2. OBJECTIVES
Introduction
Mode of transmission
Viral structure
Acute hepatitis B infection
Chronic hepatitis B infection
Clinical features
Investigation
Treatment
Prevention
3. INTRODUCTION
Hepatitis is an inflammation of the liver
The condition can be self limiting or can
progress to scarring(fibrosis), liver cancer or
cirrhosis.
4. INTRODUCTION…..
Hepatitis viruses are the common cause of
hepatitis
Other causes are alcohol, drugs and
autoimmune diseases
There are five main hepatitis viruses, type A,
B, C, D, and E
5. MODE OF TRANSMISSION
Transmitted through intravenous routes
Infected blood product
Contaminated needle of intravenous drug
abuser
Tattooists
Heterosexuals with multiple partners or
contact with infected persons
Sexual intercourse in male homosexual
Vertical transmission mother to child during
delivery
6. VIRAL STRUCTURE
The virus is Dane particles consists:
Outer surface coat – the hepatitis surface
antigen(HBsAg)
Inner core - consists double strand DNA
polymerase/reverse transcriptase
Core antigen(HBcAg) and e
antigen(HBeAg).
hepatitis e antigen is produce in excess
during active viral replication and its
detection in the serum show a higher
7. ACUTE HEPATITIS B INFECTION
Acute HBV infection may be asymptomatic or
symptomatic
Seldom associate with rashes, or polyathritis
affecting the small joints
If HBsAg is present a full profile is performed
8. ACUTE HEPATITIS B INFECTION….
The Viral marker of HBV:
HBsAg- is originate in acute Hepatitis and
persists in chronic carriers
HBsAg with HBeAg – is presence in acute
hepatitis, its existence in chronic HBV
infection is associated with increased
infectivity and progress to chronic liver
diseases
9. ACUTE HEPATITIS B INFECTION…..
HBsAg with anti-HBe – occurs in
improvement on acute infection, in chronic
infection specify decreased infectivity
Anti- HBs – come out late and signify
immunity
HBV DNA – imply constant viral replication
10. ACUTE HEPATITIS B INFECTION…..
Most patients recover completely from acute
HBV, this marked by the disappearance of
HBsAg, development of antibody to surface
antigen(anti-HBs)and immunity to
subsequent infection
Minority of patient do not clear HBsAg from
serum and become chronic carriers.
11. ACUTE HEPATITIS B INFECTION….
Risk of developing chronic HBV infection is
inversely related to age at the time of
infection
90% of infants infected at birth will become
chronically infected with HBV, but only about
5% of adult
12. CHRONIC HEPATITIS B INFECTION
About 3-5% of patients with acute HBV
progress to chronic hepatitis
The condition may be asymptomatic, or
presence with established liver diseases and
the sign of chronic liver disease in physical
examination
13. CHRONIC HEPATITIS B INFECTION…..
Serum liver biochemistry transferase is
usually abnormal, liver biopsy and
histological examination will show the
severity of diseases varying from mild
inflammatory changes to established
cirrhosis
14. CLINICAL FEATURES
Jaundice
Fever
Loss of body hair
Spider naevi
Gyenacomastia
Finger clubbing
Liver(small/large)
Dupuytren’s
contracture
Scratch mark
Testicular atrophy
Ascites
Edema
Hepatic flap
Splenomegally
15. INVESTIGATION
Hepatitis B panel
HBV DNA test
Serum bilirubin
PT, PTT, INR
AST, ALT
HIV test
CBC
Gamma-glutamyl
transpeptidase
(GGT)
Alkaline
phosphatase (ALP)
Alphafetal protein
16. TREATMENT
The primary treatment goals for patients
with hepatitis B (HBV) infection are:
To prevent progression of the disease,
particularly to cirrhosis, liver failure, and
hepatocellular carcinoma (HCC).
17. TREATMENT…..
Risk factors for progression of chronic HBV
include the following :
Persistently elevated levels of HBV DNA
and, in some patients, alanine
aminotransferase (ALT)
Male sex
Older age
18. TREATMENT…..
Family history of HCC
Elevated alpha-fetoprotein (AFP)
Coinfection with hepatitis D (delta) virus
(HDV), hepatitis C virus (HCV), or human
immunodeficiency virus (HIV)
19. TREATMENT….
For acute HBV give:
Tenofovir disoproxil fumarate (TDF) or
Entecavir (ETV).
In patients with HBV who are coinfected with
human immunodeficiency virus (HIV), it may
be possible to simplify treatment regimens
with agents that have dual effectiveness
against both viruses e.g Tenoforvir +
Lamivudine + Efarvirenz
20. PREVENTION
Screening prenatal pregnancy women to
prevent vertical transmission
Hepatitis B vaccine
The three major risk groups (heterosexuals
with multiple partners or contact with infected
persons, injection-drug users, and men who
have sex with men)should be vaccinated
against HBV.
