David Spach, MD
Professor of Medicine
Division of Allergy and Infectious Diseases
University of Washington School of Medicine
H. Nina Kim, MD, MSc
Associate Professor of Medicine
Division of Allergy and Infectious Diseases
University of Washington School of Medicine

Funded through a Centers for Disease Control and Prevention Cooperative Agreement (CDC-RFA- PS16-1608)

University of Washington


Hepatitis B Case Studies

This website will shut down on March 29, 2019 as the CE expires on March 31. An updated, expanded Hepatitis B website will launch in late 2019.

Hepatitis B Web Study

Featuring interactive, case-based modules with free CE credits

What's New

May 16th 2016 - CNE credits are now available!

Natural History

One of the hallmarks of chronic hepatitis B is the dynamic nature of this infection and the variability of viral replication and immune activity in an individual’s lifetime. This case provides an overview of the three key phases of chronic hepatitis B infection.


Knowldege of HBV serologic markers is important in understanding whether a patient is susceptible to infection, immune as a result of resolved infection, immune as a result of vaccination, acutely infected, or chronically infected.  This case provides a detailed summary of hepatitis B serologic markers using graphics and animations.
Isolated hepatitis B core antibody is a distinct serologic profile where antibody against hepatitis B core antigen exists in the absence of surface antibody or antigen. The differential diagnosis and clinical implications of this profile are discussed here.


A positive hepatitis B surface antigen (HBsAg) can represent acute and resolving hepatitis B infection or chronic persistent infection with a variety of phenotypes. This case reviews the different clinical scenarios when you can encounter positive HBsAg, and how to distinguish one from the other.
Patients with chronic hepatitis B infection who have negative hepatitis B e antigen are not always by definition “healthy carriers.” These individuals can go on to have active HBV viral replication, liver enzyme elevation and liver disease. The epidemiology, mechanism and management of patients with this serologic profile are discussed here.
High serum hepatitis B viral levels are associated with an increased risk of progression to cirrhosis and hepatocellular carcinoma; experts and guidelines have endorsed maximal HBV viral suppression with antiviral therapy to reduce this risk. This case reviews the indications and goals for initiating HBV therapy.
Seven antiviral agents are FDA-approved to treat chronic hepatitis B infection.  This case provides an overview for each of these agents, with review of pertinent data for treatment studies in patients with chronic hepatitis B infection. 
There are seven agents currently approved for use in chronic hepatitis B infection. The clinical efficacy, advantages and disadvantages of these antiviral medications are addressed in this case.
Patients with chronic hepatitis B on treatment require regular monitoring to ensure ongoing safety and efficacy. This case provides an overview of both serologic and virologic responses in different types of patients, and addresses how to manage suboptimal results.
As more patient receive long-term oral antiviral therapy for hepatitis B, resistance to oral agents has taken on increasing importance.  This case discusses practical management issues of patients with chronic hepatitis B and resistance to oral agents. 
Individuals coinfected with HBV and HIV are more likely to experience liver-related morbidity and mortality than those infected with HBV alone. This case discusses the goals of treatment and the unique issues surrounding initiating antiviral therapy in HBV-HIV-infected persons.


Hepatitis B vaccine is a safe and effective vaccine that prevents new HBV infections. This case reviews the epidemiology of HBV in the United States, indications for HBV vaccine, and recommended doses and schedules. 
Hepatitis B virus (HBV) is among the more easily transmissible viral infections in occupational settings, and given the lack of universal coverage of hepatitis B immunization among healthcare or other susceptible workers, HBV post-exposure prophylaxis remains important. The evaluation and management of occupational HBV exposures, and the use of hepatitis B vaccine and immune globulin in such settings are discussed here.
Immunoprophylaxis with a combination of hepatitis B immune globulin and hepatitis B vaccine series can greatly reduce the risk of mother-to-child transmission of HBV. The management of these neonates born to women who are chronic carriers is discussed here.