Hepatitis B

Question 1

A 30-year old pregnant female, in her 2nd trimester, presented to the hepatology clinic
after incidentally detected to have HBs Ag positive with negative HCV-Ab. She does not
have any complaint. Laboratory investigations showed that she has normal ALT and AST.
Her husband told that this is the first time to screen for liver disease and that they have 2
apparently healthy kids.

Answer 1

A- Enumerate investigations you will ask.
Hcv abs
Hiv abs
PCR
Hbeag

Question 2

B- Illustrate the management according to the results of investigations.

Answer 2

If pcr >200000, start treatment by tenovofir 300mg once daily at 24-28 weeks and 12 weeks after delivery then re-evaluate .
Baby will receive Anti hbig at the first 12 hours of delivery+ vaccine at 0,1,6 month

Question 3

Stop point of treatment in HBV

Answer 3

1-If patient is cirrohtic:
No stop of treatment
2-If patient is not cirrohtic:
A-Hbe ag negative:
Indefinitely or when hbsag seroconversion occur after 12 months of consolidation treatment
B-Hbe ag positive:
After HBeag seroconversion+undetected pcr
After:
12 months consolidation treatment,3 years of continuous treatment,age>40 years

Question 4

Follow up

Answer 4

AFP,U/S, PCR,Alt كل 6 شهور
Fibroscan كل سنتين