PG Lecture
17.07.2020
Hepatitis B
Virus:
liver is essential to life.
It is like a factory
It builds proteins and sugars for other parts of body to use
It is like a warehouse
It stores vitamins, sugars, fats and nutrients and releases them when the body needs them
It is like a recycling centre
It filters blood and breaks down
chemicals that the body cannot use
3
Liver disease has several causes:
many can be prevented and treated
Potential Causes Examples Prevention/
Treatment
Viruses1,2 Hepatitis A , B, C*
Vaccines (for hepatitis A and B), avoid risk factors, screening,
medication
Alcohol1 Alcoholic liver disease Consume alcohol in moderation/cease drinking
Drugs1
Certain medications can damage your liver (e.g. OTC pain
medications)
Follow your doctor’s recommendations
Hereditary3 Iron overload (Hemochromatosis) Remove excess iron from body
Abnormal liver cell growth4
Hepatitis B-induced liver cancer
Hepatitis B vaccines/screening to prevent HCC, cancer treatment (e.g. radiotherapy,
chemotherapy)
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*No vaccine is currently available for hepatitis C, and hepatitis A is generally not treated with medications
Hepatitis
5
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Hepatitis
Hepatitis means “inflammation of the liver”
1
Viral hepatitis is the most common cause of liver disease
2
The most common types of viral hepatitis are
1:
Hepatitis A
Hepatitis B
Hepatitis C
1. Centers for Disease Control and Prevention. Hepatitis B FAQs.
http://www.cdc.gov/print.do?url=http%3A//www.cdc.gov/hepatitis/B/bFAQ.htm%23overview. Accessed April 1, 2009.
2. American Liver Foundation. Liver Wellness. http://www.liverfoundation.org/downloads/alf_download_29.pdf. Accessed March 11, 2009.
Hepatitis B Virus
Image from ICTVdB - The Universal Virus Database, version 4.
http://www.ncbi.nlm.nih.gov/ICTVdb/ICTVdB/
Hepatitis B is a global problem
8% = High
2-7% =Intermediate <2% =Low
HBsAg prevalence
Data from 2008 7
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Hepatitis B is an infectious viral illness
HBV is up to 100 times more infectious than HIV
HBV can live outside the body for 7 days
Many people who are chronically infected with HBV do not have any symptoms
Early detection is the key to preventing hepatitis B-associated disease and death
Infection acquired in the UK (around 200 per year) but an estimated
7,000 chronic cases of hepatitis B come to the UK every year as a result of immigration to the UK from high prevalence areas.
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Vertical transmission (Mother to Child)
Hepatitis B transmission routes
9 Razors/
needles
Contact with infected fluids
9
Transfusion/
organ transplant
Unprotected sexual contact
with HBV+
11
Course of Hepatitis B virus infection
Course of HBV Infection
Adult Infant
90-95%
Acute Infection
Full Recovery Chronic
Hepatitis B 5-10%
Virus Persists 70-90%
Virus Persists
Chronic Hepatitis B
10-30%
Acute Infection
Full Recovery
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Acute
Hepatitis B
Is a short-term disease that occurs when a person is first infected with the hepatitis B virus (HBV)1
Symptoms may occur in approximately 70%
of patients about 12 weeks after exposure2
The immune system usually suppresses the virus1
Complete recovery may occur within a few months1
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Loss of appetite
Nausea and vomiting
Dark urine Yellow eyes and
skin (jaundice)
Abdominal pain
Common symptoms of acute Hepatitis B
Fatigue Joint pain
Weakness
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Chronic Hepatitis B (CHB)
Is a long-term disease that occurs when immune system does not get rid of the virus
may not have obvious symptoms
Patients often find out they are ill when they develop serious liver damage
CHB is a serious disease; it can lead to cirrhosis, liver cancer, and death
Healthy liver Fibrotic liver1 Cirrhotic liver2 Liver cancer3
This is a healthy liver
The continuous inflammation of the
liver caused by hepatitis B can lead
to fibrosis - a
formation of scar tissue in the liver
In cirrhosis of the liver, scar tissue replaces normal, healthy tissue, blocking the flow of blood through the liverand
preventing it from working properly
Liver cancer is the formation of a malignant tumor in
