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HEPATITIS B VIRUS
INFECTION
SANDE, Nyachuma Miyaga
NYANGE, Sylvia William
Bugando School of Assistant Medical Officer.
OBJECTIVES
 Introduction
 Mode of transmission
 Viral structure
 Acute hepatitis B infection
 Chronic hepatitis B infection
 Clinical features
 Investigation
 Treatment
 Prevention
INTRODUCTION
 Hepatitis is an inflammation of the liver
 The condition can be self limiting or can
progress to scarring(fibrosis), liver cancer or
cirrhosis.
INTRODUCTION…..
 Hepatitis viruses are the common cause of
hepatitis
 Other causes are alcohol, drugs and
autoimmune diseases
 There are five main hepatitis viruses, type A,
B, C, D, and E
MODE OF TRANSMISSION
 Transmitted through intravenous routes
Infected blood product
Contaminated needle of intravenous drug
abuser
Tattooists
 Heterosexuals with multiple partners or
contact with infected persons
 Sexual intercourse in male homosexual
 Vertical transmission mother to child during
delivery
VIRAL STRUCTURE
 The virus is Dane particles consists:
Outer surface coat – the hepatitis surface
antigen(HBsAg)
Inner core - consists double strand DNA
polymerase/reverse transcriptase
Core antigen(HBcAg) and e
antigen(HBeAg).
hepatitis e antigen is produce in excess
during active viral replication and its
detection in the serum show a higher
ACUTE HEPATITIS B INFECTION
 Acute HBV infection may be asymptomatic or
symptomatic
 Seldom associate with rashes, or polyathritis
affecting the small joints
 If HBsAg is present a full profile is performed
ACUTE HEPATITIS B INFECTION….
 The Viral marker of HBV:
HBsAg- is originate in acute Hepatitis and
persists in chronic carriers
HBsAg with HBeAg – is presence in acute
hepatitis, its existence in chronic HBV
infection is associated with increased
infectivity and progress to chronic liver
diseases
ACUTE HEPATITIS B INFECTION…..
HBsAg with anti-HBe – occurs in
improvement on acute infection, in chronic
infection specify decreased infectivity
Anti- HBs – come out late and signify
immunity
HBV DNA – imply constant viral replication
ACUTE HEPATITIS B INFECTION…..
 Most patients recover completely from acute
HBV, this marked by the disappearance of
HBsAg, development of antibody to surface
antigen(anti-HBs)and immunity to
subsequent infection
 Minority of patient do not clear HBsAg from
serum and become chronic carriers.
ACUTE HEPATITIS B INFECTION….
 Risk of developing chronic HBV infection is
inversely related to age at the time of
infection
 90% of infants infected at birth will become
chronically infected with HBV, but only about
5% of adult
CHRONIC HEPATITIS B INFECTION
 About 3-5% of patients with acute HBV
progress to chronic hepatitis
 The condition may be asymptomatic, or
presence with established liver diseases and
the sign of chronic liver disease in physical
examination
CHRONIC HEPATITIS B INFECTION…..
 Serum liver biochemistry transferase is
usually abnormal, liver biopsy and
histological examination will show the
severity of diseases varying from mild
inflammatory changes to established
cirrhosis
CLINICAL FEATURES
 Jaundice
 Fever
 Loss of body hair
 Spider naevi
 Gyenacomastia
 Finger clubbing
 Liver(small/large)
 Dupuytren’s
contracture
 Scratch mark
 Testicular atrophy
 Ascites
 Edema
 Hepatic flap
 Splenomegally
INVESTIGATION
 Hepatitis B panel
 HBV DNA test
 Serum bilirubin
 PT, PTT, INR
 AST, ALT
 HIV test
 CBC
 Gamma-glutamyl
transpeptidase
(GGT)
 Alkaline
phosphatase (ALP)
 Alphafetal protein
TREATMENT
 The primary treatment goals for patients
with hepatitis B (HBV) infection are:
 To prevent progression of the disease,
particularly to cirrhosis, liver failure, and
hepatocellular carcinoma (HCC).
TREATMENT…..
 Risk factors for progression of chronic HBV
include the following :
Persistently elevated levels of HBV DNA
and, in some patients, alanine
aminotransferase (ALT)
Male sex
Older age
TREATMENT…..
Family history of HCC
Elevated alpha-fetoprotein (AFP)
Coinfection with hepatitis D (delta) virus
(HDV), hepatitis C virus (HCV), or human
immunodeficiency virus (HIV)
TREATMENT….
 For acute HBV give:
Tenofovir disoproxil fumarate (TDF) or
Entecavir (ETV).
 In patients with HBV who are coinfected with
human immunodeficiency virus (HIV), it may
be possible to simplify treatment regimens
with agents that have dual effectiveness
against both viruses e.g Tenoforvir +
Lamivudine + Efarvirenz
PREVENTION
 Screening prenatal pregnancy women to
prevent vertical transmission
 Hepatitis B vaccine
 The three major risk groups (heterosexuals
with multiple partners or contact with infected
persons, injection-drug users, and men who
have sex with men)should be vaccinated
against HBV.

