Hepatitis is an inflammation of the liver that is most commonly caused by hepatitis viruses. There are several types of hepatitis viruses including hepatitis A, B, C, D, and E. Hepatitis B virus (HBV) is a major global health problem, with 350 million carriers worldwide resulting in 600,000 deaths annually. It is transmitted through body fluids and from mother to child. Symptoms may include jaundice, dark urine, fatigue, and nausea. Diagnosis involves testing for hepatitis B surface antigen and liver enzymes. Treatment options for HBV include interferon, lamivudine, adefovir, entecavir, telbivudine, and tenofovir, with tenofo

1. HEPATITIS
NIDA SEHAR Noman
MS (Pharmacology) & MBA (Finance)
nidasehar19@yahoo.com

2. what is hepatitis?
Cause
Anyother cause?
Hepatitis viruses are the most common cause of hepatitis in the world
Hepatitis is an inflammation of the liver
Other infections.
Toxic substances (e.g. alcohol, certain drugs)
Autoimmune diseases.

3. Types of hepatitis

4. 350 million hepatitis B
virus carriers
worldwide.
600,000 death due to
HBV complications
annually.
one of the major cause
of liver cancer
globally.
HEPATITIS B

5. Transmission
• It is transmitted by
• body fluids
• Hepatitis B exposure
• Intravenous drug user
• Patient immunocompromised
• Fetal or neonatal effect of maternal
infection
• Surgical procedure
• Healthcare Worker, or
• Transfusion of blood product.

6. • There are three surface antigen
HBsAg most abundant persistence past 6 months
after initial detection corresponds to chronic infection and
indicates an increased risk for cirrhosis and HCC.
HBeAg present in an acute infection and is replaced by
antibodies (anti-HBeAg ) once an infection is resolved.
HBcAgnucleocapsid protein that,when expressed on
hepatocytes,promotes immune-mediated cell ldeath.

7. Stages of HBV
Immunotolerant Immunoactive Seroconversion
HBeAg +
HBV DNA >20000IU/ml
ALT normal
HBeAg +,-
usually HBV DNA
>20000IU/ml
ALT elevated
HBeAg -
Normal ALT
Anti HBeAg

8. • Loss ofAppetite.
• Fatigue.
• Nausea and vomiting.
• Itching all over the body.
• Pain over the location of
the liver.
• Jaundice (skin and the
whites of the eyes turn
yellow in color)
• Dark urine (the color of
cola or tea)
• Pale-colored stools
SIGN AND
SYMPTOMS

9. Diagnosis is done by serological assay and liver enzymes test (LFT).
 Acute HBV infection is characterized by the presence of HBsAg and
immunoglobulin M (IgM) antibody to the core antigen, HBcAg.
During the initial phase of infection, patients are also seropositive
for hepatitis B e antigen (HBeAg). HBeAg is usually a marker of
high levels of replication of the virus. The presence of HBeAg
indicates that the blood and body fluids of the infected individual
are highly infectious.
 Chronic infection is characterized by the persistence of HBsAg for at
least 6 months (with or without concurrent HBeAg). Persistence of
HBsAg is the principal marker of risk for developing chronic liver
disease and liver cancer (hepatocellular carcinoma) later in life.
Diagnosis

12. T
R
E
A
T
M
E
N
T

13. Interferon
 IFN-alfa therapy was the first approved therapy for
treatment of HBV.
 Improves long-term outcomes and survival.
 It has antiviral,antiproliferative,and immunomodulatory
effects
 Most effective in pateints with increased ALT and HBV
DNA levels,high histologic activity score at biopsy,and
being non-Asian.
 It enhance the host immune system to defense against
HBV.

14. Lamivudine
 Lamivudine, a nucleoside analog,work by incorporating
into growing HBV DNA chain causing premature chain
termination.
 Nose is 100mg daily orally.
 No definite duration of therapy
 And there is chance of resistance
 It's not recommended as first-line therapy

15. Adefovir
 Adefovir,an analog of adenosine monophosphate,act by inhibiting
HBV reverse transcriptase and DNA polymerase.
 effective in lamivudine resistent patients
 30mg/day of adenofovir was found nephrotoxic in clinical trials.
 serum creatinine monitoring is recommended in patients with risk
of renal insuffeincy and, treated with adefovir for more than one
year.
 dose is 10mg daily for one year.
 the risk of adefovir resistence is high in lamivudine resistenent
patients.
 but no drug resistence has been seen in first year of therapy.
 not first line therapy for HBV.

16. Entecavir
 Entecavir is a guanosine nucleoside analog that inhibit
HBV replication at three stages.
 More potent than both lamivudine and adefovir.
 Effective in lamuvidine resistent patients.
 Dose 0.5 mg daily and 1mg in lamivudine resistent pts.
 No resistence has been seen but the risk of resistence
high in lamuvidine and adefovir resistent patients.
 Available by the name of Baraclude

17. Telbivudine
 Telbivudine is HBV specific nucloside analog act as
competitive inhibitor of viral reverse transcriptase and
DNA polymerase.
 As compare to lamivudine ;telbivudine is more potent
suppressor of HBV DNA.
 Telbivudine resistant mutations are cross-resistant with
lamivudine.
 Because of resistance concerns telbivudine monotherapy
has a limited role in the treatment of HBV.

18. Tenofovir
 Tenofovir is a nucleotide analog approved f or HBV in
2008.
 equally effective in both HBeAg positive and HBeAg
negative patients.
 not nephrotoxic.
 found effective in both lamuvidine and adefovir resistent
patients.
 Daily dose is 300mg orally.
 First line therapy.