Monday, January 30, 2023

Chronic Hepatitis B Without Delta Agent

How Long Can You Live With Hepatitis B

Managing Chronic Hepatitis B – Advice for GPs

Most people who contract hepatitis B during adulthood fully recover within 1 to 3 months.

People with chronic hepatitis B may have a higher risk of developing long-term liver problems, like cirrhosis or liver cancer, which require treatment and may be life threatening.

Keep in mind that the risk of developing chronic hepatitis B is higher for babies and children, especially if they have not been vaccinated against the virus.

Who Is At Risk For Hepatitis B

Anyone can get hepatitis B, but the risk is higher in:

  • Infants born to mothers who have hepatitis B
  • People who inject drugs or share needles, syringes, and other types of drug equipment
  • Sex partners of people with hepatitis B, especially if they are not using latex or polyurethane condoms during sex
  • Men who have sex with men
  • People who live with someone who has hepatitis B, especially if they use the same razor, toothbrush, or nail clippers
  • Health care and public-safety workers who are exposed to blood on the job

If you have chronic hepatitis B, you may not have symptoms until complications develop. This could be decades after you were infected. For this reason, hepatitis B screening is important, even if you have no symptoms. Screening means that you are tested for a disease even though you don’t have symptoms. If you are at high risk, your health care provider may suggest screening.

Discovery Of Hdv And Other Viral Hepatidities

Following the discovery of components of the HBV virion, efforts increased to identify other viral pathogens that cause viral hepatitis, and these subsequent discoveries aided in the eventual identification of HDV. The hepatitis A virus was discovered in 1973, using immune EM, as was similarly performed previously for visualization of HBV. Preceding epidemiologic and direct human experimentation showed that HAV was transmissible by oral inoculation with filtered stool extracts from infected patients. Using this information, Feinstone, Kapikian, and Purcell discovered HAV in fecal samples obtained from human volunteers with appropriate clinical histories for hepatitis A . Specifically, stool specimens from these patients were incubated with convalescent serum from other distinct patients with hepatitis A, leading to the visualization of virus particles heavily coated with serum antibody. With the discovery of both HAV and HBV, research on viral hepatitis progressed, permitting isolation of more elusive viral pathogens with less distinctive clinical phenotypes.

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What Are The Treatments For Hepatitis B

If you think you may have been exposed to hepatitis B, its important to talk with a healthcare professional as soon as possible.

A doctor or other healthcare professional may administer the first dose of the hepatitis B vaccine and a shot of hepatitis B immunoglobulin. This is a combination of antibodies that provide short-term protection against the virus.

Though both can be given up to a week after exposure, theyre most effective at preventing infection if administered within 48 hours.

If you receive a diagnosis of acute hepatitis B, a doctor may refer you to a specialist. They may advise you to get regular blood tests to ensure you dont develop chronic hepatitis.

Many people with acute hepatitis B dont experience serious symptoms. But if you do, it can help to:

  • get plenty of rest
  • take over-the-counter pain mediation, like naproxen, when needed

Other lifestyle changes may also be needed to manage your infection, such as:

  • eating a nutritious, balanced diet
  • avoiding substances that can harm your liver, such as:
  • alcohol
  • certain herbal supplements or medications, including acetaminophen

If blood tests show you still have an active infection after 6 months, your doctor may recommend further treatment, including medications to help control the virus and prevent liver damage.

How Can I Be Sure That The Patient Has Hepatitis B Virus Infection

Hepatitis d

HBV infection presents with nonspecific features. Infection with HBV has a wide spectrum of manifestations, including subclinical hepatitis, anicteric hepatitis, icteric hepatitis, and fulminant hepatitis during the acute phase and the asymptomatic carrier state. HBV infection includes chronic hepatitis, cirrhosis, and hepatocellular carcinoma during the chronic phase.

