Assessment of the newly diagnosed patient with chronic hepatitis B virus infection.

An expanding population of patients with chronic hepatitis B (CHB) infection, including immigrants from endemic countries, are being identified in the United States. All newly diagnosed patients with CHB should be evaluated for initial disease severity and potential antiviral treatment options. Following a history and physical examination, routine laboratory measurements along with serum markers of hepatitis B virus (HBV) replication should be obtained. A liver biopsy provides important information regarding disease activity and stage and can help identify suitable candidates for antiviral therapy. Untreated patients with CHB should undergo periodic monitoring of serum aminotransferase and HBV DNA levels, as well as surveillance for hepatocellular carcinoma. Avoidance of hepatotoxic medications and immunosuppressants, as well as oral antiviral prophylaxis in selected clinical circumstances, is recommended for all patients with CHB. Behavioral modifications and education can help minimize the risk of inadvertent HBV transmission to close contacts. Although HBV is an entirely preventable disease via the use of a safe and highly effective vaccine, continued morbidity and mortality will likely be encountered due to the delay in diagnosis and treatment of the large number of patients with chronic HBV in the United States and worldwide.