Intended for healthcare professionals

Clinical Review

Treatment for hepatitis B

BMJ 2010; 340 doi: (Published 05 January 2010) Cite this as: BMJ 2010;340:b5429
  1. Graham S Cooke, senior lecturer infectious diseases12,
  2. Janice Main, reader infectious diseases3,
  3. Mark R Thursz, professor of hepatology3
  1. 1Department of Infectious Diseases, St Mary’s Campus, Imperial College London, London SW7 2AZ
  2. 2Africa Centre for Health and Population Studies, University of KwaZulu Natal, South Africa
  3. 3Department of Hepatology, St Mary’s Campus, Imperial College London
  1. Correspondence to: G Cooke g.cooke{at}

    Summary points

    • Hepatitis B is common in UK practice, particularly among those born in countries with high prevalence

    • Hepatitis B surface antigen is the screening test of choice in most circumstances

    • Individuals positive for hepatitis B surface antigen should be referred for specialist evaluation

    • Liver biopsy remains an important part of assessment

    • New treatments to reduce long term complications with favourable side effect profiles are available

    • Most individuals at risk of death from hepatitis B cannot access treatment

    Hepatitis B virus is estimated to have infected 350 million individuals globally, accounting for over 500 000 deaths each year.1 An effective and widely available vaccine provides protection from infection, but treatment is rarely curative. Recent developments in antiviral treatment have brought the opportunity for greatly improved management of those chronically infected with hepatitis B virus, and for patients infected both with HIV and hepatitis B virus there is now the potential to treat both viruses with a simplified combination of drugs. This brief review discusses detection, referral, and management of patients with hepatitis B virus infection.

    Who is at risk of acquiring hepatitis B virus infection?

    Hepatitis B virus is endemic in many countries of the world (figure 1), particularly in South East Asia, Central Asia, the Amazon Basin, and Africa. Transmission occurs through contact with infected blood or body fluids.2 The infection is commonly acquired from an infected mother at the time of birth (vertical transmission) or from infected family members during childhood (horizontal transmission). When exposure to the virus occurs early in life, the likelihood of chronic infection is high: 90% for vertical transmission, 8-15% for horizontal transmission.3 4 For those born or brought up in regions with a low prevalence of the virus, transmission through other routes is more common (box 1).5 Acquisition of infection in adult life is associated with a likelihood of chronic infection …

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