Approximately 70% of patients with acute HBV infection have subclinical hepatitis or anicteric hepatitis, whereas 30% become icteric. Acute liver failure develops in approximately 0.1% to 0.5% of patients. The incubation period lasts 1 to 4 months. A serum sickness-like syndrome may develop during the prodromal period. This is followed by constitutional symptoms such as low-grade fever, malaise, anorexia, nausea and vomiting, and right upper quadrant or midepigastric pain. Jaundice usually appears as the constitutional symptoms begin to subside. Clinical symptoms and jaundice generally disappear after 1 to 3 months, but some patients may have prolonged fatigue, even after normalization of aminotransferase levels.

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Hepatitis B And Pregnancy

Hepatitis B can be transmitted from a birthing parent to a newborn infant. This is because the newborn is exposed to blood and bodily fluids during delivery.

In fact, 90% of mothers with an acute hepatitis B infection and 10% to 20% of mothers with chronic hepatitis B will transmit the virus to their newborn, estimates the American College of Obstetricians and Gynecologists.

For this reason, birthing parents are routinely screened for hepatitis B during each pregnancy.

Additionally, the hepatitis B vaccine and hepatitis B immune globulin are both administered to infants with an HBV-positive birthing parent within of birth to prevent infection.

According to the

  • people with hepatitis C infection
  • men who have sex with men
  • people with multiple sexual partners
  • people who are seeking treatment for a sexually transmitted infections
  • people with current or recent injection drug use
  • family members or sexual partners of those with hepatitis B
  • people with chronic liver disease
  • people traveling to areas with high rates of hepatitis B
  • people on maintenance dialysis
  • people who are incarcerated

The hepatitis B vaccine is usually administered in three shots, given 1 month and 6 months after the first dose. Another recently approved vaccine is completed in two doses spaced 1 month apart.

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The following cases of disease should be notified:

  • Confirmed acute
  • Although it is recognized that chronic hepatitis B infections are not reportable in all provinces and territories, where possible, chronic and unspecified infections should be notified to the national level.

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Discovery Of The Australian Antigen

The early 1960s marked several important milestones in the history of viral hepatitis, catapulted by the discovery of the HBV surface antigen by Blumberg and Alter. Although it was a peculiar and serendipitous discovery, Blumbergs previous exploits had enabled the initial experiments to be conducted. In the 1950s, he collected blood samples from several indigenous populations located throughout the world. His goal was to study the inherited diversity in humans with a focus on finding the basis behind variability in disease susceptibility and outcomes. After these initial blood collection efforts, Blumberg assumed a position at the National Institutes of Health , where at the same time Alter was studying patients who had undergone a blood transfusion and subsequently developed febrile transfusion reactions. Using agar gel double diffusion, also known as Ouchterlony, Alter began testing serum from patients who had received multiple transfusions against serum that Blumberg had collected from individuals during his travels . Initial efforts were focused on identifying new serum lipoproteins because Blumberg had already established that lipoproteins were polymorphic between individuals .

What Is Hepatitis B

Viral Hepatitis

Hepatitis B is a type of viral hepatitis. It can cause an acute or chronic infection. People with an acute infection usually get better on their own without treatment. Some people with chronic hepatitis B will need treatment.

Thanks to a vaccine, hepatitis B is not very common in the United States. It is more common in certain parts of the world, such as sub-Saharan Africa and parts of Asia.

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What Other Problems Can Hepatitis B Cause

In rare cases, acute hepatitis B can cause liver failure.

Chronic hepatitis B can develop into a serious disease that causes long-term health problems such as cirrhosis , liver cancer, and liver failure.

If you have ever had hepatitis B, the virus may become active again, or reactivated, later in life. This could start to damage the liver and cause symptoms.

What Is The Right Therapy For The Patient With Hepatitis B Virus Infection

Treatment with antiviral therapy is recommended in patients with chronic hepatitis B in the immune active phase with elevated HBV DNA levels and ALT greater than 2x the ULN. Patients with cirrhosis and HBV DNA > 2,000 IU/mL should be treated regardless of ALT levels. If patients do not meet these cutoff criteria, antiviral therapy should still be considered if older age, positive family history, presence of extrahepatic manifestations, or prior treatment).

