Clinics & services

Hepatitis B Treatment (for GPs)

Austin Health supports shared care for people living with hepatitis B. Many patients can be monitored safely in primary care, while others require specialist review, treatment initiation, or ongoing specialist input.

This page is designed to help GPs understand who can remain in community-based care, when referral is recommended, and where to find the key clinical resources and referral pathways.

About the service

Our service provides specialist support for patients with chronic hepatitis B who require assessment, treatment consideration, complex monitoring, or shared care with primary care.

We work closely with GPs to support:

  • assessment of chronic hepatitis B
  • treatment decision-making
  • antiviral initiation where indicated
  • management of patients with cirrhosis or complex liver disease
  • surveillance planning for patients at risk of hepatocellular carcinoma
  • advice for patients with pregnancy, immunosuppression, co-infection, or other complicating factors.

Where appropriate, patients may be managed in a shared care model, with routine monitoring undertaken by the GP and specialist input provided for treatment decisions or more complex issues.

Who can often be managed in primary care?

Many people living with chronic hepatitis B do not require immediate antiviral treatment, but they do require regular review and monitoring.

Primary care management may be appropriate for patients who:

  • have confirmed chronic hepatitis B and are clinically stable
  • do not currently meet treatment criteria
  • do not have evidence of cirrhosis, significant fibrosis, or decompensated liver disease
  • can have regular pathology and imaging arranged in the community
  • have a clear monitoring plan in place.

This may include routine monitoring of:

  • liver function tests
  • hepatitis B serology and viral load, as clinically indicated
  • liver cancer surveillance for eligible patients
  • treatment adherence and follow-up, where shared care arrangements are in place.

When to refer

Referral to Austin Health should be considered for patients with hepatitis B who may benefit from specialist review, including:

  • patients who are hepatitis B surface antigen (HBsAg) positive
  • pregnant patients with hepatitis B
  • patients who are immunosuppressed or are starting immunosuppressive therapy and have isolated hepatitis B core antibody (HBcAb)
  • patients with suspected cirrhosis, advanced fibrosis, or other evidence of significant liver disease
  • patients being considered for antiviral therapy
  • patients with complex management issues, diagnostic uncertainty, or co-infection
  • patients requiring specialist advice regarding long-term monitoring, surveillance, or treatment.

Referral may also be appropriate where the GP would like specialist input to confirm the management plan or establish shared care.

Urgent referral or emergency escalation

Please arrange urgent escalation for patients with red flag features such as:

  • acute liver failure
  • severe hepatic encephalopathy
  • sepsis in a patient with cirrhosis
  • severe ascites, particularly if restricting movement or breathing.

If clinically unstable, patients should be directed to the Emergency Department.

How to refer to Austin Health

Austin Health’s preferred referral method is electronic referral (eReferral) via HealthLink.

When submitting a Specialist Clinics referral ensure all relevant pathology, imaging and clinical information are attached.

Information to include with referral

To support triage, referrals should include as much relevant information as possible, such as:

  • hepatitis B serology, including HBsAg, hepatitis B surface antibody and hepatitis B e serology
  • hepatitis B PCR / viral load
  • hepatitis C and HIV serology
  • liver function tests
  • full blood examination
  • pregnancy status / gestational age if relevant
  • current medication list, including non-prescription medicines and supplements
  • upper abdominal ultrasound results, if available
  • prior liver biopsy or FibroScan results, if available
  • relevant treatment history and prior specialist input.

You can find more information on how to use HealthLink on our GP referrals page.

Visit the Department of Health website for the statewide referral criteria for Hepatitis B.

Escalation and re-entry to specialist care

Patients with chronic hepatitis B may move between primary care and specialist services over time depending on their disease phase and treatment eligibility.

Patients who are currently monitored in primary care should be referred (or re-referred) for specialist review if their clinical situation changes, including where:

  • antiviral treatment may be indicated
  • viral load or liver enzymes increase
  • there is concern about progression of liver disease
  • cirrhosis is suspected or newly diagnosed
  • pregnancy occurs
  • immunosuppressive therapy is planned or commenced
  • there is diagnostic uncertainty or complex management issues.

GPs are encouraged to submit a new Specialist Clinics referral if specialist review is required. Patients previously known to the service can be re-referred through the usual referral pathway.

Where clinically appropriate, patients may transition between GP-led monitoring and specialist care as part of an ongoing shared-care approach.

Clinical guidance and useful resources

GPs may find the following resources helpful:

ASHM Hepatitis B Referral and Clinical Support Resources
Practical guidance for testing, monitoring, treatment decisions and referral pathways.

Australian consensus recommendations for the management of hepatitis B infection
National clinical recommendations covering diagnosis, monitoring, treatment and special populations.

Frequently asked questions

Does every patient with chronic hepatitis B need treatment?

No. Many patients do not require treatment immediately, but they do require regular monitoring because disease phase and treatment eligibility can change over time.

Does a Hepatitis B carrier need any follow up?

Yes. So-called “hepatitis B carriers” (people with chronic hepatitis B but no liver inflammation) may still be at risk of fibrosis, cirrhosis or liver cancer, even when asymptomatic, and should usually have ongoing monitoring based on ALT, HBV DNA and HCC risk.

Can patients be managed by their GP?

Yes, many patients can be monitored in primary care, particularly where there is a clear management plan and specialist input is available when needed.

When is specialist referral especially important?

Specialist referral is particularly important where there is pregnancy, immunosuppression, suspected cirrhosis, treatment consideration, diagnostic uncertainty, or complex liver disease.

Which patients need liver cancer surveillance?

Some patients with chronic hepatitis B require regular hepatocellular carcinoma surveillance. Please refer to current Australian guidance to determine eligibility and surveillance intervals.