Pharmacist's Perspective on Hepatitis B

Household and sexual contacts of patients with hepatitis B should be vaccinated regardless of contact type, with post-vaccination antibody testing reserved for those at highest ongoing risk.

For patients with HIV who fail to mount adequate immunity after a standard aluminum-adjuvanted hepatitis B vaccine series, switching to the cytosine-guanine-adjuvanted Heplisav-B offers superior immunogenicity and more reliable protection.

For patients with a creatinine clearance below 15 mL/min or intolerance to tenofovir-based therapies, entecavir remains a viable and well-supported treatment option per the 2026 American Association for the Study of Liver Disease and Infectious Diseases Society of America guidelines.

An undetectable viral load does not mean hepatitis B is cured, and discontinuing antiviral therapy can trigger severe immune-mediated liver damage.

When a patient tests positive for total hepatitis B core antibody but negative for both surface antigen and surface antibody, additional workup is essential to distinguish between resolved infection, occult disease, early infection, or a false positive result.

In patients co-infected with hepatitis B and HIV, entecavir should be avoided, and a tenofovir-based regimen active against both viruses is preferred.