PG Lecture 17 07 2020 Hepatitis B Virus

PG Lecture 17. 07. 2020

Hepatitis B Virus:

liver is essential to life. It is like a factory It builds proteins and sugars for other parts of body to use It is like a warehouse It stores vitamins, sugars, fats and nutrients and releases them when the body needs them It is like a recycling centre It filters blood and breaks down chemicals that the body cannot use 3

Liver disease has several causes: many can be prevented and treated Examples Prevention/ Treatment Hepatitis A , B, C* Vaccines (for hepatitis A and B), avoid risk factors, screening, medication Alcoholic liver disease Consume alcohol in moderation/cease drinking Drugs 1 Certain medications can damage your liver (e. g. OTC pain medications) Follow your doctor’s recommendations Hereditary 3 Iron overload (Hemochromatosis) Remove excess iron from body Hepatitis B-induced liver cancer Hepatitis B vaccines/screening to prevent HCC, 4 cancer treatment (e. g. radiotherapy, chemotherapy) Potential Causes Viruses 1, 2 Alcohol 1 Abnormal liver cell growth 4 *No vaccine is currently available for hepatitis C, and hepatitis A is generally not treated with medications

Hepatitis 5

Hepatitis means “inflammation of the liver” 1 Viral hepatitis is the most common cause of liver disease 2 The most common types of viral hepatitis are 1: Hepatitis A Hepatitis B Hepatitis C 1. Centers for Disease Control and Prevention. Hepatitis B FAQs. Hepatitis B Virus Image from ICTVd. B - The Universal Virus Database, version 4. http: //www. ncbi. nlm. nih. gov/ICTVdb/ICTVd. B/ http: //www. cdc. gov/print. do? url=http%3 A//www. cdc. gov/hepatitis/B/b. FAQ. htm%23 overview. Accessed April 1, 2009. 2. American Liver Foundation. Liver Wellness. http: //www. liverfoundation. org/downloads/alf_download_29. pdf. 6

Hepatitis B is a global problem HBs. Ag prevalence 8% = High 2 -7% =Intermediate <2% =Low Data from 2008 7

Hepatitis B is an infectious viral illness HBV is up to 100 times more infectious than HIV HBV can live outside the body for 7 days Many people who are chronically infected with HBV do not have any symptoms Early detection is the key to preventing hepatitis B-associated disease and death Infection acquired in the UK (around 200 per year) but an estimated 7, 000 chronic cases of hepatitis B come to the UK every year as a result of immigration to the UK from high prevalence areas. 8

Hepatitis B transmission routes Vertical transmission (Mother to Child) Contact with infected fluids Razors/ needles 99

Transfusion/ organ transplant Unprotected sexual contact with HBV+

Course of Hepatitis B virus infection Course of HBV Infection Adult 90 -95% Acute Infection 5 -10% Virus Persists Full Recovery Chronic Hepatitis B Infant 70 -90% Virus Persists Chronic Hepatitis B 10 -30% Acute Infection Full Recovery 11

Acute Hepatitis B Is a short-term disease that occurs when a person is first infected with the hepatitis B virus (HBV)1 Symptoms may occur in approximately 70% of patients about 12 weeks after exposure 2 The immune system usually suppresses the virus 1 Complete recovery may occur within a few months 1 12

Common symptoms of acute Hepatitis B Yellow eyes and skin (jaundice) Abdomin al pain Joint pain Fatigue Loss of appetite Nausea and vomiting Dark urine Weaknes s 13

Chronic Hepatitis B (CHB) Is a long-term disease that occurs when immune system does not get rid of the virus may not have obvious symptoms Patients often find out they are ill when they develop serious liver damage CHB is a serious disease; it can lead to cirrhosis, liver cancer, and death 14

