FAQs
Key takeaways:
- There are a number of common questions and scenarios which can complicate hepatitis B care.
- Understanding these can improve the hepatitis B care you provide to patients.
On this page
What precautions should I take?
Standard precautions prevent transmission by treating all blood as potentially infectious, whether a person is aware of their hepatitis status or not. Standard precautions are the work practices required to achieve a basic level of infection prevention and control. They include (but are not limited to) hand hygiene and the safe use and disposal of sharps. For a full list of standard precautions, see here.
All healthcare professionals are responsible for following the same standard of infection control precautions with every patient.
See further information on what precautions to take here.
Further Information
Infection control – standard and transmission-based precautions | Website | Victorian Government Department of Health
What does it mean when my patient’s results show an isolated anti-HBc?
This could mean various things for your patient including: distant resolved infection (most common), recovering from acute hepatitis B, false positive, or ‘occult’ hepatitis B.
Occult hepatitis B is a rare situation where active hepatitis B infection occurs in the absence of detectable hepatitis B infection. This can be determined by detecting HBV DNA in serum. This test is not Medicare rebatable in the absence of HBsAg. A HBV DNA test should be considered if there is clinical or biochemical evidence of active liver disease.
Confirmation of results via repeat pathology should be considered. Interpreting hepatitis B serology can be difficult. For further information see the hepatitis B testing portal.
Further Information
Decision making in hepatitis B | PDF | ASHM
B Positive: Hepatitis B virus testing and interpreting test results | Website | ASHM
What should I know about hepatitis B and immunosuppression?
Universal testing for people undergoing cancer chemotherapy or other significant immunosuppressive treatment is recommended.
Individuals with resolved (anti-HBc positive +/- anti-HBs positive > 10 IU/mL) or current infection are at risk of reactivation and a flare of hepatitis with rising ALT levels. Reactivation of hepatitis B is the sudden increase or reappearance of HBV DNA in the setting of past infection.
Specific guidelines on the use of prophylactic antiviral therapy for patients receiving immunosuppressive therapy are in the Australian consensus recommendations for the management of hepatitis B infection (2022). Pre-emptive treatment is recommended, and specialist referral advised.
Further Information
Australian consensus recommendations for the management of hepatitis B infection | PDF | Gastroenterological Society of Australia
B Positive: Complex situations, co-infection and immunosuppression | Website | ASHM
National Hepatitis B Testing Policy | Website | ASHM
What does it mean when my patient seroconverts HBsAg? How common is this?
The annual rate of both spontaneous and treatment-induced HBsAg clearance is low, at about 1%. The long-term outcomes are similar to the outcomes for people with naturally resolved HBV infection.
Interpreting hepatitis B serology can be difficult. For further information see the hepatitis B testing portal.
Further Information
Australian consensus recommendations for the management of hepatitis B infection | PDF | Gastroenterological Society of Australia
National Hepatitis B Testing Policy | Website | ASHM
My patient has HIV, hepatitis C or hepatitis D. What do I need to do?
Due to shared modes of transmission, all people living with hepatitis B should be tested for HIV, hepatitis C and hepatitis D.
Co-infection with other blood-borne viruses can alter the natural history of hepatitis B and complicate treatment and management approaches.
Referral to or shared care with a tertiary specialist or experienced s100 prescriber is advised for co-infected people.
Further Information
B Positive: Complex situations, co-infection and immunosuppression | Website | ASHM
How do I navigate MBS billing & the PBS for hepatitis B?
Chronic hepatitis B qualifies as a chronic disease for Medicare purposes.
The 3 main codes are:
- GPMP (721)
- TCA 1–2 yearly reviews (723)
- TCA 6-monthly reviews (item 732).
Streamlined authority codes for antivirals are available. However, in community settings, these may only be used by accredited s100 hepatitis B community prescribers. The exception to this is the provision for medical practitioners to prescribe maintenance therapy when it is impractical to get a prescription from the treating affiliated specialist medical practitioner and the specialist has agreed to the prescription.
Further Information
MBS online | Website | Australian Government Department of Health and Aged Care
Using the MBS items online checker in HPOS | Website | Services Australia
Chronic disease GP management plans and team care arrangements | Website | Services Australia
Where can I find support to conduct a clinical audit on hepatitis B?
Quality improvement and clinical audits are an increasing area of primary health care. See below for links to relevant information and resources.
As projects in this space develop, further information will be included here.
Further Information
Maximising Cancer Screening Quality Improvement Project: Hepatitis B and C education videos | Videos | North Western Melbourne Primary Health Network
Can I contact an integrated hepatitis nurse for support? What other support is available in Victoria?
“If you’re feeling unsure about what to do with a patient with hepatitis B or what the results mean… there’s always someone to call or contact. Start with the Integrated Hepatitis Nurses, they can help guide you and connect you to the local liver clinic and specialist.” – Dr Jacqui Richmond | Viral Hepatitis Nurse Consultant | Barwon Public Health Unit and Burnet Institute
The Victorian Integrated Hepatitis C Services deliver a range of services including:
- Consulting, mentoring and capacity building for health professionals
- Outreach, including co-located clinics in established services and individual client outreach
- Education and training
- Fibroscan clinics
Nurses from 12 health and community services make up the Integrated Hepatitis C Services across Victoria.
While these roles are hepatitis C focussed, they may also be able to assist with hepatitis B.
A contact list can be found here.
The Victorian Viral Hepatitis Nurse Educator based at St Vincent’s Hospital can also provide resources and education. For further information and contact details see here.
Further Information
Victorian Integrated Hepatitis C Services: Nurse led models of care | Website | Victorian Government Department of Health
Training and education | Webpage | St Vincent’s Hospital
