1) High risk groups for hepatitis B infection include people with high risk sexual practices like sex workers, MSM, and TG individuals, people who inject drugs, healthcare workers, and those who are HIV positive. 2) Testing includes HBsAg, anti-HBs, HBeAg, anti-HBe, and HBV DNA. 3) Treatment is recommended for anyone who is HBeAg positive or has elevated ALT levels. Tenofovir is the treatment of choice for adolescents over 12 and adults while entecavir is preferred for children ages 2-12.

1. Narrative (Part III)
of
Clinical Workshop on HIV & Hepatitis
(attended in KTM on NOV 20-22, 2018, organized by WHO & NCASC)
by:
Dr. Pawan KB Agrawal,
MBBS, MDGP (IOM, Maharajgunj), Distance Fellowship in Diabetes Management (CMC, Vellore)
Consultant, General Practice & Emergency, Nyaya Health Nepal-Possible
13th January, 2019, Sunday.

2. Antimicrobe.org

3. Natural History

4. At risk population
• High risk sexual practices (sex workers &their clients, MSM, TGs)
• PWIDs
• Healthcare workers
• HIV positive

5. Lab Investigations

9. Interpretation

10. WHO recommendation for treatment initiation

11. Treatment
• Tenofovir 300mg once daily indicated for adolescents >12 years and
adults.
• Entecavir 0.5 mg once daily in solution form for age 2-12 yrs.
• In presence of cirrhosis, entecavir is preferred @ 0.5 mg daily in
compensated and 1mg daily in decompensated cirrhosis.

12. Dose adjustment

13. Duration of treatment
• Lifelong in cases of cirrhosis or APRI >2
• Discontinuation is exception unlike Hepatitis C and can be considered in
non cirrhotic patients if
• Persistently normal ALT
• There is loss of HBeAg and seroconversion to anti Hbe which is sustained for at
least a year.
• Patient can be followed long term for reactivation
• Persistently undetectable HBV DNA

14. Case
• 40 yrs old male found HBsAg positive during preoperative screening for
hernioplasty.
• Past history unremarkable

15. Case

16. Case