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Wednesday, January 07, 2009

A young man presents with HBsAg positive, HBeAg negative and normal levels of AST and ALT

Question 80
A young man presents with HBsAg positive, HBeAg negative and normal levels of AST and ALT normal. He is asymptomatic. What is the next line of management
a.       Wait and Watch
b.      Antivirals
c.       Immunoglobulin
d.      Liver Transplant
a.       Wait and Watch
Nelson 15th Edition Chapter 221
Harrison 16th Edition Pg 1825, 15th  Edition page 1729
·         Routine screening for hepatitis B requires assay of at least two serologic markers.
·         HBsAg is the first serologic marker of infection to appear and is found in almost all infected persons; its rise coincides closely with the onset of symptoms.
·         HBeAg is often present during the acute phase and indicates a highly infectious state.
·         Because HBsAg levels fall before the end of symptoms, IgM antibody to hepatitis B core antigen (IgM anti-HBcAg) also is required because it rises early after infection and persists for many months before being replaced by IgG anti-HBcAg, which persists for years. IgM anti-HBcAg usually is not present in perinatal HBV infections.
·         Anti-HBcAg is the most valuable single serologic marker of acute HBV infection because it is present almost as early as HBsAg and continues to be present later in the course of the disease when HBsAg has disappeared.
·         Only anti-HBsAg is present in persons immunized with hepatitis B vaccine, whereas anti-HBsAg and anti-HBcAg are detected in persons with resolved infection.
Considering all the points, the best option would be to wait and watch
HBV infections in neonates are much more common, but most infections are not associated with clinically evident disease. Most HBV infections occur at the time of delivery or in the early postpartum period; transplacental transmission occurs but is uncommon. The infection usually is caused by one of three mechanisms.
Ä     The virus is divided into four major serotypes (adr, adw, ayr, ayw) based on antigenic epitopes present on its envelope proteins.
Ä     The virus is divided into eight genotypes (A-H) according to overall nucleotide sequence variation of the genome. The genotypes have a distinct geographical distribution and are used in tracing the evolution and transmission of the virus. Differences between genotypes affect the disease severity, course and likelihood of complications, and response to treatment and possibly vaccination.[

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