What patient education is recommended for Hepatitis B (HBV) infection?

From the Guidelines

Hepatitis B infection patient education should prioritize comprehensive management and prevention of transmission, focusing on lifestyle modifications, antiviral therapy, and vaccination of contacts, as outlined in the most recent guidelines 1.

Key Components of Patient Education

• Patients should understand that hepatitis B is a viral infection affecting the liver, transmitted through blood, sexual contact, or from mother to child during birth.
• For acute infections, treatment typically focuses on supportive care including rest, adequate nutrition, and hydration while the body fights the virus.
• For chronic hepatitis B, antiviral medications such as entecavir (0.5-1mg daily), tenofovir disoproxil fumarate (300mg daily), or tenofovir alafenamide (25mg daily) may be prescribed for long-term use to suppress viral replication and prevent liver damage, as recommended by the EASL guidelines 1.
• Patients should avoid alcohol completely as it can accelerate liver damage, and should consult their healthcare provider before taking any medications including over-the-counter drugs or supplements that could stress the liver.
• Regular medical follow-up is essential with liver function tests, viral load monitoring, and periodic liver imaging to assess disease progression.

Prevention of Transmission

• To prevent transmission, patients should not share personal items like razors or toothbrushes, should practice safe sex using condoms, cover any wounds, and inform sexual partners and household members who should be tested and vaccinated if not immune.
• Family members and close contacts should receive the hepatitis B vaccine series (typically three doses over 6 months) for protection, as emphasized in the guidelines for management of chronic hepatitis B 1.
• Additionally, individuals negative for HBsAg and anti-HBs should be vaccinated, especially if they are at increased risk of HBV infection, such as household members and sexual partners of patients with chronic HBV infection.

Importance of Vaccination

• The hepatitis B vaccine series induces a protective antibody response (anti-HBs >10 mIU/mL) in >90% of recipients, and is crucial for preventing vertical transmission and protecting against HBV infection in high-risk individuals 1.
• Post-vaccination testing of anti-HBs status is recommended in certain subjects, such as newborns of HBV-infected mothers or immunocompromised individuals, to ensure adequate protection against HBV infection.
• Booster vaccination may be needed in dialysis patients or immunocompromised individuals with an anti-HBs level of <10 mIU/mL, as indicated by the guidelines for management of chronic hepatitis B 1.

From the FDA Drug Label

Patients should be informed that treatment with entecavir has not been shown to reduce the risk of transmission of HBV to others through sexual contact or blood contamination. Patients should be advised that treatment with entecavir will not cure HBV Patients should be informed that entecavir may lower the amount of HBV in the body, may lower the ability of HBV to multiply and infect new liver cells, and may improve the condition of the liver. Patients should be informed that it is not known whether entecavir will reduce their chances of getting liver cancer or cirrhosis Your hepatitis B virus (HBV) infection may get worse if you stop taking entecavir tablets. If you have or get HIV that is not being treated with medicines while taking entecavir tablets, the HIV virus may develop resistance to certain HIV medicines and become harder to treat

Key Points for Patient Education:

• Entecavir does not reduce the risk of HBV transmission through sexual contact or blood contamination.
• Entecavir will not cure HBV.
• Entecavir may lower HBV levels, reduce liver infection, and improve liver condition.
• It is unknown if entecavir reduces the risk of liver cancer or cirrhosis.
• Stopping entecavir can worsen HBV infection.
• Untreated HIV infection can lead to HIV resistance while taking entecavir. 2

From the Research

Patient Education for Hepatitis B Infection

• The goal of antiviral therapy in patients with chronic hepatitis B is to prevent cirrhosis and hepatocellular carcinoma through persistent suppression of HBV replication 3.
• Ideal candidates for treatment are hepatitis B e antigen-positive patients with a prolonged phase of immune clearance and hepatitis B e antigen-negative patients with elevated levels of serum HBV DNA, abnormal alanine aminotransferase, and histologic evidence of moderate or severe liver necroinflammation and/or fibrosis 3.
• Patients with compensated or decompensated cirrhosis should be treated to prevent disease flare and improve liver function, even if alanine aminotransferase levels are normal and/or serum HBV DNA levels are low 3.

Antiviral Therapy Options

• Seven drugs are available for antiviral therapy: IFN-alpha, pegylated interferon, lamivudine, adefovir dipivoxil, entecavir, telbivudine, and tenofovir 3.
• Entecavir and tenofovir are the preferred antiviral agents for treatment of chronic hepatitis B in patients with cirrhosis due to their high antiviral potency and high genetic barrier to resistance 4.
• Pegylated interferon-α is another therapeutic option for chronic hepatitis B patients with well-compensated cirrhosis, but it is contraindicated in patients with decompensated cirrhosis 4.

Prevention and Management of Viral Resistance

• Preventing HBV antiviral drug resistance is crucial, and using an agent or combination of agents with a high genetic barrier to resistance is recommended 5.
• Frequent assessment of quantitative serum HBV DNA is the best approach to early detection of resistance, and antiviral therapy should be modified as soon as resistance is detected 5.
• The addition or substitution of newer antiviral agents can restore suppression of viral replication, normalize alanine aminotransferase levels, and reverse histologic progression in patients with resistance to lamivudine 5.

Effectiveness of Antiviral Therapy

• Moderate-quality evidence supports the effectiveness of antiviral therapy in patients with immune active chronic HBV infection in reducing the risk of cirrhosis, decompensated liver disease, and hepatocellular carcinoma 6.
• Tenofovir and entecavir are the most effective antiviral agents for chronic hepatitis B, with high predicted probabilities of inducing undetectable levels of HBV DNA, normalization of alanine aminotransferase levels, and histologic improvement of the liver 7.