## Management of Acute Hepatitis B **Key Point:** Acute hepatitis B in immunocompetent adults is a self-limited illness that resolves spontaneously in >95% of cases without antiviral intervention. Treatment is supportive. **High-Yield:** Antiviral therapy (nucleos(t)ide analogues or interferon) is NOT indicated in acute HBV infection unless there is evidence of: - Fulminant hepatic failure (INR >1.5, encephalopathy) - Severe hepatitis (bilirubin >10 mg/dL with coagulopathy) - Immunocompromised state **Clinical Pearl:** The natural history of acute HBV in immunocompetent individuals is spontaneous clearance with seroconversion to anti-HBs. Antiviral therapy is reserved for chronic HBV (HBsAg persistence >6 months) or acute-on-chronic presentations. ## Why Supportive Care Is Correct | Aspect | Acute HBV (Immunocompetent) | Chronic HBV | |--------|---------------------------|-------------| | Natural clearance | >95% | <5% | | Antiviral indicated | Only if fulminant | Yes, if HBeAg+ or high ALT | | First-line approach | Supportive (rest, nutrition) | Lamivudine, tenofovir, or interferon | | Monitoring | LFTs, INR, bilirubin | HBV DNA, HBeAg, ALT trends | **Tip:** In exam questions on acute HBV, always ask: "Is there fulminant failure or severe hepatitis?" If no → supportive care. If yes → consider antivirals or even transplantation. [cite:Harrison 21e Ch 297]
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