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Hepatitis B Management

​Summary

  • Determining the phase of chronic hepatitis B (CHB) infection is essential to the clinical assessment of the patient with HBV.
  • CHB is dynamic and moves through phases over time. People with CHB require regular monitoring for liver damage and disease progression.
  • Complications of CHB include cirrhosis, liver failure and hepatocellular carcinoma. All complications can be prevented or minimised with effective antiviral therapy.
  • ASHM provides a range of resources and training in hepatitis B management for primary care providers.

 Hepatitis B Management in Australia

There are 218,000 Australians are thought to be living with chronic hepatitis B.

Of these:

  • 124,500 (57%) are estimated to be diagnosed.
  • 28,350 (13%) are receiving guideline based care (annual HBV DNA or treatment)
  • 11,000 (5%) are on treatment.

This cascade of care for ​chronic hepatitis B shows that 190,000 people (87%) living with CHB are not engaged in care, defined as either receiving annual HBV DNA viral load testing or receiving antiviral treatment1

Monitoring CHB

There are four phases of CHB. The host immune response in each phase determines the outcome of infection and the severity of liver injury. Liver damage is caused by the host immune response rather than the hepatitis B virus (HBV) itself.

Determining the phase of virus infection is essential to the clinical assessment of the patient with HBV. HBV DNA, liver function testing and fibrosis assessment (non-invasive liver imaging with or without biopsy) are all key components of this assessment.

Not all people with CHB need treatment, but they all require regular (six to 12 months) monitoring.

Treatment

People in the immune clearance and immune-escape phase of infection should be considered for antiviral therapy. All patients with cirrhosis are candidates for treatment.

First-line treatment options for most patients are oral antiviral therapy: one tablet, once a day. Once started, treatment is long-term.

The National Hepatitis B Strategy 2014-17 sets a target to increase the proportion of people living with chronic hepatitis B who are receiving antiviral treatment to 15% by 2017.

Hepatitis B Prescriber Program

The hepatitis B prescriber program serves to educate and train general practitioners to prescribe maintenance scripts for hepatitis B antiviral therapy.

ASHM is striving to increase the capacity and confidence of primary care practitioners in diagnosing and caring for patients with hepatitis B. We administer the Hepatitis B S100 Community Prescriber Program.

The prescriber program enables GPs to prescribe Highly Specialised Drugs for the maintenance treatment of chronic hepatitis B — in Australian Capital Territory, New South Wales, Northern Territory and South Australia.

ASHM develops a range of resources in hepatitis B management.

These include the B Positive website and manual; decision-making tools; testing guidelines; and continuing professional development opportunities.

Many resources can be downloaded from our resources page.

List of ASHM-Trained Hepatitis B s100 Prescribers

Effective 28 May 2015, here are the lists of prescribers for:

Australian Capital Territory

New South Wales


Resources​​ ​

​1. Allard N, MacLachlan JH, Cowie BC. A national health system response to chronic hepatitis B: using population data to define gaps in clinical care provision. J Hepatol 2014;60(1):S295-S62014;60(1):S295-S6



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