HEPATITIS B VIRUS INFECTION:

CURRENT STATUS
The american journal of medicine

YUDRIK MAULANA

What is Hepatitis B?
Liver Disease
caused by HBV
(Hep B Virus)

Common throughout the world especially Asia and Africa

Cummon transmission?

Virology

Hepatitis B virus is a double stranded DNA

virus with 4 partially overlapping open reading
frames:
1.
2.
3.
4.

HBsAg
HBcAg
X gene
P gene (polymerase)

Viral mutation
Because hepatitis B virus polymerase replicated
through RNA intermediates, it is easy to
mutation, under pressure from external or
internal.

Genotypes of hepatitis B
HBV has been classified into 8 genotype, from A-H.
-clinical outcome
-treatment
-responses
-mutation

Immunopathogenesis
Hepatitis B virus doesnt cause direct cell injury
except in unussual case
The respons of immun determine the course of
infection and degree of liver injury
In patient with immunosupresant terapy, control
of infection may be lost and hepatitis b
replication is exaggerated

Diagnosis and Treatment

Target missing viral replication decrease
hepatic inflamation, even degree of fibrosis
Diagnosis by serologycal test
HBsAg (+) evaluate patient
Immaging the liver with USG and MRI
chirrosis and hepatocelluler carsinoma

4 Drugs have been approved by FDA

Interferon
Lamivudine
Adenofir dipiroxil
Entecavir

Begining terapy and choice of agent

The decision to treat must be individualized and
appropriate with several data:
Age
Viral load
Aminotransferase load
Generaly by elevated aminotransferase and viral
titers exceeding 1 million copies/ml are
considered to treatment

Special population: human

immunodeficiency virus co-infection
In the presence of HIV infection, hepatitis b
virus is more likely to persist with more rapid
evolution of liver damage and progression to
cirrosis than mono infection
Lamivudin is effective to againt both virus

Hepatocelluler carcinoma
Resolution of cronic hepatitis b significantly
diminishes the risk of hepatocelluler carcinoma
The use of routine screening by USG on annual
is recommended but may not be cost effective

Liver transplantation
1/3 HBV patient develop to be cirrhosis or liver
cancer
Liver transplantation is effective therapy for
patient with HBV end stage

Hepatitis B vaccine
Until recently, hepatitis B vaccine effective to
reduce the prevelence of cronic HBsAg
Taiwan 9,8% 1,3% in 10 years
Vaccination program by who have been innitiated
in afica in at lease 2-3 years

Future
Change high risk behavior
In endemic area HBV vaccin has not yet reach

THANK YOU