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Prof Arif

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  • 1. Understanding Hepatitis-B
    Prof Arif M. Siddiqui
    MBBS(KE);MRCP(UK);FRCP(London)
    FRCP(Edin);FRCP(Glasg)
    AllamaIqbal Medical College/Jinnah Hospital Lahore
  • 2. Prologue
    There has been an explosion of information on Hepatits B in the last few years and this many doctors have not been able to grasp fully.
    New management guidelines have emerged.
    I will, in this short time, try to explain few basic important facts on which the understanding and management of this disease is based.
  • 3. PAKISTAN
    151 millionpopulation
    35% Urban
    65% Rural
    22 millionchildren under 5 years
    6.6 million childreninfected by HBV before the age of 5 years go on to develop Chronic Hepatitis B infection.
    Hepatitis
    2.6% prevalence among general public
    3.8% prevalence among pregnant women
    Ref: WHO/MDG
  • 4. HBV worldwide distribution, 2000sWHO2003
    WHO 2003
  • 5. HBV by age at infection
  • 6. Global distribution of HBV genotypes (A to H)
    A, D
    B,C
    G
    A, C, B, D, G
    B, C
    A,D
    F, H
    E
    F
    A
    * Defined by divergence in the entire genome sequence > 8%.
  • 7. Hepatitis B
    Source: Centers for Disease Control and Prevention, USA
    Revised December 2003
  • 8. Hepatitis B - diagnostic tools
    Antibodies to the virus
    Severity of liver damage
    Markers of the virus
    Markers of liver damage
    HBV
  • 17. Hepatitis-B
    HBsAg
    Anti-HBsAg
    HBe
    Anti-HBe
    HBc (does not appear in blood)
    Anti-HBc IgG & IgM
    HBV-DNA by PCR
  • 18. Hepatitis-B
    HBsAg
    Anti-HBsAg
    HBe-Ag
    Anti-Hbe (Hbe-Ab)
    HBc (does not appear in blood)
    Anti-HBcIgG & IgM
    HBV-DNA by PCR
  • 19. Hepatitis-B
    HBsAg
    Anti-HBsAg
    Hbe-Ag
    Anti-HBe
    HBc (does not appear in blood)
    Anti-HBcIgG & IgM
    HBV-DNA by PCR
  • 20. Hepatitis-B
    HBsAg
    Anti-HBsAg
    HBe-Ag
    Anti-HBe
    HBc (does not appear in blood)
    Anti-HBcIgG & IgM
    HBV-DNA by PCR
  • 21. Hepatitis-B
    HBsAg
    Anti-HBsAg
    HBe
    Anti-HBe
    HBc (does not appear in blood)
    Anti-HBc IgG & IgM
    HBV-DNA by PCR
  • 22. Hepatitis-B
    HBsAg
    Anti-HBsAg
    Hbe
    Anti-Hbe
    HBc (does not appear in blood)
    Anti-HBc IgG & IgM
    HBV-DNA by PCR
  • 23. Hepatitis-B
    HBsAg
    Anti-HBsAg
    Hbe
    Anti-Hbe
    HBc (does not appear in blood)
    Anti-HBc IgG & IgM
    HBV-DNA by PCR
  • 24. Hepatitis-B
    HBsAg
    Anti-HBsAg
    Hbe
    Anti-Hbe
    HBc (does not appear in blood)
    Anti-HBc IgG & IgM
    HBV-DNA by PCR
  • 25. Acute HBV Infection: Appearanceand Disappearance of Viral Markers
    viraemia
    (HBV-DNA, DNA-polymerase)
    ALT
    HBeAg
    HBsAg
    anti-HBc
    anti-HBs
    ALT
    anti-HBe
    8
    10
    12
    2
    4
    6
    2
    4
    6
    Months
    Years
    HBV
  • 26. Acute Hepatitis B Virus Infection with Recovery Typical Serologic Course
    Symptoms
    anti-HBe
    HBeAg
    Total anti-HBc
    Titer
    anti-HBs
    IgM anti-HBc
    HBsAg
    0
    4
    8
    12
    16
    24
    28
    32
    52
    100
    20
    36
    Weeks after exposure
  • 27. Progression to Chronic Hepatitis B Virus Infection Typical Serologic Course
    Acute
    (6 months)
    Chronic
    (years)
    HBeAg
    anti-HBe
    HBsAg
    Total anti-HBc
    Titer
    IgM anti-HBc
    0
    4
    8
    16
    20
    24
    28
    36
    12
    32
    52
    Years
    Weeks after exposure
  • 28. Progression to Chronic Hepatitis B Virus Infection Typical Serologic Course
    Acute
    (6 months)
    Chronic
    (years)
    HBeAg
    anti-HBe
    HBsAg
    Total anti-HBc
    Titer
    IgM anti-HBc
    0
    4
    8
    16
    20
    24
    28
    36
    12
    32
    52
    Years
    Weeks after exposure
  • 29. Natural Course of CHB
    Immune
    Tolerance
    Immune
    Clearance
    Phase
    Late/Residual
    Pre-C mutant
    Reactivation
    HBV-DNA
    anti-HBe(+)
    HBeAg(+)
    HBsAg
    Clearance
    Cirrhosis
    HCC
    ALT/Grading
    HBeAg Nuclear Cytoplasm (++ ~) (-)
    (+++) Membrane (++ ~)
    HBsAg/preS Membrane Cytoplasm (++ ~) Cytoplasm (+++)
    (+++) Membrane (++ ~)
    HLA-1 (-) (++) (++)
    20
    40
    60
    Age
  • 30. Treatment
    When to treat
    With what to treat
    How to monitor
    How long to treat

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