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Hepatitis B virus Infection

  • 1. HEPATITIS B VIRUS INFECTION SANDE, Nyachuma Miyaga NYANGE, Sylvia William Bugando School of Assistant Medical Officer.
  • 2. OBJECTIVES  Introduction  Mode of transmission  Viral structure  Acute hepatitis B infection  Chronic hepatitis B infection  Clinical features  Investigation  Treatment  Prevention
  • 3. INTRODUCTION  Hepatitis is an inflammation of the liver  The condition can be self limiting or can progress to scarring(fibrosis), liver cancer or cirrhosis.
  • 4. INTRODUCTION…..  Hepatitis viruses are the common cause of hepatitis  Other causes are alcohol, drugs and autoimmune diseases  There are five main hepatitis viruses, type A, B, C, D, and E
  • 5. MODE OF TRANSMISSION  Transmitted through intravenous routes Infected blood product Contaminated needle of intravenous drug abuser Tattooists  Heterosexuals with multiple partners or contact with infected persons  Sexual intercourse in male homosexual  Vertical transmission mother to child during delivery
  • 6. VIRAL STRUCTURE  The virus is Dane particles consists: Outer surface coat – the hepatitis surface antigen(HBsAg) Inner core - consists double strand DNA polymerase/reverse transcriptase Core antigen(HBcAg) and e antigen(HBeAg). hepatitis e antigen is produce in excess during active viral replication and its detection in the serum show a higher
  • 7. ACUTE HEPATITIS B INFECTION  Acute HBV infection may be asymptomatic or symptomatic  Seldom associate with rashes, or polyathritis affecting the small joints  If HBsAg is present a full profile is performed
  • 8. ACUTE HEPATITIS B INFECTION….  The Viral marker of HBV: HBsAg- is originate in acute Hepatitis and persists in chronic carriers HBsAg with HBeAg – is presence in acute hepatitis, its existence in chronic HBV infection is associated with increased infectivity and progress to chronic liver diseases
  • 9. ACUTE HEPATITIS B INFECTION….. HBsAg with anti-HBe – occurs in improvement on acute infection, in chronic infection specify decreased infectivity Anti- HBs – come out late and signify immunity HBV DNA – imply constant viral replication
  • 10. ACUTE HEPATITIS B INFECTION…..  Most patients recover completely from acute HBV, this marked by the disappearance of HBsAg, development of antibody to surface antigen(anti-HBs)and immunity to subsequent infection  Minority of patient do not clear HBsAg from serum and become chronic carriers.
  • 11. ACUTE HEPATITIS B INFECTION….  Risk of developing chronic HBV infection is inversely related to age at the time of infection  90% of infants infected at birth will become chronically infected with HBV, but only about 5% of adult
  • 12. CHRONIC HEPATITIS B INFECTION  About 3-5% of patients with acute HBV progress to chronic hepatitis  The condition may be asymptomatic, or presence with established liver diseases and the sign of chronic liver disease in physical examination
  • 13. CHRONIC HEPATITIS B INFECTION…..  Serum liver biochemistry transferase is usually abnormal, liver biopsy and histological examination will show the severity of diseases varying from mild inflammatory changes to established cirrhosis
  • 14. CLINICAL FEATURES  Jaundice  Fever  Loss of body hair  Spider naevi  Gyenacomastia  Finger clubbing  Liver(small/large)  Dupuytren’s contracture  Scratch mark  Testicular atrophy  Ascites  Edema  Hepatic flap  Splenomegally
  • 15. INVESTIGATION  Hepatitis B panel  HBV DNA test  Serum bilirubin  PT, PTT, INR  AST, ALT  HIV test  CBC  Gamma-glutamyl transpeptidase (GGT)  Alkaline phosphatase (ALP)  Alphafetal protein
  • 16. TREATMENT  The primary treatment goals for patients with hepatitis B (HBV) infection are:  To prevent progression of the disease, particularly to cirrhosis, liver failure, and hepatocellular carcinoma (HCC).
  • 17. TREATMENT…..  Risk factors for progression of chronic HBV include the following : Persistently elevated levels of HBV DNA and, in some patients, alanine aminotransferase (ALT) Male sex Older age
  • 18. TREATMENT….. Family history of HCC Elevated alpha-fetoprotein (AFP) Coinfection with hepatitis D (delta) virus (HDV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV)
  • 19. TREATMENT….  For acute HBV give: Tenofovir disoproxil fumarate (TDF) or Entecavir (ETV).  In patients with HBV who are coinfected with human immunodeficiency virus (HIV), it may be possible to simplify treatment regimens with agents that have dual effectiveness against both viruses e.g Tenoforvir + Lamivudine + Efarvirenz
  • 20. PREVENTION  Screening prenatal pregnancy women to prevent vertical transmission  Hepatitis B vaccine  The three major risk groups (heterosexuals with multiple partners or contact with infected persons, injection-drug users, and men who have sex with men)should be vaccinated against HBV.