Treatment with antiviral therapy is generally not recommended for patients with immune tolerant chronic hepatitis B. However, patients should have labs checked every 6 months to look for evidence of activation. Additionally, in spite of normal ALT levels, patients should be treated with antiviral therapy if there is evidence of necroinflammation or fibrosis.

What treatment options are effective?

Several agents are currently approved for the treatment of chronic hepatitis B: interferon alpha , pegylated interferon alfa 2a, lamivudine, adefovir, entecavir, telbivudine, and tenofovir. Each agent has inherent limitations.

With the drugs currently available, the physician may consider two different concepts for the treatment of chronic hepatitis B: the first concept is that of sustained response obtained after a limited duration of therapy with pegylated interferon the second concept is that of maintained response obtained during prolonged administration of therapy with analogues.

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Severe Morbidity And Mortality

For patients with a principal diagnosis of acute hepatitis B, 2,408 hospital bed days were recorded. The median length of stay was three days, with longer stays for adults aged 60 years and over . There were 22 deaths from acute hepatitis B recorded in the two years 2003 to 2004, 17 in males and five in females. All of the deaths occurred in those aged 25 years and over, and nearly two thirds were aged over 60 years, in whom nine of the fourteen were males. In 2003, there were twice as many deaths as in 2004 . There were four cases of hepatic coma recorded among hospitalisations with a principal diagnosis of acute hepatitis B, with none of these cases recorded as having delta co-infection . There were three deaths reported to NNDSS in notified cases between 2003 and 2005.

Table 5. Acute hepatitis B notifications, hospitalisations and deaths, Australia, 2002 to 2005,* by age group

Age group
4 0.8

* Measured using National Hospital Morbidity data where the month of hospital separation was between 1 July 2002 and 30 June 2005.

ICD-10-AM codes B16.0 and B16.2.

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A Listing Of A Subset Of Second

Infectious diseases in children

There are currently six medications approved for use in the United States. Choice of antiviral agent is driven by side effect profile, co-morbidities, prior therapy exposure, HBV genotype, costs, and pregnancy state.

Peg-IFN-2a: dose of 180 mcg weekly. Side effects include flu-like symptoms, mood disturbances, cytopenias, autoimmune disorders. Monitoring should include a CBC and TSH every 3 months, monitoring for infection, autoimmune disorders, neuropsychiatric complications, and infections. Pregnancy category C.

Entecavir: dose of 0.5 or 1.0 mg daily. Side effects include lactic acidosis. Pregnancy category C.

Tenofovir: dose of 300mg daily. Side effects include nephropathy, Fanconi-like syndrome, osteomalacia, lactic acidosis. Monitoring should include yearly creatinine clearance, serum phosphate, urine glucose and protein annually, as well as bone density scan if at risk. Pregnancy category B.

Lamivudine: dose of 100mg daily. Side effects include pancreatitis, lactic acidosis. Monitoring should include creatinine kinase and lactic acid if clinical concerns. Pregnancy category C.

Telbivudine: dose of 600mg daily. Side effects include creatine kinase elevations, myopathy, peripheral neuropathy, and lactic acidosis. Monitor creatinine kinase if symptoms. Pregnancy category B.

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Genetics Of Infection With Hepatitis B

Several genes, many having to do with the host immune response, have been implicated in the susceptibility to chronic hepatitis B infection. The TNFSF9 gene encodes the CD137L protein, and its expression was found to be significantly higher in patients with chronic hepatitis B infection than in healthy controls. Its expression was also found to be higher in patients who had chronic hepatitis B with cirrhosis, in contrast to those without cirrhosis.

Research done in West Africa, where 90% of the population is infected with hepatitis B, shows that certain human leukocyte antigen class II haplotypes influence the likelihood of chronic infection. For reasons that are not completely clear, persons in the study who were heterozygous for the HLA-DRA and HLA-DQA1 genes were found to be less likely to develop a chronic infection.

