Patients with Hepatitis B virus infection may present to the treating clinicians at various stages of natural history of hepatitis B infection, including acute viral hepatitis, chronic active hepatitis, incidental hepatitis B s antigen-positive patients and those with decompensated cirrhosis and hepatocellular carcinoma. Management of chronic hepatitis B patients, especially those with e antigen-negative disease poses the biggest challenge today. There are various treatment options available and choosing the correct drug according to the patient profile is important both for optimum response and preventing drug resistance. This article reviews an exciting new molecule tenofovir, which has been approved in August 2008 by the US Food and Drug Administration for treatment of chronic hepatitis B.
{"title":"Tenofovir for HBV: The beginning of the end or the end of the beginning?","authors":"Naresh Bhat, A. Yelsangikar","doi":"10.4103/0972-9747.76904","DOIUrl":"https://doi.org/10.4103/0972-9747.76904","url":null,"abstract":"Patients with Hepatitis B virus infection may present to the treating clinicians at various stages of natural history of hepatitis B infection, including acute viral hepatitis, chronic active hepatitis, incidental hepatitis B s antigen-positive patients and those with decompensated cirrhosis and hepatocellular carcinoma. Management of chronic hepatitis B patients, especially those with e antigen-negative disease poses the biggest challenge today. There are various treatment options available and choosing the correct drug according to the patient profile is important both for optimum response and preventing drug resistance. This article reviews an exciting new molecule tenofovir, which has been approved in August 2008 by the US Food and Drug Administration for treatment of chronic hepatitis B.","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127580729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.4103/0972-9747.190075
R. Kavitha, K. S. Kumar, K. Sandesh, T. Ramachandran, T. Varghese
Aim: To evaluate the occurrence of Hepatitis B surface antigen positivity in family members of HBsAg-positive patients, to assess the profile of HBV infection in them, to identify possible risk factors in a close family environment, and to evaluate the burden of liver disease in these family members. Materials and Methods: All Hepatitis B surface antigen-positive patients who attended the Liver Clinic of the Gastroenterology Department of the Calicut Medical College, from January 2009 to December 2010, were studied. The index case was evaluated with HBeAg, anti HBeAb, HBV DNA, liver function tests (LFTs), ultrasonogram of the abdomen, and alpha fetoprotein, as also liver biopsy in indicated cases. The index patient was interviewed and a detailed history with special emphasis on probable risk factors was taken. All first-degree relatives and relatives staying in the same house of the index case were screened for HBsAg. The relatives who tested negative for the infection were advised HBV vaccination, while the relatives who tested positive were evaluated for disease activity using LFTs, HBeAg, anti-HBeAb, HBV DNA, ultrasonogram of abdomen, alpha fetoprotein, and biopsy as per indication. Results: There were 376 index cases available for the study, 230 males (61.17%) and 146 females (38.83%). Male : Female ratio was 1.57 : 1. Mean age was 32.8 years (range 6-76). Seventy-six persons (20.21%) were detected to be HBsAg-positive during various preprocedural screenings, 42 (11.17%) were detected during medical checkup for jobs in gulf countries, and 30 (7.98%) were detected during screening for blood donation. Among the female patients, 88 (60.27%) were detected during antenatal screening. Ninety-six patients (25.53%) did not turn up after the initial visit. Among the remaining 280 patients, 48 (17.14%) were HBeAg positive. LFT abnormalities were seen in 153 (54.64%) cases. Out of 280 patients, 46 (16.43%) had established cirrhosis and 10 (3.57%) had HCC. Twenty-one cases (7.5%) presented as acute hepatitis. Complete family screening was done for 173 (61.78%) index cases. Out of the 280 index cases, 47 (16.79%) patients were reluctant for family screening. Among the 173 cases whose family members were screened, 95 (54.91%) had at least one family member who was HBsAg positive. Among the 95 index cases with at least one family member affected, 25 (26.31%) were HBeAg positive . On HBsAg screening of the relatives, it was found that brothers were affected in 45 (26.01%), sisters in 33 (19.08%), mothers in 18 (10.40%), fathers in 19 (10.98%), sons in nine (6.08%), and daughters in two (1.35%) cases. Ten (5.78%) index cases had second-degree relatives affected. Among a total of 173 index cases screened, 148 were married and among them 4.72% of the spouses were found to be HBsAg positive on screening. A total of 1115 family members of the 173 index cases were screened, of whom 162 (14.53%) were HBsAg positive. Of the 162 family members who were HBsAg positive
