OUTCOMES AND THE PATIENT Hepatitis B : Evaluation , Management , and Prevention

INTRODUCTION Hepatitis B is a prevalent infectious disease in the United States and throughout the world [1]. The clinical sequelae of hepatitis B virus (HBV) infection range from subclinical hepatitis to symptomatic, chronic hepatitis, which may evolve into cirrhosis and hepatocellular cancer. Each year approximately 5000 Americans die of hepatitis B–related liver disease [2]. In the United States, there are an estimated 1.2 million infectious carriers of HBV and more than 200,000 cases of acute HBV infection each year. The estimated lifetime risk of acquiring HBV in the United States is approximately 5% [3]. Identifying and treating patients with hepatitis B is an important public health issue. Treatment may slow the progression of liver disease and reduce morbidity and mortality in individuals with chronic infection [4]. Primary prevention via hepatitis B vaccination can not only reduce the prevalence of hepatitis B but also significantly reduce the development of hepatocellular cancer in highly endemic areas of the world [5]. However, until a comprehensive vaccine policy has been successfully implemented in low-prevalence areas like the United States, significant morbidity and mortality due to hepatitis B can be expected. The following case study highlights important considerations in the diagnosis, prevention, and management of HBV infection.