Types of liver disease: potentially caused by Chronic Hepatitis B (CHB) Healthy liver Fibrotic liver 1 Cirrhotic liver 2 Liver cancer 3 This is a healthy liver The continuous inflammation of the liver caused by hepatitis B can lead to fibrosis - a formation of scar tissue in the liver In cirrhosis of the liver, scar tissue replaces normal, healthy tissue, blocking the flow of blood through the liver and preventing it from working properly Liver cancer is the formation of a malignant tumor in the liver 15

Untreated Hepatitis B can cause liver cancer Hepatitis B virus is second only to tobacco smoke in causing cancer deaths globally The incidence of liver cancer is 9 times higher in Asian American men than their white counterparts Hepatitis B-associated liver cancer destroying a normal liver 16

Hepatitis B Diagnosis 17

Chronic Hepatitis B screening A simple blood test is the only way to detect HBV infection Screening for hepatitis B is necessary to: Identify people who have chronic hepatitis B so they can receive medical treatment Identify those who are unprotected so they can be vaccinated 18

screening for Chronic Hepatitis B All patients who have abnormal LFTs or who are HCV + All foreign-born persons from areas where the rate of HBV infection is moderate to high Household and sexual contacts of infected persons Pregnant women HIV-positive people Haemodialysis patients Injecting drug users People with selected medical conditions* e. g. requiring chemotherapy, immunosuppressive drugs (steroids) etc 19

results of Hepatitis B screening Hepatitis B Surface Antigen (HBs. Ag) Negative: Normal Positive >6 months: Patient has chronic hepatitis B Hepatitis B surface antibody (Anti-HBs) Negative: Not immune Positive: Immunity to hepatitis B from either previous infection or vaccination 20

Hepatitis B Treatment 21

Do’s if diagnosed with Chronic Hepatitis B Although there is no cure, chronic hepatitis B can be managed Many patients, once treated, can live normal and healthy lives Early detection and proper management can help save lives Take care by scheduling regular doctor appointments to monitor your chronic hepatitis B progression Protect family by avoiding transmission of the virus Receive treatments to help delay and prevent liver damage from chronic hepatitis B 22

Medications used to treat Chronic Hepatitis B Oral medications: Adefovir dipivoxil Entecavir Lamivudine Telbivudine Tenofovir disoproxil fumarate Two injectable medications: Interferon alfa-2 b Peginterferon alfa-2 a 23

Treatment for Hepatitis B may reduce the risk of cirrhosis and liver cancer Treatment Cirrhosis Hepatitis B Virus Liver Cancer 24 Iloeje UH, et al. Gastroenterol. 2006; 130: 678 -686. Chen CJ, et al. JAMA. 2006; 295: 65 -73.

Hepatitis B Prevention 25

Hepatitis B Can Be Prevented Vaccination is the best way to protect Some other ways to guard against infection include: Learn more about hepatitis, its prevention and treatment Use condoms during intimate contact Don’t share razors or toothbrushes with an infected person Prevent transmission to infants by making sure the infant receives vaccination Consider the risks before getting a tattoo or body piercing, shaving 26 If you have had hepatitis B, don’t donate blood, organs or semen

Pregnancy is a time for Hepatitis B screening and prevention Pregnant women can be tested for chronic hepatitis B at an early pre-natal visit Infants born to women with chronic hepatitis B should receive hepatitis B vaccination +/- hepatitis B immune globulin (HBIG) After giving birth, women with chronic hepatitis B should talk to their doctors about managing their chronic hepatitis B 27

Common Myths About Hepatitis B 28

Common myths about hepatitis B transmission Hepatitis B is Not transmitted by Sharing food, water, utensils or drinking glasses Mosquitoes Tears, sweat, urine or stools 29

Common myths about hepatitis B transmission Hepatitis B is Not transmitted by Hugging or kissing Breastfeeding Asian Liver Center. 2007 Physician’s Guide to Hepatitis B: A Silent Killer. http: //liver. stanford. edu/Education/2007 Handbook. pdf. Accessed April 1, 2009. Coughing or sneezing 30

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