Viral Hepatitis B & C — Super-Pocket Investigation + Treatment Guide (2025)
- Mayta
- Jun 14
- 2 min read
1 Hepatitis B (HBV)
Investigate
Screen: HBsAg, anti-HBs, total anti-HBc ± IgM anti-HBc (if acute suspected)
If HBsAg + : HBeAg, HBV DNA (quantitative), ALT; stage liver (APRI/FIB-4 or elastography) who.int
Start drug when ≥ 1 of these triggers (WHO 2024 simplified):
Cirrhosis - clinical or APRI > 2 / FIB-4 > 3.25 / LS ≥ 11 kPa who.int
HBV DNA ≥ 2 000 IU/mL and ALT > ULN (30 U/L men, 19 U/L women) who.int
LS ≥ 8 kPa plus DNA ≥ 2 000 IU/mL (even with normal ALT) who.int
High-risk host (HIV/HCV/HDV, strong family HCC, age > 30, impending immunosuppression) and DNA ≥ 2 000 IU/mL who.int
Pregnancy 28-32 wk with DNA ≥ 200 000 IU/mL or HBeAg + worldhepatitisalliance.org
Severe acute/fulminant hepatitis (INR ≥ 1.5, encephalopathy) hcvguidelines.org
First-line drug (choose ONE potent NA)
Drug | Daily dose | Pick when… |
Tenofovir DF | 300 mg | default |
Tenofovir AF | 25 mg | renal/BMD issues |
Entecavir | 0.5 mg (1 mg if 3TC-resistant) | eGFR < 15 mL/min or TDF/TAF unavailable |
No combination tablets needed; monotherapy is standard. hepb.org
Follow-up
ALT + HBV DNA q3–6 mo (then q6–12 mo once suppressed);
ultrasound ± AFP q6 mo when ≥ F3.
2 Hepatitis C (HCV)
Investigate
Screen: Anti-HCV antibody.
If Ab + → Reflex HCV RNA (or core Ag) on the same sample for confirmation. cdn.who.int
Stage liver: APRI/FIB-4 ± elastography.
Start DAAs when: any detectable HCV RNA (acute or chronic) — treat immediately. hcvguidelines.org
Pan-genotypic regimens (pick ONE)
Liver status | Regimen | Duration |
No cirrhosis | Glecaprevir 300 mg / Pibrentasvir 120 mg | 8 wk hcvguidelines.org |
Sofosbuvir 400 mg / Velpatasvir 100 mg | 12 wk hcvguidelines.org | |
Compensated cirrhosis (Child-Pugh A) | Same two options | 8 wk (G/P) or 12 wk (SOF/VEL) hcvguidelines.org |
Decompensated cirrhosis (B/C) | SOF/VEL + Ribavirin | 12 wk (24 wk if RBV-ineligible) hcvguidelines.org |
Follow-up
Few/no on-treatment labs (unless cirrhotic or ribavirin).
SVR12 (RNA – 12 wk post-Rx) = cure.
Ultrasound ± AFP q6 mo lifelong if baseline F3/F4.
Vaccinate against HAV & HBV if non-immune.
Lightning Mnemonics
HBV: “C or 2K + ALT → Tenofovir or Entecavir.”
HCV: “RNA = Rx; 8/12 weeks → cure.”
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