A positive chronic hepatitis B diagnosis requires follow-up, from clinical tests to patient education, including:1,2

Post-diagnosis follow-up and testing

Following a positive test result for chronic infection, patients will require a thorough history and physical examination followed by evaluation tests.1,2

  • 1. History and physical examination to assess:
  • Risk factors for viral hepatitis
  • Family history of HCC
  • Route of transmission
  • History of alcohol use
  • Presence of comorbid
  • Risk factors for HIV coinfection
  • Duration of infection
  • 2. Evaluation tests may include:
  • Serial testing for HBV DNA and ALT
  • HBeAg and anti-HBe
  • LFTs, including CBC, PLT and PT
  • Tests for antibodies to HAV, HCV, HDV, and HIV
  • HCC screening
  • Transient elastography or liver biopsy*
  • Urinalysis
  • HBV genotype

ALT=alanine transaminase; CBC=complete blood count; HAV=hepatitis A virus; HBV DNA=hepatitis B virus deoxyribonucleic acid; HCC=hepatocellular carcinoma; HCV=hepatitis C virus; HDV=hepatitis D virus; LFT=liver function tests; PLT=platelet test; PT=prothrombin time.
*Liver biopsy is optional for patients indicated for treatment, but may be helpful in those with normal ALT and >35-40 years of age.


CHB patients may not be aware of how they contracted the virus.3

In the United States, the most common routes of transmission are through perinatal and sexual contact but it may be transmitted through any type of exposure to body fluids, such as blood and semen, of people with either an acute or chronic hepatitis B infection.4

  • Perinatal transmission is the major route by which hepatitis B infection is perpetuated in endemic populations5,6
  • Children born to mothers infected with chronic hepatitis B, who are not perinatally infected, remain at risk of horizontal transmission so vaccination should be considered.5

There are many myths about how hepatitis B is transmitted so appropriate patient education about the virus and common routes of transmission is important.7

Hepatitis B (HBV) modes of transmission3

Hepatitis B Transmission Hepatitis B Transmission
To download a brochure offering recommendations for patients to help prevent transmission, visit VIEW SITE
REFERENCES: 1. Shah HA, Abu-Amara M. Education provides significant benefits to patients with hepatitis B virus or hepatitis C virus infection: a systematic review. Clin Gastroenterol Hepatol. 2013;11:922-933. 2. Martin P, Lau D, Nguyen M, et al. A treatment algorithm for the management of chronic hepatitis B virus infection in the United States: 2015 update. Clin Gastroenterol Hepatol. 2015;13:2071-2087. 3. Weinbaum CM, Williams I, Mast EE, et al., and The National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Viral Hepatitis. Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recomm Rep. 2008;57(RR08):1-20. 4. Centers for Disease Control and Prevention. Hepatitis B. In: Hamborsky J, Kroger A, Wolfe S, eds. Epidemiology and Prevention of Vaccine - Preventable Diseases. 13th ed. Washington D.C.: Public Health Foundation;2015:149-174. 5. Kim WR. Epidemiology of hepatitis B in the United States. 2009;49(5 suppl):S28–S34. 6. World Health Organization. Hepatitis B fact sheet.​mediacentre/​factsheets/​fs204/​en/. Updated July 2017. Accessed August 2017. 7. Asian Liver Center at Stanford University. 2013 Physician’s Guide to Hepatitis B: A silent Killer. Palo Alto, CA: Asian Liver Center; 2014. 8. Sarin SK, Kumar M. Epidemiology, screening, and natural history of chronic hepatitis B infection. In: Shetty K, Wu GY, eds. Clinical Gastroenterology: Chronic Viral Hepatitis. Totowa, NJ: Humana Press; 2009:185-241. 9. Tan NC, Cheah, SL. How do general practitioners improve compliance of disease monitoring by patients with chronic hepatitis B infection in primary care? A qualitative study. Asia Pacific Family Medicine. 2004;3:29-37. 10. Giang L, Selinger CP, Lee AU. Evaluation of adherence to oral antiviral hepatitis B treatment using structured questionnaires. World J Hepatol. 2012;4:43-49. 11. Fattovich G, Bortolotti F, Donato F, et al. Natural history of chronic hepatitis B: special emphasis on disease progression and prognostic factors. J Hepatol. 2008;48:335-352. 12. Burns GS, Thompson AJ. Viral hepatitis B: clinical and epidemiological characteristics. Cold Spring Harb Perspect Med. 2014;4:a024935. 13. Terrault N, Bzowej NH, Chang KM, et al. AASLD Guidelines for treatment of chronic hepatitis B. Hepatology. 2016;63(1):261-283. 14. Tseng TC, Liu CJ, Yang HC, et al. Higher proportion of viral basal core promoter mutant increases the risk of liver cirrhosis in hepatitis B carriers. Gut. 2015;64:292-302. 15. Trépo C, Chan HL, Lok A. Hepatitis B virus infection. Lancet. 2014;384:2053-2063. 16. Lin CL, Kap JH. Risk stratification for hepatitis B virus related hepatocellular carcinoma. J Gastroenterol Hepatol. 2012;28:10-17. 17. Chen CJ, Yang HI, Su J, et al. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA. 2006;295:65-73. 18. Tong MJ, Pan CQ, Hann HW, et al. The management of chronic hepatitis B in Asian Americans. Dig Dis Sci. 2011;56:3143-3162. 19. Lok ASF, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology. 2009;50:1-36.