the liver
Types of liver disease:
potentially caused by Chronic Hepatitis B (CHB)
15
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Untreated Hepatitis B can cause liver cancer
Hepatitis B virus is second only to tobacco smoke in causing cancer deaths globally
The incidence of liver cancer is 9 times
higher in Asian American men than their
white counterparts
Hepatitis B-associated liver cancer destroying a normal liver
Hepatitis B Diagnosis
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Chronic Hepatitis B screening
A simple blood test is the only way to detect HBV infection
Screening for hepatitis B is necessary to:
Identify people who have chronic hepatitis B so they can receive medical treatment
Identify those who are unprotected so they can be vaccinated
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screening for Chronic Hepatitis B
All patients who have abnormal LFTs or who are HCV +
All foreign-born persons from areas where the rate of HBV infection is moderate to high
Household and sexual contacts of infected persons
Pregnant women
HIV-positive people
Haemodialysis patients
Injecting drug users
People with selected medical conditions*
e.g. requiring chemotherapy, immunosuppressive drugs (steroids) etc
results of Hepatitis B screening
Hepatitis B Surface Antigen (HBsAg)
Negative: Normal
Positive >6 months: Patient has chronic hepatitis B
Hepatitis B surface antibody (Anti-HBs)
Negative: Not immune
Positive: Immunity to hepatitis B from either previous infection or vaccination
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Hepatitis B Treatment
21
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Do’s if diagnosed with Chronic
Hepatitis B
Although there is no cure, chronic hepatitis B can be managed
Many patients, once treated, can live normal and healthy lives
Early detection and proper management can help save lives
Take care by scheduling regular doctor appointments to monitor your chronic hepatitis B progression
Protect family by avoiding transmission of the virus
Receive treatments to help delay and prevent liver damage from chronic hepatitis B
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Medications used to treat Chronic Hepatitis B
Oral medications:
Adefovir dipivoxil
Entecavir
Lamivudine
Telbivudine
Tenofovir disoproxil fumarate
Two injectable medications:
Interferon alfa-2b
Peginterferon alfa-2a
Treatment for Hepatitis B may reduce the risk of cirrhosis and liver cancer
Cirrhosis
Liver Cancer
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Iloeje UH, et al. Gastroenterol. 2006;130:678-686.
Chen CJ, et al. JAMA. 2006;295:65-73.
Hepatitis B Virus
Treatment
Treatment
Hepatitis B Prevention
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Hepatitis B Can Be Prevented
Vaccination is the best way to protect
Some other ways to guard against infection include:
Learn more about hepatitis, its prevention and treatment
Use condoms during intimate contact
Don’t share razors or toothbrushes with an infected person
Prevent transmission to infants by making sure the infant receives vaccination
Consider the risks before getting a tattoo or body piercing, shaving
If you have had hepatitis B, don’t donate blood, organs or semen
Pregnancy is a time for Hepatitis B screening and prevention
Pregnant women can be tested for chronic hepatitis B at an early pre-natal visit
Infants born to women with chronic hepatitis B should receive hepatitis B vaccination +/- hepatitis B immune globulin (HBIG)
After giving birth, women with chronic hepatitis B should talk to their doctors about managing their chronic hepatitis B
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Common Myths About Hepatitis B
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Common myths about
hepatitis B transmission
Hepatitis B is Not Not transmitted by
Sharing food, water, utensils or drinking
glasses
Mosquitoes Tears, sweat,
urine or stools 29
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Common myths about hepatitis B transmission
Hugging or kissing Breastfeeding Coughing or sneezing
Hepatitis B is Not Not transmitted by
Asian Liver Center. 2007 Physician’s Guide to Hepatitis B: A Silent Killer.
http://liver.stanford.edu/Education/2007Handbook.pdf. Accessed April 1, 2009.