{"title":"Intrafamilial occurrence of hepatitis B virus (HBV) infection and the profile of liver disease in close relatives of patients with HBV infection","authors":"R. Kavitha, K. S. Kumar, K. Sandesh, T. Ramachandran, T. Varghese","doi":"10.4103/0972-9747.190075","DOIUrl":"https://doi.org/10.4103/0972-9747.190075","url":null,"abstract":"Aim: To evaluate the occurrence of Hepatitis B surface antigen positivity in family members of HBsAg-positive patients, to assess the profile of HBV infection in them, to identify possible risk factors in a close family environment, and to evaluate the burden of liver disease in these family members. Materials and Methods: All Hepatitis B surface antigen-positive patients who attended the Liver Clinic of the Gastroenterology Department of the Calicut Medical College, from January 2009 to December 2010, were studied. The index case was evaluated with HBeAg, anti HBeAb, HBV DNA, liver function tests (LFTs), ultrasonogram of the abdomen, and alpha fetoprotein, as also liver biopsy in indicated cases. The index patient was interviewed and a detailed history with special emphasis on probable risk factors was taken. All first-degree relatives and relatives staying in the same house of the index case were screened for HBsAg. The relatives who tested negative for the infection were advised HBV vaccination, while the relatives who tested positive were evaluated for disease activity using LFTs, HBeAg, anti-HBeAb, HBV DNA, ultrasonogram of abdomen, alpha fetoprotein, and biopsy as per indication. Results: There were 376 index cases available for the study, 230 males (61.17%) and 146 females (38.83%). Male : Female ratio was 1.57 : 1. Mean age was 32.8 years (range 6-76). Seventy-six persons (20.21%) were detected to be HBsAg-positive during various preprocedural screenings, 42 (11.17%) were detected during medical checkup for jobs in gulf countries, and 30 (7.98%) were detected during screening for blood donation. Among the female patients, 88 (60.27%) were detected during antenatal screening. Ninety-six patients (25.53%) did not turn up after the initial visit. Among the remaining 280 patients, 48 (17.14%) were HBeAg positive. LFT abnormalities were seen in 153 (54.64%) cases. Out of 280 patients, 46 (16.43%) had established cirrhosis and 10 (3.57%) had HCC. Twenty-one cases (7.5%) presented as acute hepatitis. Complete family screening was done for 173 (61.78%) index cases. Out of the 280 index cases, 47 (16.79%) patients were reluctant for family screening. Among the 173 cases whose family members were screened, 95 (54.91%) had at least one family member who was HBsAg positive. Among the 95 index cases with at least one family member affected, 25 (26.31%) were HBeAg positive . On HBsAg screening of the relatives, it was found that brothers were affected in 45 (26.01%), sisters in 33 (19.08%), mothers in 18 (10.40%), fathers in 19 (10.98%), sons in nine (6.08%), and daughters in two (1.35%) cases. Ten (5.78%) index cases had second-degree relatives affected. Among a total of 173 index cases screened, 148 were married and among them 4.72% of the spouses were found to be HBsAg positive on screening. A total of 1115 family members of the 173 index cases were screened, of whom 162 (14.53%) were HBsAg positive. Of the 162 family members who were HBsAg positive","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128067330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hepatitis B virus (HBV) infection is an important indication for liver transplantation worldwide. The most important concern is the prevention of viral recurrence in the post transplant period. With the introduction of Hepatitis B immunoglobulin, there has been a significance reduction in the rate of HBV recurrence with improved patient & graft survival rates. The combination of oral nucleosides along with Hepatitis B immunoglobulin has further reduced the rate of HBV recurrence, and currently the outcome of liver transplantation for HBV infection is comparable to other indications for liver transplantation.
