2. Features and
Epidemiology
Causes acute and chronic hepatitis
Infection is preventable by vaccination (95%
efficiency).
One of the most commoncauses of liver
cirrhosis.
HepatitisB virus (HBV) is the most common
viral hepatitis worldwide.
Highest prevalence :- Asia, sub-Saharan
Africa, South America, and the Middle East
In the United States :- Approximately2 million
people have chronic HBV.
Very low prevalence in children < 12 years of
age.
3. Transmission
The only reservoir for HBV:
humans.
Unprotected sexual
intercourse: ⅔ of cases.
Parenteral: e.g., shared IV
drug needles.
Mother to child: most
common.
4. Pathphysiology
HBV infects liver
cells expressing
viral peptides on
the surface
1
Peptides activate
lymphocytes
(CD8+ cytotoxic T
cells)
2
WBCs mount a
cellular immune
response against
infected liver cells
3
Destruction of
hepatocytes
4
Liver
inflammation
5
5. Clinical
presentation –
Acute
infection.
Incubation time: 1–6 months
⅔ of individuals with acute infection are
asymptomatic.
⅓ of individuals develop symptoms of
acute hepatitis:
• Nausea and vomiting
• Jaundice
• Fever
• Tiredness
• Dark urine
• Abdominal pain
• Myalgias and arthralgias
Symptom duration: often only a few weeks
Death is rare.
6. Clinical
presentation –
Chronic
infection.
When infection is acquired at a younger age, the
rate of progression to chronic hepatitis B is higher.
Can lead to acute-on-chronic exacerbation.
Acute reactivation:
• Asymptomatic
• May mimic the course of acute infection
• May develop liver failure
• Cirrhosis
• Hepatocellular carcinoma (HCC)
Extrahepatic manifestations:
• Vasculitis :- Panarteritis nodosa, Sicca
syndrome, Raynaud syndrome, Uveitis.
• Neuritis and polyneuropathy.
• Glomerulonephritis.
• Skin rashes.
7. Diagnosis
Viral markers :-
• Hepatitis B surface antigen.
• Hepatitis B surface antibody.
• Hepatitis B core antigen.
• Hepatitis B core antibody.
• HBV DNA.
8. Management –
Acute.
No specific therapy available
Treatment is supportive.
Hepatitis B immune globulin and hepatitis B vaccine are
recommended for nonimmune household members
and sexual contacts.
9. Management –
Chronic.
1st-line treatment:
• Pegylated interferon alfa (PEG-IFN-α)
• Entecavir (ETV)
• Tenofovir disoproxil fumarate (TDF)
Treatment goals:
• Reversal of liver disease.
• ↓ DNA levels of HBV.
• Seroconversion to anti-Hbe
Liver transplantation: the only curative treatment option
in cases of end-stage liver disease
