Hepatitis B for health professionals

The Hepatitis Foundation of New Zealand (HFNZ) is a charitable trust, contracted to Health New Zealand to provide a health monitoring programme that supports people living with hepatitis B.

Our national monitoring programme is for people living with chronic hepatitis B (CHB). Approximately 25,000 individuals are enrolled. People infected with chronic hepatitis B (CHB) are at risk of liver failure and liver cancer. Long-term regular blood test monitoring has been shown to reduce morbidity and mortality from CHB.

We work closely with many partners around New Zealand and offshore to provide effective support and achieve positive health outcomes for people living with hepatitis. Collaboration between health organisations enables a seamless delivery of health services.

GPs can refer patients to us

• through our referral form

• via phone

• by printing and completing a patient referral form and returning it to us

• via post, fax or email (we have compliant MoH IT security and firewalls), or electronically via CareSelect, HealthLink (our EDI is NZhepfnd), Best Practice or Medtech Outbox.

Hepatitis B high risk factors

• Anyone over 35 years of age unless they have been fully vaccinated.

• Especially Māori, Pacific Island or South Asian ethnicity

• Born outside New Zealand, from a country with high hepatitis B endemicity, including Asia, the Pacific Islands, Africa, the Middle East, and southern Europe

• Have a mother or close family member with hepatitis B

• Live with someone who has hepatitis B

• Have ever had unprotected sexual contact with an HBV-infected person

• Have ever injected drugs

Natural history of chronic hepatitis B 

In determining when to start anti-viral therapy, it is helpful to consider the natural history of CHB. Most are infected in infancy or early childhood and for many years the virus is present at very high titres (>10^8). The virus itself is not hepatotoxic and there is minimal damage occurring to the liver during this period.

This may be followed, often in later childhood or early adulthood, by a period of active hepatitis when the immune system tries to destroy the virus by killing infected liver cells (known as HBeAg-positive chronic hepatitis or immune-active CHB). A person may then become HBeAg-negative and move into a prolonged phase of normal liver function and a much lower viral load (HBeAg-negative chronic infection or inactive chronic hepatitis B).

Treatment

Chronic hepatitis B is often a lifelong condition. Not everyone with it needs anti-viral therapy; the decision to begin treatment depends on several factors including age, serial ALT and HBV DNA levels and severity of liver disease (degree of fibrosis). The three major international societies for the study of liver disease (APASL, EASL and AASLD) have recently published updated guidelines on the management of hepatitis B. The degree of fibrosis present is an important factor in making treatment decisions in some scenarios. In most cases this can be obtained non-invasively with a fibroscan. In a small number of cases a liver biopsy may be useful.

The goal of therapy for patients with chronic hepatitis B is to improve survival and quality of life by preventing disease progression and consequently HCC development. Additional goals of antiviral therapy are to prevent mother-to-child transmission, hepatitis B reactivation and the prevention and treatment of HBV-associated extra-hepatic manifestations.

Pegylated interferon

The rationale for pegylated interferon is to induce long-term immunological control with a finite duration of therapy.  Pre-treatment predictors of response include HBeAg positive, HBV DNA < x10^8, elevated ALT and genotype A.