Hepatitis B (cont.)
Mary D. Nettleman, MD, MS, MACP
Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
In this Article
- What is hepatitis?
- How is the hepatitis B virus spread (transmitted)?
- What are the symptoms of acute hepatitis B infection?
- What are the symptoms of chronic hepatitis B infection?
- How is hepatitis B diagnosed?
- What is the role of a liver biopsy in chronic hepatitis B?
- What is the natural course of chronic hepatitis B?
- What medications are used to treat hepatitis B?
- What are the effects of alcohol on hepatitis B?
- What are the effects of immunosuppressive medications on hepatitis B?
- What is delta hepatitis?
- What about co-infection with hepatitis B virus and hepatitis C virus?
- What happens in co-infection with hepatitis B virus and human immunodeficiency virus?
- What is the role of liver transplantation in hepatitis B?
- What can be done to prevent hepatitis B?
- What is new in the treatment of hepatitis B?
- Hepatitis B At A Glance
- Find a local Gastroenterologist in your town
What is new in the treatment of hepatitis B virus?
New agents are under development to treat hepatitis B. Many of these are nucleoside/nucleotide analogues that investigators hope will be more effective than older agents. Experts also are working on treatment guidelines and the use of multi-drug therapy. Vaccination remains the key to preventing hepatitis B and holds the most promise for reducing disease burden.
Hepatitis B At A Glance
- The hepatitis B virus is a DNA virus belonging to the Hepadnaviridae family
of viruses. Hepatitis B virus is not related to the hepatitis A virus or the
hepatitis C virus.
- Some people with hepatitis B never clear the virus and are chronically
infected. Approximately 350 million individuals in the world and one million in
the United States are chronically infected with hepatitis B. Many of these
people appear healthy but can spread the virus to others.
- Hepatitis B infection is transmitted through sexual contact, contact with
contaminated blood (for example, through shared needles used for illicit,
intravenous drugs), and from mother to child. Hepatitis B is not spread through
food, water, or casual contact.
- Serologic (blood) markers specifically for hepatitis B virus are used to
diagnose hepatitis B viral infection. The blood tests can also identify people
who are at highest risk for complications.
- Injury to the liver by hepatitis B virus is caused by the body's immune
response as the body attempts to eliminate the virus.
- In the United States, 95% of adults who get hepatitis B are able to clear
the virus and cure themselves of infection. The remaining 5% of adults with
acute hepatitis B go on to develop chronic hepatitis B. Those who acquire the
infection in childhood are much more likely to have chronic infection. Chronic
hepatitis B may lead to cirrhosis or liver failure. Approximately 15% to 25% of
persons with chronic infection will die prematurely as a result of the
- Progression of chronic hepatitis B viral infection occurs insidiously
(subtly and gradually), usually over several decades. The course is determined
primarily by the age at which the hepatitis B viral infection is acquired and
the interaction between the virus and the body's immune system.
- Treatment with interferons or nucleoside/nucleotide analogues suppresses
viral reproduction in about 40% to 90% of patients with chronic hepatitis B. The
medications are also effective in reducing inflammation and improving blood
tests. This can delay or reduce complications such as cirrhosis. However, most
people do not have a permanent response and relapse is common. The medications
do not cure the infection.
- Liver transplantation should be considered for patients with impending
liver failure due to acute (initial) infection or advanced cirrhosis.
- Hepatitis B is preventable through vaccination. All children should receive the vaccine. In addition, adults at high risk for hepatitis B should be vaccinated. Unvaccinated people who are exposed to hepatitis B should be evaluated by a physician to determine if they need specific immune globulin (HBIG).
Reference: Centers for Disease Control and Prevention, "Viral Hepatitis FAQs for the Public," January 15, 2009
Last Editorial Review: 3/24/2009
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