{"title":"Management of Hepatitis B in the peri-transplant period","authors":"S. Saigal, Amit Basnotra, A. Soin","doi":"10.4103/0972-9747.76903","DOIUrl":"https://doi.org/10.4103/0972-9747.76903","url":null,"abstract":"Hepatitis B virus (HBV) infection is an important indication for liver transplantation worldwide. The most important concern is the prevention of viral recurrence in the post transplant period. With the introduction of Hepatitis B immunoglobulin, there has been a significance reduction in the rate of HBV recurrence with improved patient & graft survival rates. The combination of oral nucleosides along with Hepatitis B immunoglobulin has further reduced the rate of HBV recurrence, and currently the outcome of liver transplantation for HBV infection is comparable to other indications for liver transplantation.","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130753681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.4103/0972-9747.193287
N. Patel, S. Singh
Tuberculosis (TB) and Hepatitis B virus (HBV) infections are quite common in the developing world especially South Asia. As both are so common, co-infection is not very uncommonly encountered in clinical practice. However, since anti-tuberculosis therapy (ATT) can be hepatotoxic in around 10% of patients, the occurrence of hepatotoxicity can complicate management especially in the presence of already compromised liver function due to HBV. Therefore, co-infection of TB and HBV is an important public health issue. Unfortunately the regional and National hepatology societies of South Asia have not bothered to provide any guidance in this matter. This article reviews the epidemiology and management of co-infection with Tuberculosis (TB) and Hepatitis B virus (HBV) and the hepatotoxicity due to ATT.
{"title":"Antituberculosis therapy in patients with hepatitis B viral infection","authors":"N. Patel, S. Singh","doi":"10.4103/0972-9747.193287","DOIUrl":"https://doi.org/10.4103/0972-9747.193287","url":null,"abstract":"Tuberculosis (TB) and Hepatitis B virus (HBV) infections are quite common in the developing world especially South Asia. As both are so common, co-infection is not very uncommonly encountered in clinical practice. However, since anti-tuberculosis therapy (ATT) can be hepatotoxic in around 10% of patients, the occurrence of hepatotoxicity can complicate management especially in the presence of already compromised liver function due to HBV. Therefore, co-infection of TB and HBV is an important public health issue. Unfortunately the regional and National hepatology societies of South Asia have not bothered to provide any guidance in this matter. This article reviews the epidemiology and management of co-infection with Tuberculosis (TB) and Hepatitis B virus (HBV) and the hepatotoxicity due to ATT.","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131303857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Delta hepatitis or hepatitis D leads to acute and chronic liver disease in humans. The causative agent, the hepatitis delta virus (HDV), is a defective virus which leads to hepatitis in humans in the presence of the hepatitis B virus. This helper function of HBV is required for transmission and propagation of HDV infection but not for replication. HDV RNA replication occurs through the double-rolling circle model and does not possess a reverse transcription step. Hepatitis D-induced liver disease is immune-mediated and occurs either as co-infection of both viruses or as superinfection of a hepatitis B carrier with hepatitis D. Based on a sequence variation of 19-38%, to date seven genotypes of HDV have been described. HDV infection has declined significantly in many endemic areas in the last decades, however, due to migration to industrialized countries, this decline appears to have reached a plateau in western countries. The clinical course of delta hepatitis in general is associated with rapid progression. Delta hepatitis may be an additional risk factor for the development of hepatocellular carcinoma. The only established management for delta hepatitis consists of treatment with interferon for a period of at least one year. For those unresponsive to interferon treatment and patients with advanced disease new therapies are an urgent need. Such therapies may be on the horizon but translation of bench work to clinical practice is required.
