Acute Hepatitis B in an Urban Tertiary Care Hospital in the United States

Abstract

The incidence of acute hepatitis B virus (HBV) infection in the United States is declining, and precise epidemiology for newly acquired infection remains obscure. We sought to clarify the clinical presentation and management of acute symptomatic HBV infection at a hepatology referral center. We prospectively evaluated the demographic, epidemiological, clinical, and treatment data of 32 patients with acute symptomatic HBV who were referred to a single urban tertiary care hospital in the United States. Slightly more than half of the patients were male (53%) or belonged to the black race (53%) and slightly fewer than half of the patients (47%) were unemployed. The median patient age was 41.9 years, and 20 (63%) patients were unmarried. The most common HBV risk factor was a new sexual partner over the previous months (34%). Fifteen percent of the patients reported no known risk factors. Four (13%) patients were diabetic. Presenting symptoms included jaundice (75%), abdominal pain (63%), and marked fatigue (59%). The mean peak for aspartate aminotransferase/alanine aminotransferase was 1822/2109 IU/L, for total bilirubin was 12.6 mg/dL, and for International Normalized Ratio was 1.53. Eight patients (25%) were started on oral nucleot(s)ide therapy. One diabetic patient underwent liver transplantation. In a sample of patients from a US urban tertiary hepatology center, common epidemiological features of acute symptomatic hepatitis B were being middle aged and unmarried and having acquired the infection through a new sexual contact. Antiviral therapy was sometimes but not commonly started. These data reinforce the need for HBV vaccination of individuals at risk, including those not traditionally targeted.