Clinical Case Database / Category: Patient Management

The investigation and management of chronic hepatitis B virus infection

Publication details

Dr Charlotte Skinner, Dr Aruna Dias
Foundation Years Journal, volume 9, issue 2, p.54 (123Doc Education, London, February 2015)


Hepatitis B (HBV) is the commonest blood borne viral infection in the world with almost 2 billion people previously infected and 350 million who are currently chronic carriers of the disease. Chronic infection with hepatitis B carries an increased risk of developing liver cirrhosis, decompensated liver disease and hepatocellular carcinoma (HCC). Approximately 600,000 to 1.2 million individuals die each year from HBV due to acute or chronic HBV or HCC. HCC is the 5th commonest cancer worldwide and its incidence is increasing with approximately 300,000 to 500,000 new cases each year (1). Most cases are found in Sub-Saharan Africa, the Far East, the Indian Sub-Continent and increasingly Eastern Europe. Because of air travel and migration, prevalence in Western Europe and North America is increasing. The aim of this article is to provide a framework for investigating and managing the common aspects of chronic hepatitis B infection that foundation doctors will come across in primary and secondary care based on a number of cases highlighted below.

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Dr Charlotte Skinner

CT2 in medicine, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, Whitechapel, London, E1 1BB.

Dr Aruna Dias (Corresponding author)

Consultant Hepatologist, Barts Health NHS Trust,
Newham University Hospital, Glen Road, Plaistow, London, E13 8SL.


1. Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat 2004; 11(2):97-107.
2. Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology 2009; 50(3):661-662.
3. EASL clinical practice guidelines: Management of chronic hepatitis B virus infection. J Hepatol 2012; 57(1):167-185.
4. British Viral Hepatitis Group. BVHG Consensus Statement – UK guidelines for the management of babies born to women who are HBsAg positive. http://www basl org uk/uploaded_files/HBV in pregnancy pdf (2008).
5. NICE National Institute for Health and Care Excellence. Hepatitis B (chronic): Diagnosis and management of chronic hepatitis B in children, young people and adults. https://www nice org uk/guidance/cg165/resources/guidance-hepatitis-b-chronic-pdf [ 2013 Available from: URL:


Conflict Of Interest

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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.