Hepatitis B
Doctors vs Hep B Monitoring patients with hepatitis B is crucial to stop the development of liver cancer
H
epatitis B is a diverse illness — both in terms of the ways the disease manifests and the broad range of communities it affects in Australia.
It is estimated that more than 218,000 Australians have chronic hepatitis B — which is about 1% of the population. About 45% of the 100,000 Australians estimated to be living with hepatitis B haven’t even been diagnosed.1
Diagnosis To assess a patient’s hepatitis B status, order HBsAg, antiHBs and anti-HBc to determine susceptibility, immunity through previous vaccination or past infection; or current acute or chronic infection (table 1).6
This results in poor outcomes for those affected, including liver failure and liver cancer, and the risk of ongoing transmission to other susceptible people.
Liver cancer, of which most is caused by viral hepatitis, is the fastest increasing cause of cancer death in Australians.2 Most people diagnosed with liver cancer die within 1-2 years of diagnosis. A significant number die within the first month after diagnosis.3 Prevention of liver cancer, particularly through the effective treatment of people living with viral hepatitis, is an urgent public health priority.
Monitoring Once diagnosed, a person with chronic hepatitis B should be monitored regularly to assess their level of disease activity and to allow consideration of treatment where appropriate. The virus can reactivate after years of immune control; we now know that there is no such thing as a healthy carrier. Factors that influence the frequency of monitoring include:
Although hepatitis serology tests attract a Medicare rebate, to order all three diagnostic tests (HBsAg, anti-HBs, and anti-HBc)
There is increasing evidence that the early detection, followup and monitoring of chronic hepatitis B substantially reduces the risk of poor outcomes. GPs have a central role to play in the process. Testing is simple and covered by Medicare. Australia has recently published the National Hepatitis B Testing Policy, which offers guidance for clinicians regarding testing.4
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simultaneously and to qualify, the requesting doctor should write “? chronic hepatitis B” or something similar on the request slip. If acute HBV is suspected, IgM anti-HBc can also be ordered.
• HEPATITIS SA COMMUNITY NEWS • SEPTEMBER 2013
The phase of chronic hepatitis B (see below). The extent of liver damage. The presence of complicating factors (see below).