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. Topics covered The six hepatitis B markers and what each means The serologic grid and the isolated core antibody The phase grid of chronic infection Treatment principles, thresholds, and the drug menu Reactivation under immunosuppression and prophylaxis Pregnancy: the three-pillar vertical-transmission bundle Hepatitis D: coinfection versus superinfection Hepatitis D treatment and bulevirtide Key decisions Read 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. The 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. Treat with entecavir or a tenofovir prodrug indefinitely, choosing alafenamide for renal or bone protection and tenofovir disoproxil in pregnancy. Reactivation 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. The pregnancy bundle is universal surface-antigen screening, infant immunoglobulin plus vaccine within twelve hours regardless of viral load, and maternal tenofovir disoproxil from twenty-eight to thirty-two weeks when DNA exceeds two hundred thousand. Tell coinfection from superinfection by the core antibody: coinfection shows core IgM with acute B and D, while superinfection shows total core without IgM because the underlying B is chronic. Test for hepatitis D when a chronic hepatitis B patient has an ALT flare with low DNA, because hepatitis D drives injury using circulating surface antigen without needing active B replication. For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com. Questions or feedback: [email protected]. (00:00) - Introduction and the phase-grid idea (00:47) - The six hepatitis B markers (02:10) - The serologic grid and isolated core antibody (03:29) - The phase grid of chronic infection (06:04) - Treatment principles and the drug menu (08:25) - Reactivation under immunosuppression (11:10) - Pregnancy: the three-pillar bundle (13:52) - Hepatitis D: coinfection versus superinfection (16:16) - Hepatitis D treatment and bulevirtide

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“What did the council decide on item 42?” — answered with the speaker and the moment.

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