Can hepatitis B be treated by GPs?
General practitioners (GPs) can treat hepatitis B if they have undertaken training and are authorised as a prescriber.
There is a lot of information that can help you to advise and support patients who are concerned about, or may have been diagnosed with hepatitis B.
Who should be tested for hepatitis B?
Opportunistic testing should be conducted for:
- individuals born overseas, especially from high hepatitis B prevalence countries.
- high prevalence populations including immigrants
- Aboriginal and Torres Strait Islander people.
Other people that should be tested include:
- Pregnant women – early intervention can prevent mother to baby transmission
- Adults at heightened risk of transmission, including
- sexual and household contacts
- men who have sex with men
- injecting drug users
- individuals with more than one sexual partner
- sex workers
- patients undergoing haemodialysis.
- The presence of co-infection with HIV and/or hepatitis C may affect health outcomes and treatment decisions; therefore, it’s important to test hepatitis C and HIV patients.
- Patients commencing chemotherapy or immunosuppressive therapy should be screened for hepatitis B virus). Undiagnosed hepatitis B in these patients may lead to a life-threatening flare of hepatitis B on reconstitution of the immune system otherwise known as Immune Reconstitution Inflammatory Response (IRIS).
- People with clinical presentation of liver disease or elevated ALT or AFP of unknown cause
- Health and Allied Health care professionals that may be engaged in exposure prone procedures
- Military personnel.
What hepatitis B diagnostic tests are needed?
Current serological tests for HBV are:1
- Hepatitis B surface antigen (HBsAg)
- Antibody to surface antigen (anti-HBs)
- Antibody to core antigen (anti-HBc).
These serology tests are covered under Medicare rebates.
Can hepatitis B be treated?
The most common way people contract hepatitis B is at birth through mother to baby transmission. 90% of babies born to mothers living with hepatitis B will develop chronic hepatitis B. 10% of people who contract hepatitis B as an adult will develop chronic hepatitis B.
People living with chronic hepatitis B would need to be engaged with a doctor and will be given treatment when advised by their doctor. Not everyone who has hepatitis B will need treatment immediately. People with chronic hepatitis B will only need treatment if there is significant activity in the immune system where it can lead to liver damage. Treatment aims to prevent, stop and even mildly reverse the progression of liver injury. However, there is no cure for the hepatitis B virus.
What treatments are available?
There are several medications to treat chronic hepatitis B. Currently, Entecavir and Tenofovir are first line treatment options for anti-viral therapy2 and are funded under the Australian Government through the Pharmaceutical Benefits Scheme (PBS).3
How easy is it to access the treatments?
Any pharmacy can supply these treatments under prescription. Supply should be available in all geographical areas. However, we advise ringing your local pharmacy to ensure continuity of access for your patient.
For any queries about pharmacies contact the LiverLine on 1800 703 003.
Do GPs need to undertake any special training to treat patients with hepatitis B?
Hepatitis B medications have a classification of S100 ‘highly specialised drugs’. To be able to prescribe these medications, GPs need to undergo additional training to become S100 prescribers.
The Hepatitis B s100 Prescriber Program for general practitioners, other community based medical practitioners, and nurse practitioners can be accessed through the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM).
Visit the ASHM website for further information.
