Evidence-based management of Chronic Hepatitis B according to Uganda Clinical Guidelines 2023
Uganda Clinical Guidelines 2023 · all from source →
General Adult
Diagnosis
Clinical Features
Symptomatic or asymptomatic. Weakness, malaise, low-grade fever, right upper quadrant pain. Jaundice, dark urine, severe pruritus. Complications: Cirrhosis, Hepatocarcinoma.
Investigations
HBsAg positive for >6 months. Negative IgM / Positive IgG core antibody. APRI (AST to Platelets Ratio Index) marker for fibrosis. Alpha fetoprotein at 6 months, Abdominal US at 4-6 months. HIV Serology.
Treatment
General Management
Screen for HIV. If positive, refer for ART. If negative, refer to regional hospital. Treatment is lifelong. Avoid alcohol.
Antiviral Indications
Treat if: Cirrhosis present (APRI > 2), HIV co-infection (use tenofovir), OR no cirrhosis but persistently elevated ALT & viral load >20,000 IU/L.
First-Line Antivirals
Adults/Children >12yrs or >35kg: Tenofovir 300 mg once a day. Child 2-11yrs: Entecavir 0.02 mg/kg.
Contraindications for Treatment
DO NOT treat patients without cirrhosis (APRI <2) who have persistently normal ALT and HBV viral load < 2000 IU/ml.
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