IFNGR1 gene

Several additional genes are associated with susceptibility to hepatitis B infection. The IFNGR1 gene is located at 6q23.3 and encodes the interferon gamma receptor 1, which has an important role in cell-to-cell communications and can be activated in response to infection, but it is not specific to hepatitis B. Patients with significant dysfunction in this gene have a particular immune deficiency that leaves them extremely susceptible to mycobacterial infections.

IFNAR2 gene

Variations in vaccine response

The Icd Code B16 Is Used To Code Hepatitis B

Hepatitis B is an infectious disease caused by the hepatitis B virus which affects the liver. It can cause both acute and chronic infections. Many people have no symptoms during the initial infection. Some develop a rapid onset of sickness with vomiting, yellowish skin, feeling tired, dark urine and abdominal pain. Often these symptoms last a few weeks and rarely does the initial infection result in death. It may take 30 to 180 days for symptoms to begin. In those who get infected around the time of birth 90% develop chronic hepatitis B while less than 10% of those infected after the age of five do. Most of those with chronic disease have no symptoms however, cirrhosis and liver cancer may eventually develop. These complications result in the death of 15 to 25% of those with chronic disease.


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Chronic Hepatitis B Infection

People who test positive for the hepatitis B virus for more than six months are diagnosed as having a chronic infection. This means their immune system was not able to get rid of the hepatitis B virus and it still remains in their blood and liver.

The risk of developing a chronic hepatitis B infection is also directly related to the age at which one first becomes exposed to the hepatitis B virus:

  • 90% of infected newborns and babies will develop a chronic hepatitis B infection
  • Up to 50% of infected children will develop a chronic hepatitis B infection
  • 5-10% of infected adults will develop a chronic hepatitis B infection

Learning that you have a chronic hepatitis B infection can be very upsetting. Because most people do not have symptoms and can be diagnosed decades after their initial exposure to the hepatitis B virus, it can be a shock and a surprise to be diagnosed with a chronic hepatitis B infection. The good news is that most people with chronic hepatitis B should expect to live a long and healthy life.

There are effective drug therapies that can control and even stop the hepatitis B virus from further damaging a liver. There are also promising new drugs in the research pipeline that could provide a cure in the very near future. Although the risk of developing a serious liver disease or liver cancer is higher for those living with chronic hepatitis B than those who are not infected, there are still many simple things a person can do to help reduce their risks.

Listing Of Usual Initial Therapeutic Options Including Guidelines For Use Along With Expected Result Of Therapy

Hepatitis D Virus (HDV) Infection by Dr. Teke Apalata, MD, PhD

Goals of antiviral therapy are HBeAg seroconversion , HBsAg loss, and suppression of HBV DNA. All patients with cirrhosis should continue treatment indefinitely. Patients without cirrhosis can consider discontinuation after 12 months of achieving above mentioned goal. However, the risk for seroconversion or recurrent viremia persists and patients need to be monitored every 3 months for at least one year after discontinuation of antiviral therapy.

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Acute Vs Chronic Hepatitis B

A hepatitis B infection can result in either an acute infection or a chronic infection. When a person is first infected with the hepatitis B virus, it is called an “acute infection” . Most healthy adults that are infected do not have any symptoms and are able to get rid of the virus without any problems. Some adults are unable to get rid of the virus after six months and they are diagnosed as having a “chronic infection.” A simple blood test can diagnose an acute or chronic hepatitis B infection.

The risk of developing a chronic hepatitis B infection is directly related to the age at which a person is first exposed to the hepatitis B virus. The younger a person is when they are first infected, the greater the risk of developing a chronic hepatitis B infection:

  • More than 90% of infants that are infected will develop a chronic hepatitis B infection
  • Up to 50% of young children between 1 and 5 years who are infected will develop a chronic hepatitis B infection
  • 5-10% of healthy adults 19 years and older who are infected will develop a chronic hepatitis B infection

The recommendation for hepatitis B vaccination of babies and children is so important because they are at the greatest risk of developing a chronic infection if they are not protected against the hepatitis B virus as soon as possible.

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