{"title":"Chronic delta hepatitis: An overview","authors":"C. Yurdaydın","doi":"10.4103/0972-9747.58807","DOIUrl":"https://doi.org/10.4103/0972-9747.58807","url":null,"abstract":"Delta hepatitis or hepatitis D leads to acute and chronic liver disease in humans. The causative agent, the hepatitis delta virus (HDV), is a defective virus which leads to hepatitis in humans in the presence of the hepatitis B virus. This helper function of HBV is required for transmission and propagation of HDV infection but not for replication. HDV RNA replication occurs through the double-rolling circle model and does not possess a reverse transcription step. Hepatitis D-induced liver disease is immune-mediated and occurs either as co-infection of both viruses or as superinfection of a hepatitis B carrier with hepatitis D. Based on a sequence variation of 19-38%, to date seven genotypes of HDV have been described. HDV infection has declined significantly in many endemic areas in the last decades, however, due to migration to industrialized countries, this decline appears to have reached a plateau in western countries. The clinical course of delta hepatitis in general is associated with rapid progression. Delta hepatitis may be an additional risk factor for the development of hepatocellular carcinoma. The only established management for delta hepatitis consists of treatment with interferon for a period of at least one year. For those unresponsive to interferon treatment and patients with advanced disease new therapies are an urgent need. Such therapies may be on the horizon but translation of bench work to clinical practice is required.","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132608858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Currently available options for the treatment of chronic hepatitis B virus (HBV) infection include standard and pegylated interferon alfa and Thymosin alpha, four oral antiviral agents (lamivudine, adefovir, entecavir, and telbivudine), two agents Tenofovir and emtricitabine approved in the HIV HBV co-infection are likely to be approved for HBV infection in immediate future. These treatment strategies are either therapies of finite duration that aim to achieve sustained off-therapy responses, or long-term treatments that aim to maintain on-therapy remission. Most agents designed to target hepatitis B are hindered by the development of resistance, poor tolerability or limited efficacy; therefore, new agents and treatment strategies are needed. Although therapy of hepatitis B is evolving, which between single and/or combined agents are most effective, how long therapy should last, which criteria should be used to start or continue and switch or stop therapy are to be defined. This paper provides a review of management with the available treatment options for HBV associated liver diseases.
{"title":"Management overview of chronic hepatitis B with established therapies","authors":"D. Amarapurkar","doi":"10.4103/0972-9747.45093","DOIUrl":"https://doi.org/10.4103/0972-9747.45093","url":null,"abstract":"Currently available options for the treatment of chronic hepatitis B virus (HBV) infection include standard and pegylated interferon alfa and Thymosin alpha, four oral antiviral agents (lamivudine, adefovir, entecavir, and telbivudine), two agents Tenofovir and emtricitabine approved in the HIV HBV co-infection are likely to be approved for HBV infection in immediate future. These treatment strategies are either therapies of finite duration that aim to achieve sustained off-therapy responses, or long-term treatments that aim to maintain on-therapy remission. Most agents designed to target hepatitis B are hindered by the development of resistance, poor tolerability or limited efficacy; therefore, new agents and treatment strategies are needed. Although therapy of hepatitis B is evolving, which between single and/or combined agents are most effective, how long therapy should last, which criteria should be used to start or continue and switch or stop therapy are to be defined. This paper provides a review of management with the available treatment options for HBV associated liver diseases.","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"167 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134076600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.4103/0972-9747.193289
P. Das, A. Ahuja, Siddhartha Datta Gupta
About two billion people worldwide have been infected with the hepatitis B virus and about 350 million live with chronic infection. Besides, an estimated 600 000 persons die each year due to the acute or chronic consequences of hepatitis B. The course of HBV infection is a dynamic process and is influenced by many factors including viral, host, and exogenous factors. Clinical suspicion of acute viral hepatitis usually does not necessitate biopsy; however, persistence of clinical symptoms or biochemical evidence of hepatotrophic viral infection for more than six months duration necessitates a liver biopsy - in several instances to primarily establish the histopathological diagnosis, to grade and stage the hepatic changes (determine management and prognosis), to document the severity and extent of the hepatic inflammation, as a guide to therapy or to monitor the changes of liver histology while on treatment. Moreover, improvement in liver histology can be used as an endpoint in clinical trials for new forms of therapy. Additionally, in some cases there is considerable clinical overlap between the states of exacerbation of chronic hepatitis and acute hepatitis. Biopsy is helpful in these cases too. Nevertheless, it must be mentioned that with the current trends and various guidelines, the indications for liver biopsy in chronic hepatitis B are somewhat reduced. It is hoped that with non-invasive markers the number of liver biopsies will reduce further. This article provides an overview of the histopathology of chronic hepatitis B virus infection.
