Capital B: update in the management of Hepatitis B
Approximately 165,000 Australians are estimated to be living with chronic hepatitis B virus (HBV) infection, with one third having never been diagnosed. This failure to diagnose leads to poor outcomes for those affected, and ongoing transmission to susceptible contacts. An estimated 2,500 incident hepatitis B infections occurred in Australia in 2010, only 10% of which were notified to health departments. Of notified acute cases with exposure data available, approximately one quarter are reported to be sexually acquired. Approximately 2-10 cases of fulminant acute hepatitis B infection are estimated to occur in Australia annually, with a further 325 deaths due to complications of chronic hepatitis B each year.
It is essential that all clinicians seeing patients with risk factors for incident or chronic hepatitis B opportunistically establish the presence of infection or immunity, vaccinate those susceptible, and appropriately manage those found to be chronically infected. The management paradigm for chronic hepatitis B has changed significantly in recent years, as has the range and efficacy of available antiviral agents.
Workforce development and enhancing access to appropriate treatment and care are cornerstones of Australia’s First National Hepatitis B Strategy and the WHO Viral Hepatitis Resolution, both of which were endorsed in 2010. It is now time for clinicians, policy makers and public health workers to prioritise the actions in these strategic plans to address the cause of one of the world’s most common, and Australia’s fastest increasing causes of cancer death.
