred for management by a specialist.

Treatment of Chronic Hepatitis B Infection

Pregnancy and Breastfeeding

 

 

 

 

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