{"title":"Overview of the histopathology of chronic hepatitis B infection","authors":"P. Das, A. Ahuja, Siddhartha Datta Gupta","doi":"10.4103/0972-9747.193289","DOIUrl":"https://doi.org/10.4103/0972-9747.193289","url":null,"abstract":"About two billion people worldwide have been infected with the hepatitis B virus and about 350 million live with chronic infection. Besides, an estimated 600 000 persons die each year due to the acute or chronic consequences of hepatitis B. The course of HBV infection is a dynamic process and is influenced by many factors including viral, host, and exogenous factors. Clinical suspicion of acute viral hepatitis usually does not necessitate biopsy; however, persistence of clinical symptoms or biochemical evidence of hepatotrophic viral infection for more than six months duration necessitates a liver biopsy - in several instances to primarily establish the histopathological diagnosis, to grade and stage the hepatic changes (determine management and prognosis), to document the severity and extent of the hepatic inflammation, as a guide to therapy or to monitor the changes of liver histology while on treatment. Moreover, improvement in liver histology can be used as an endpoint in clinical trials for new forms of therapy. Additionally, in some cases there is considerable clinical overlap between the states of exacerbation of chronic hepatitis and acute hepatitis. Biopsy is helpful in these cases too. Nevertheless, it must be mentioned that with the current trends and various guidelines, the indications for liver biopsy in chronic hepatitis B are somewhat reduced. It is hoped that with non-invasive markers the number of liver biopsies will reduce further. This article provides an overview of the histopathology of chronic hepatitis B virus infection.","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115715632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.4103/0972-9747.193288
S. Balasubramanian, Arulselvan Velusamy, A. Krishnan, J. Venkatraman
Background and Aim: Hepatitis B virus (HBV)-related liver disease is not an uncommon problem in India. There are very few reports on pattern of chronic HBV infection from South India. The aim of the present study was to determine the spectrum of chronic HBV infection among patients attending the liver clinic in a tertiary referral center. Materials and Methods: Hepatitis B surface antigen (HBsAg) positive patients registered in the liver clinic between July 2010 and March 2011 were included in the study. All patients had baseline liver function tests, serological markers for HBV infection (hepatitis B e antigen [HBeAg], anti-HBe, anti-HBc total, and anti-HBc IgG, and HBV DNA quantification), serum alpha-fetoprotein, and ultrasound. Based on the viral profile and transaminase levels and ultrasound findings, patients were categorized as immunotolerant, inactive carriers, immune clearance and reactivation phase, and chronic liver disease with or without hepatocellular carcinoma. Results: Majority of the patients were asymptomatic and incidentally detected during blood donation camps, master health checkup (MHC), or during initial screening. Almost 40% of patients were either in immune inactive phase or had features of chronic liver disease. In the immunotolerant phase (24 patients), women were a decade younger than their male counterparts. Alanine aminotransferase (ALT) levels were similar in both HBeAg-positive and negative patients. The mean HBV DNA values were significantly high in HBeAg-positive men and women. In the immune inactive phase (58 patients), there were only three patients who were HBeAg positive. The ALT levels were in the normal range. HBV DNA values were low or not detectable. Among patients with elevated ALT and HBV DNA levels (immune clearance/immune reactive) (fifty patients), the mean ALT levels were higher in HBeAg-negative patients. HBV DNA quantity was significantly high in patients who were HBeAg positive. Conclusion: A significant proportion of HBsAg-positive patients is in inactive or in immunotolerant phase and do not require treatment. Patients with elevated ALT and HBV DNA levels need further evaluation to categorize them into immune clearance or immune reactive phase.
