B Positive – all you wanted to know about - ASHM

Executive Summary
this monograph aims to provide primary
care practitioners with an overview of
current hepatitis b knowledge in australia—
a field which is constantly changing and
evolving. it is not intended to be read as a
cover-to-cover text, but rather to be referred
to as an information resource for advice
and explanation of issues that may arise
in clinical practice. chapters 1 to 5 deal
with the theory of hepatitis b disease from
australian epidemiology through to virology,
natural history, interpretation of hepatitis b
tests and vaccination. chapters 6 to 10 are
more practically based, and deal with the
assessment and treatment of the hepatitis
b-positive patient, the management of
advanced liver disease and hepatocellular
carcinoma (Hcc) and complex situations, such
as pregnancy and HiV co-infection. chapter
11: infection control and occupational health
and chapter 12: Privacy, confidentiality
and other legal responsibilities deal with
occupational and legal issues surrounding
hepatitis b. chapter 13 explores the role of
alternative or complementary therapies.
the information contained in many of the
chapters is related, or has relevance, to
material in other chapters. Hyperlinks placed
at the start of each chapter in the electronic
version and through the text allow the reader
to move between related topics as required.
internet and other related resources that may
be helpful for the providers involved in the
assessment and management of hepatitis
b-positive patients, along with a patient fact
sheet, are also included for further reference.
the effective prevention and management
of hepatitis b virus (HbV) infection
represents a major challenge to health care
providers within australia today. recent
years have seen significant advances in the
management of hepatitis b disease, with the
8 b Positive – all you wanted to know about hepatitis b: a guide for primary care providers
wider availability of new sensitive diagnostic
tests and effective therapies, coupled with
a better understanding of the complex
virology and natural history of hepatitis
b. such developments have heightened
awareness of the need to effectively target
those at risk for vaccination and treatment.
the implementation of appropriate strategies
is likely to have a major impact on the
burden of hepatitis b-related disease, and in
particular primary liver cancer (hepatocellular
carcinoma), in australia into the future. the
achievement of these goals rests largely with
the primary care provider, both to screen
and vaccinate those at potential risk of
hepatitis b, and to identify, refer and monitor
those who may benefit from anti-hepatitis b
therapy. this monograph aims to update and
inform the primary care clinician on current
knowledge regarding hepatitis b infection.
the epidemiology of hepatitis b is discussed
in chapter 1: Prevalence and epidemiology
of hepatitis b. World Health organization
(WHo) estimates indicate that over 400
million people worldwide have hepatitis b
infection, the majority of whom live in the
developing world. the asia-Pacific region
bears one of the highest burdens of hepatitis
b infection, with a prevalence rate of more
than 8% throughout the region. Migration
from asian countries, in particular china
and Vietnam, is largely responsible for the
increasing prevalence of chronic hepatitis b
and its complications in australia in recent
years. almost half of the primary liver
cancers diagnosed in australia today arise
in people born overseas. since hepatitis b
testing in australia is not mandatory and
relies on notifications of new diagnoses
to state and territory Health departments
(collated nationally in the national notifiable
diseases surveillance system—nndss),
actual numbers of people with HbV infection