Patients with chronic Hepatitis B may also have concomitant infection with hepatitis delta virus (HDV), human immuno-deficiency virus (HIV), and/or hepatitis C virus (HCV). Because of the potential for coinfection, patients who are diagnosed with HBV therefore should be tested for their presence. Drs. Nguyen and Sterling review the essentials of diagnosis and management of the coinfected patient.

Treatment can be deferred in chronic HBV patients with inactive or mild liver disease without risk of liver disease progression, while patients with active or advanced liver disease should be treated. Dr. Papatheodoridis reviews approaches to classifying patients and how to determine the most appropriate treatment plans.

In some clinical situations, Hepatitis B requires immediate treatment. Dr. Perrillo reviews the characteristics of patients who may need prompt or even urgent care.

Although effective therapies for chronic Hepatitis B are available, antiviral drug resistance represents a serious potential complication. With very few new drugs in the development pipeline, providers must make every effort to prevent resistance by following clear indications for therapy, counseling patients repeatedly on adherence, and monitoring closely for the development of virologic breakthrough. Drs. Tana and Ghany explain.

Tram Tran, MD, an Associate Professor of Medicine from Cedars Sinai Medical Center and a CLD author, discusses HBV treatment in a woman of reproductive age. Dr. Tran addresses HBV transmission risk in pregnancy, antiviral therapy in women of childbearing age and treatment in the third trimester, as well as introducing treatment algorithms for the management of HBV in women planning a pregnancy, with an unexpected pregnancy, and during pregnancy.

Drs. Vigano and Lampertico weigh in on the nucleos(t)ide analogues (NAs)-pegylated interferon (PEG-IFN) debate, addressing first line therapy selection, monitoring of the patient treated with NAs, and when if ever it is appropriate to stop treatment.

Drs. Villamil and Cairo review the best available evidence on managing the HBV patient who has received a solid organ transplantation. For liver transplant patients, the authors address whether there is a role for hepatitis B immunoglobulin, whether antiviral monotherapy sufficient, and how best to manage liver transplantations from antibody to hepatitis B core antigen (anti-HBc) positive donors. In the kidney transplant patient, Drs. Villamil and Cairo discuss kidney transplant in HBsAg-positive patients, as well as kidney transplants from anti-HBc positive donors.

Quantitative Hepatitis B Surface Antigen provides information concerning disease activity over and above an estimation of viral replication. It is an indispensable tool in the clinical assessment and management of chronic hepatitis B viral infection. Drs. Wong and Chan highlight what the clinician needs to know.

Hepatitis B can lead to several severe clinical outcomes, including cirrhosis, hepatic decompensation, and hepatocellular carcinoma. While the establishment of a risk prediction tool for various clinical outcomes for patients with HBV is still in a preliminary phase, the use and refinement of these prediction tools may supply HBV patients with a comprehensive individualized management measure based on the risk perspectives. Drs. Yang and Chen explain.

Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer and is a major global health problem. Dr. Agarwal discusses risk factors, surveillance, and management strategies for the primary care provider.