Hepatitis B infection affects the liver and is caused by the hepatitis B virus (HBV). Currently, HBV infection is considered one of the most important health problems in the world. In 2019, there were 296 million people with chronic HBV infection and 820,000 deaths. In most cases, HBV infection is asymptomatic and self-limiting. However, about 90% of infants and 2–6% of adults with hepatitis B can develop chronic hepatitis B. In the long term, these patients can develop liver cirrhosis and hepatocellular carcinoma. The therapeutic methods for patients with HBV vary according to disease stage. For chronic patients, the infection can be managed using antivirals (nucleos(t)ides analogs and interferons), while for patients with end-stage liver disease, the best therapeutic option is liver transplantation.
The most common antivirals to treat HBV infection are lamivudine, adefovir, telbivudine, entecavir, tenofovir, interferon alfa-2b and peginterferon alfa-2a. In 2021, the cost of one year of treatment with lamivudine was US$1296 (150 mg tablet), while one year with entecavir cost US$2866 (500 mg tablet), and tenofovir cost US$4130 (25 mg tablet). Also, an injection of interferon alfa-2b (5 million IU/mL) and peginterferon alfa-2a (180 µg/0.5 mL) can cost around US$74 and US$250, respectively. Notably, the cost of these treatments can increase since some antiviral drugs must be taken in combination to reduce the risk of resistance mutations. In the United States, the average price of a liver transplant is US$163,438 (US$145,277–181,598), and the ablation of one or more liver tumors by radiofrequency costs at least US$50,000. These procedures are expensive, and their success depends on the patient’s clinical and nutritional status. A study in HBV patients with liver transplants due to hepatocellular carcinoma found that life expectancy is 76% in the first year, and 49% of people lived at least five years after transplantation
Hepatitis B Vaccination
The Advisory Committee on Immunization Practices (ACIP) recommends:
administration of hepatitis B vaccine and hepatitis B immune globulin (HBIG) for infants born to HBV-infected women within 12 hours of birth, followed by completion of the vaccine series and postvaccination serologic testing;
universal hepatitis B vaccination within 24 hours of birth, followed by completion of the vaccine series; and
vaccination of children and adolescents aged <19 years who have not been vaccinated previously.