{"title":"Spectrum of hepatitis B infection in Southern India: A cross-sectional analysis","authors":"S. Balasubramanian, Arulselvan Velusamy, A. Krishnan, J. Venkatraman","doi":"10.4103/0972-9747.193288","DOIUrl":"https://doi.org/10.4103/0972-9747.193288","url":null,"abstract":"Background and Aim: Hepatitis B virus (HBV)-related liver disease is not an uncommon problem in India. There are very few reports on pattern of chronic HBV infection from South India. The aim of the present study was to determine the spectrum of chronic HBV infection among patients attending the liver clinic in a tertiary referral center. Materials and Methods: Hepatitis B surface antigen (HBsAg) positive patients registered in the liver clinic between July 2010 and March 2011 were included in the study. All patients had baseline liver function tests, serological markers for HBV infection (hepatitis B e antigen [HBeAg], anti-HBe, anti-HBc total, and anti-HBc IgG, and HBV DNA quantification), serum alpha-fetoprotein, and ultrasound. Based on the viral profile and transaminase levels and ultrasound findings, patients were categorized as immunotolerant, inactive carriers, immune clearance and reactivation phase, and chronic liver disease with or without hepatocellular carcinoma. Results: Majority of the patients were asymptomatic and incidentally detected during blood donation camps, master health checkup (MHC), or during initial screening. Almost 40% of patients were either in immune inactive phase or had features of chronic liver disease. In the immunotolerant phase (24 patients), women were a decade younger than their male counterparts. Alanine aminotransferase (ALT) levels were similar in both HBeAg-positive and negative patients. The mean HBV DNA values were significantly high in HBeAg-positive men and women. In the immune inactive phase (58 patients), there were only three patients who were HBeAg positive. The ALT levels were in the normal range. HBV DNA values were low or not detectable. Among patients with elevated ALT and HBV DNA levels (immune clearance/immune reactive) (fifty patients), the mean ALT levels were higher in HBeAg-negative patients. HBV DNA quantity was significantly high in patients who were HBeAg positive. Conclusion: A significant proportion of HBsAg-positive patients is in inactive or in immunotolerant phase and do not require treatment. Patients with elevated ALT and HBV DNA levels need further evaluation to categorize them into immune clearance or immune reactive phase.","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122615421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Viral hepatitis : The need for action","authors":"C. Gore","doi":"10.4103/0972-9747.76901","DOIUrl":"https://doi.org/10.4103/0972-9747.76901","url":null,"abstract":"","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129913914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.4103/0972-9747.162109
A. Duseja
Despite the development of a number of antiviral agents for treatment of Chronic Hepatitis B, the treatment of chronic hepatitis B continues to be a challenge for physicians due to the high burden of the disease and the limited efficacy of available therapy. The primary goal of treatment is to eliminate or suppress HBV in order to decrease pathogenicity and infectivity, and reduce hepatic necroinflammation. Clinically, the short-term goal of treatment is to reduce hepatic activity, to prevent the development of hepatic decompensation, to ensure loss of HBeAg (with seroconversion to anti-HBe) and/or HBV-DNA with alanine aminotransferase (ALT) normalization at the end or 6-12 months after the end of treatment. The long-term goals are eradication of infection, prevent progression to cirrhosis, prevent development of HCC, and ultimately prolong survival. This review discusses the goals of therapy in patients with chronic hepatitis B.
{"title":"Goals of therapy in patients with CHB.","authors":"A. Duseja","doi":"10.4103/0972-9747.162109","DOIUrl":"https://doi.org/10.4103/0972-9747.162109","url":null,"abstract":"Despite the development of a number of antiviral agents for treatment of Chronic Hepatitis B, the treatment of chronic hepatitis B continues to be a challenge for physicians due to the high burden of the disease and the limited efficacy of available therapy. The primary goal of treatment is to eliminate or suppress HBV in order to decrease pathogenicity and infectivity, and reduce hepatic necroinflammation. Clinically, the short-term goal of treatment is to reduce hepatic activity, to prevent the development of hepatic decompensation, to ensure loss of HBeAg (with seroconversion to anti-HBe) and/or HBV-DNA with alanine aminotransferase (ALT) normalization at the end or 6-12 months after the end of treatment. The long-term goals are eradication of infection, prevent progression to cirrhosis, prevent development of HCC, and ultimately prolong survival. This review discusses the goals of therapy in patients with chronic hepatitis B.","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134531030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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