Hepatitis B Infection

Rob Heyderman

Epidemiology
One third of the worlds population (2 billion) people have been infected
5% chronically infected

China and sub-Saharan Africa 10-20% seroprevelence

Europe and north America 0.2-0.5% 500,000 deaths

Transmission
Congenital
Childhood Sexual Blood transfusion Needles, acupuncture, IVDU etc Health workers

Progression
Immune response to viral antigens displayed on the hepatocyte surface determines hepatocellular injury
Non-cytolytic clearance

Patients with immune defects have mild liver injury but high rates of carriage

Progression
Usually asymptomatic Children < 1yr Children 1-5 years Children >5 years and adults 90% become chronic 30% become chronic 2% become chronic

Yearly frequency for clearance 0.1-0.8%

Progression
*DNA may be detectable at low levels

DNA

DNA

* ? Infectious

Progression
15-40% Chronic Carriage 20% Cirrhosis

Liver failure

X100 risk afp U/S screening

Hepatoma

Diagnosis
Hepatitis B surface antigen
HBeAg HBeAb PCR

Liver biopsy

Treatment
ALT 1.5X normal HBV detectable

Interferon a = immunomodulation
Lamivudine and adefovir = viral suppression Liver transplantation Endpoints (controversial)
ALT

Loss of HBeAg
?anti-HBeAb Undetectable HBV DNA Histology (?tissue PCR)

Prevention
General measures
Universal precautions Blood screening Maternal screening

Hepatitis B vaccination
3 doses ? Life-long immunity

? Side effects
Escape mutants

Immunoprophylaxis