{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 18, Ep 2 of 3: Hepatitis B and D","html":"","width":"100%","height":180,"duration":1031,"description":"Episode two steps inside hepatitis B, where the serologic panel is not just diagnostic but a phase grid that determines treatment, the pregnancy strategy, the reactivation rule, and the hepatitis D testing decision. It reads two grids: the serologic grid of surface antigen, core antibody, and surface antibody that places the patient, and the phase grid of e-antigen, DNA, and ALT that decides whether to treat. From there it covers the nucleoside analogs, the three-pillar pregnancy bundle, the preemptive reactivation prophylaxis rule under immunosuppression, and hepatitis D with its new entry inhibitor bulevirtide. Every threshold, drug, and cutoff is named as the boards test it.\n \nTopics covered\n\nThe six hepatitis B markers and what each means\nThe serologic grid and the isolated core antibody\nThe phase grid of chronic infection\nTreatment principles, thresholds, and the drug menu\nReactivation under immunosuppression and prophylaxis\nPregnancy: the three-pillar vertical-transmission bundle\nHepatitis D: coinfection versus superinfection\nHepatitis D treatment and bulevirtide\n \n \nKey decisions\n\nRead the serologic grid of surface antigen, core antibody, and surface antibody to place the patient, with isolated core antibody positivity worked up by viral DNA and a repeat panel.\nThe phase grid of e-antigen status, viral DNA, and ALT decides treatment: immune-tolerant and inactive-carrier phases are not treated, while both immune-active phases are.\nTreat with entecavir or a tenofovir prodrug indefinitely, choosing alafenamide for renal or bone protection and tenofovir disoproxil in pregnancy.\nReactivation is prevented preemptively, not rescued: surface-antigen-negative core-antibody-positive patients starting rituximab or transplant get prophylaxis because their risk approaches the surface-antigen-positive group.\nThe pregnancy bundle is universal surface-antigen screening, infant immunoglobulin plus vaccine within twelve hours regardless of viral load, and maternal tenofovir...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}