TUTORIAL

KLINIK
HEPATITIS B

SYLMI ROSA AMALIA

 Seorang pasien
datang dengan HBsAg
positif dan membawa
hasil Lab SGOT 125
dan SGPT 87
Persistent Hepatitis B

Two clinical patterns

Chronic liver disease
Elevated LFTS
Abnormal hepatic histology
20% develop cirrhosis
Asymptomatic carrier
Normal LFTs
Asymptomatic
Near normal liver histology
Both risk development of Hepatocellular
Carcinoma
ANAMNESIS
PF
 Px
PENUNJANG
 Overview HBV
HBV has a complex structure
DNA polymerase HBV DNA

Outer lipid envelope

containing surface
antigen (HBsAg)
Inner protein
core (HBcAg)

HBsAg

HBeAg
HBcAg = hepatitis B core antigen Howard C. J Gen Virol 1986; WHO 2002:
HBeAg = hepatitis B e antigen http://www.who.int/csr/disease/hepatitis/whocdscsrlyo20022/en/index2.html
HBsAg = hepatitis B surface antigen (accessed February 2013)
Hepatitis B Characteristics
A Hepadnaviridae partially double-
stranded DNA virus
HBsAg stimulates protective antibodies, a
marker for current infection
HBcAg localized within liver cells,
identifies acute infection, anti-HBcAg
persists for life and is a marker of past
infection
HBeAG a marker of active replication and
infectivity
Immune control inactive
disease
Immune Immune Immune Immune Escape/
Tolerant Clearance Control Reactivation
HBeAg+ HBeAg
HBV DNA

ALT

HBeAg + Inactive Carrier HBeAg

Chronic Hepatitis B Status Chronic HBV

Immune control treatment not required

Diagnosis

Diagnosis infeksi hepatitis B kronis didasarkan pada

pemeriksaan serologi, petanda virologi, biokimiawi dan
histologi.
Secara serologi pemeriksaan yang dianjurkan HBsAg,
HBeAg, anti HBe dan HBV DNA.
Algoritme Terapi HBeAg positif
Konsensus PPHI 2012

Jumlah virus dan

ALT sebagai acuan terapi
 Treatment options for CHB

Immuno-modulators
Antivirals
IFN
(Lamivudine)
PEG-IFN
Adefovir
Cytokines CD8+ HBV
Entecavir
Vaccine therapy
Telbivudine
Tenofovir
Emtricitabine
[Clevudine]
Treatment Combinations
Treatment Sequential
Hepatitis B
Treatment
For acute infection, no medication is
available; treatment is supportive.
For chronic infection, several antiviral
drugs (adefovir dipivoxil, interferon alfa-
2b, pegylated interferon alfa-2a,
lamivudine, entecavir, and telbivudine)
are available.
Persons with chronic HBV infection require
medical evaluation and regular monitoring to
determine whether disease is progressing
and to identify liver damage or