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Marie

Meet Marie . . .

  • She is a graduate student who lives on her own
  • She keeps busy as a teaching assistant and has a tutoring service
  • She also tries to maintain a busy social life

Patient demographics and diagnosis

Sex: Female
Age: 27 years
Race/Ethnicity: Haitian

Diagnosed with CHB by her PCP after her mother was diagnosed with HCC and found to have CHB 

Initial visit with hepatologist

Past medical history: Unremarkable
Medications: Oral contraceptive pill
Past surgical history: None

    • Immigrated to the US from Haiti with her parents at age 8
    • Parents born in Haiti
    • Not currently sexually active
    • Has 1–2 servings of alcohol on weekends
    • Has never smoked tobacco products
    • Has never used recreational drugs

    • Mother was recently diagnosed with hepatocellular carcinoma. She was also found to have CHB. She underwent Y-90 radioembolization a month ago and is currently undergoing work up for liver transplantation
    • Father is HBsAg (–)
    • One younger brother aged 21 who has not been screened for HBV
    • Mother also has hypertension; father has hypertension and diabetes

    • Devastated and has become more guarded with friends
    • Has not disclosed CHB status to others outside her family
    • Scared that she will develop liver cancer like her mother

  • Marie presents with the following labs

    • Triple panel results: HBsAg (+), anti-HBs (−), and anti-HBc total (+)
    • ALT: 20 U/L (ULN: 25 U/L)1
    1. Terrault NA, et al. Hepatology. 2018;67(4):1560-1599.

  • Marie's hepatologist ordered additional lab tests

    Anti-HBc IgM (–); HBeAg (–); anti-HBe (+); HBV DNA, 1800 IU/mL
    Anti-HCV Ab, anti-HDV Ab, and HIV RNA: All negative
    AFP: 3.5 ng/mL (normal: <10 ng/mL)1

  • Vibration-controlled transient elastography

    • 6.0 kPa (significant fibrosis cutoff, >7.0 kPa)1

    Controlled attenuation parameter

    • 290 dB/min (steatosis cutoff, ≥288 dB/min)2
    1. European Association for the Study of the Liver. J Hepatol. 2025;83(2):502-583. 2. Terrault NA, et al. Hepatology. 2018;67(4):1560-1599.

  • Abdominal ultrasound:

    • Mild hepatic steatosis
    • No suspicious focal hepatic lesions
    • No biliary ductal dilatation
    • Patent portal vein with normal hepatopetal flow

    • Marie’s hepatologist explained she may have acquired hepatitis B by mother-to-child transmission
    • Her hepatologist recommended that her brother be screened and subsequently learns he is HBsAg (+)

  • What guidance would you offer her? 

    • She cannot transmit the virus to others through routine forms of contact, such as hugging or sharing meals. She should, however, avoid sharing of personal hygiene items, such as toothbrushes and razors1
    • HBV can be transmitted through sexual activity, and you recommend that sexual partners are screened and receive HBV vaccination if not immune, or use barrier contraception if their HBV status is unknown1–3
    • Alcohol use can increase the risk of cirrhosis, and you recommend abstinence, if possible, or limited use of alcohol only1
    • Finally, you counsel her on a healthy diet, regular exercise, and maintenance of a healthy weight to help her liver as hepatic steatosis is associated with the development of liver disease complications4,5
    1. Terrault NA, et al. Hepatology. 2018;67(4):1560-1599. 2. World Health Organization. Global Hepatitis Report. 2024. 3. Razavi-Shearer D, et al. Poster at: AASLD The Liver Meeting; Nov 15-19, 2024. 4. Rinella ME, et al. Hepatology. 2023;77(5):1797-1835. 5. Mao X, et al. Hepatology. 2023;77(5):1735-1745.

    • Shared decision-making is an important part of conversations with patients, especially when considering treatment options
    • Recommend starting treatment since her mother has HCC, and review follow-up care:
      • She will have blood tests to check for liver inflammation (ALT) and how much virus is in her blood (HBV DNA) every 3 months during the first year and then every 6–12 months if everything is stable1
    • Emphasize that if she decides to start treatment, she will need to take antiviral medication daily. Treatment typically lasts many years and may even be lifelong
    • Additionally, considering her family history, you recommend that she be monitored for HCC every 6 months via ultrasound and alpha-fetoprotein (AFP) assessment1
    • Together, you and Marie decide to start her on treatment
    1. European Association for the Study of the Liver. J Hepatol. 2025;83(2):502-583.

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