Dear
Editors:
I
have a patient with acute hepatitis B, who is healthy otherwise. HIV status is pending,
unclear source of infection, clinically stable but persistent Bili of 18-20,
transaminases 800-1200 and PT stable so far. Initial symptoms of fatigue
resolved 2-3 weeks ago; pt under medical care for one week as outpatient. Should
I start lamivudine or Adefovir now? I will order HBV DNA ,+ other tests next
week.
L G
Dear
LG:
The
standard approach to patients with acute hepatitis B is observation, since only
about 1% will progress to fulminant hepatic failure and 2% to 5% to chronic
hepatitis B. You should confirm that this patient has acute hepatitis B versus
reactivation of chronic hepatitis B by serology (positive IgM anti-HBc) and
history. These patients usually need initial weekly follow-up with laboratory tests
to be sure there is not progression to fulminant hepatic failure (monitoring
the INR is most useful in this regard), and then less frequent follow-up to
confirm resolution (loss of HBsAg and development of anti-HBs) versus
progression to chronic hepatitis B. There is no proven role of either
lamivudine or adefovir in patients with acute hepatitis B.