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PG Lecture

17.07.2020

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Hepatitis B

Virus:

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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

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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

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Hepatitis

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Hepatitis

Hepatitis means “inflammation of the liver”

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Viral hepatitis is the most common cause of liver disease

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The most common types of viral hepatitis are

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:

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/

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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

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Transfusion/

organ transplant

Unprotected sexual contact

with HBV+

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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

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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)

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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

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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

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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

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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

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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

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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

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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.

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