Chronic Viral Hepatitis

Clinical Description

There are five types of Viral Hepatitis: A, B, C, D and E. Chronic Viral Hepatitis is usually caused by Hepatitis B, C and D. These three types are acquired either vertically through mother to child transmission perinatally, horizontally or parenterally.

The most common type is Hepatitis B and carries the highest disease burden globally.

Chronicity is defined as persistence of Hepatitis B surface antigen for 6 months or more. It manifests either asymptomatically, with mild symptoms or with signs of severe liver damage.

Signs and Symptoms

Clinical features of Chronic liver damage from Hepatitis B depend on severity of liver damage and are the following:

Signs and Symptoms

Caput Medusae

Ascites

Hepatic encephalopathy

Spider nevi

Hematemesis

Investigations

Hepatitis B surface antigen test :

HIV test

Full Blood Count

Liver Function Test

Abdominal Ultrasound

Abdominal Fibroscan

Treatment

Patients with a positive Hepatitis B surface antigen test need to be eligible for treatment prior to commencement.

Eligibility for ADULTS is calculated using ONE or more of the following:

• Clinical assessment showing any signs and symptoms of chronic hepatitis B.
• A calculated Aspartate Amino Transferase to Platelet Ratio Index (APRI) score of greater than 0.65
• Abdominal Ultrasound signs suggestive of cirrhosis
• Abdominal Fibroscan findings suggestive of fibrosis or cirrhosis
• Persistently raised ALT over two consecutive visits (3 months apart)
• Persistent positive Hepatitis B surface antigen tests (6 months apart)
• Family history of Hepatocellular carcinoma or cirrhosis with extrahepatic manifestations

Eligibility for CHILDREN follows a conservative approach. However, any ONE of the following is an indication for treatment:

• Persistently elevated ALT on 3 or more consecutive visits over a 12-month period.
• Necro inflammatory changes on a liver biopsy
• HBV DNA PCR result of greater than 20,000IU/mL

Adults 30kg and above (without Renal complications)

• Tenofovir(300mg) and Lamivudine (300mg) OD

Adults (with any Renal complications)

• Entecavir 0.5mg OD

Paediatrics

• Entecavir

Entecavir 0.5mg (SDF) Preferred for children less than 30kg

Alternative/second line for patients with renal disease

Recommended once daily dose for children

Kg mg 10-11 0.15 >11-14 0.2 >14-17 0.25 >17-20 0.3 >20-23 0.35 >23-26 0.4 >26-30 0.45 >30 0.5