Hepatitis B Infection

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Contents

Etiology

Epidemiology

  • without increased mortality [4]
  • 32% convert to HBsAg-

Pathology

Genetics

  • susceptibility linked to:
  • most cases are asymptomatic

Laboratory

  • abnormal liver function tests

Complications

  • persistent HBV viral replication 6 months after exposure

Management

  • indicated for immune-mediated necro- inflammatory activity in the liver ( ALT > 100 U/L)
  • goal is low circulation HBV DNA levels (< 200 pg/mL)
  • duration of treatment = 1 year
  • may be transient rise in ALT after intiation of therapy
  • contraindicated with

More General Terms

Additional Terms

Internet Database

OMIM: 610424

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, American College of Physicians, Philadelphia 1998, 2006, 2009
  2. Journal Watch 22(9):71, 2002 Goldstein ST et al Incidence and risk factors for acute hepatitis B in the United States, 1982-1998: implications for vaccination programs. J Infect Dis 185:713, 2002 PMID: [1]
  3. Prescriber's Letter 9(7):40 2002
  4. Journal Watch 24(21):162, 2004 Manno M, Camma C, Schepis F, Bassi F, Gelmini R, Giannini F, Miselli F, Grottola A, Ferretti I, Vecchi C, De Palma M, Villa E. Natural history of chronic HBV carriers in northern Italy: morbidity and mortality after 30 years. Gastroenterology. 2004 Sep;127(3):756-63. PMID: [2]
  5. Journal Watch 24(21):162-63, 2004 Marcellin P, Lau GK, Bonino F, Farci P, Hadziyannis S, Jin R, Lu ZM, Piratvisuth T, Germanidis G, Yurdaydin C, Diago M, Gurel S, Lai MY, Button P, Pluck N; Peginterferon Alfa-2a HBeAg-Negative Chronic Hepatitis B Study Group. Peginterferon alfa-2a alone, lamivudine alone, and the two in combination in patients with HBeAg-negative chronic hepatitis B. N Engl J Med. 2004 Sep 16;351(12):1206-17. PMID: [3]
  6. Journal Watch 25(4):30-31, 2005 Janssen HL, van Zonneveld M, Senturk H, Zeuzem S, Akarca US, Cakaloglu Y, Simon C, So TM, Gerken G, de Man RA, Niesters HG, Zondervan P, Hansen B, Schalm SW; HBV 99-01 Study Group; Rotterdam Foundation for Liver Research. Pegylated interferon alfa-2b alone or in combination with lamivudine for HBeAg-positive chronic hepatitis B: a randomised trial. Lancet. 2005 Jan 8;365(9454):123-9. PMID: [4]
  7. Journal Watch 25(16):130, 2005 Hadziyannis SJ, Tassopoulos NC, Heathcote EJ, Chang TT, Kitis G, Rizzetto M, Marcellin P, Lim SG, Goodman Z, Ma J, Arterburn S, Xiong S, Currie G, Brosgart CL; Adefovir Dipivoxil 438 Study Group. Long-term therapy with adefovir dipivoxil for HBeAg- negative chronic hepatitis B. N Engl J Med. 2005 Jun 30;352(26):2673-81. PMID: [5]
    - Lau GK, Piratvisuth T, Luo KX, Marcellin P, Thongsawat S, Cooksley G, Gane E, Fried MW, Chow WC, Paik SW, Chang WY, Berg T, Flisiak R, McCloud P, Pluck N; Peginterferon Alfa-2a HBeAg-Positive Chronic Hepatitis B Study Group. Peginterferon Alfa-2a, lamivudine, and the combination for HBeAg-positive chronic hepatitis B. N Engl J Med. 2005 Jun 30;352(26):2682-95. PMID: [6]
    - Lok AS. The maze of treatments for hepatitis B. N Engl J Med. 2005 Jun 30;352(26):2743-6. No abstract available. PMID: [7]
  8. Mast EE, Margolis HS, Fiore AE, Brink EW, Goldstein ST, Wang SA, Moyer LA, Bell BP, Alter MJ; Advisory Committee on Immunization Practices (ACIP). A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part 1: immunization of infants, children, and adolescents. MMWR Recomm Rep. 2005 Dec 23;54(RR-16):1-31. PMID: [8]
  9. Lim SG et al, A double-blind placebo-controlled study of emtricitrabine in chronic hepatitis B Arch Intern Med 2006; 166:49 PMID: [9]
  10. Chen C-J, Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA 2006; 295:65 PMID: [10]
  11. Chang T-T et al, A comparison of entacavir and lamivudine for HBeAg-positive chronic hepatitis B. N Engl J Med 2006; 354:1001 PMID: [11]
    - Lai C-L et al, Entacavir versus lamivudine for patients with HBeAg-negative chronic hepatitis B N Engl J Med 2006; 354:1011 PMID: [12]
  12. Kanwal F et al, Treatment alternatives for hepatitis B cirrhosis: A cost effective analysis. Am J Gastroenterol 2006, 101:2076 PMID: [13]
  13. Mast EE, Margolis HS, Fiore AE, Brink EW, Goldstein ST, Wang SA, Moyer LA, Bell BP, Alter MJ; Advisory Committee on Immunization Practices (ACIP). A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part 1: immunization of infants, children, and adolescents. MMWR Recomm Rep. 2005 Dec 23;54(RR-16):1-31. Erratum in: MMWR Morb Mortal Wkly Rep. 2006 Feb 17;55(6):158-9. <PubMed> PMID: [14] <Internet> [15]
  14. Kumar M et al, A randomized controlled trial of lamividine to treat acute hepatitis B. Hepatology 2007, 45:97 PMID: [16]
  15. Weinbaum CM et al, Centers for Disease Control and Prevention (CDC) Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recomm Rep. 2008 Sep 19;57(RR-8):1-20. PMID: &dopt=Abstract
  16. Sorrell MF et al. National Institutes of Health consensus development conference statement: Management of hepatitis B. Ann Intern Med 2009 Jan 20; 150:104. PMID: [17]
    - Shamliyan TA et al. Antiviral therapy for adults with chronic hepatitis B: A systematic review for a National Institutes of Health consensus development conference. Ann Intern Med 2009 Jan 20; 150:111. PMID: [18]
  17. Shim JH et al Efficacy of entecavir in treatment-naïve patients with hepatitis B virus-related decompensated cirrhosis. J Hepatol 2010 Feb; 52:176. PMID: [19]
  18. Chronic hepatitis B (AASLD guidelines) 2007 [20]
  19. What I need to know about Hepatitis B [21]
  20. National Guideline Clearinghouse Chronic hepatitis B: update 2009. American Association for the Study of Liver Diseases ngc-guideline: [22]
    - United Kingdom national guideline on the management of the viral hepatitides A, B, and C 2008. (British Association of Sexual Health and HIV) ngc-guideline: [23]
    - Hepatitis B virus. ngc-guideline: [24]
    - A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States. Recommendations of the Advisory Committee on Immunization Practices (ACIP) part 1: immunization of infants, children, and adolescents. Centers for Disease Control and Prevention ngc-guideline: [25]
    - Tenofovir disoproxil for the treatment of chronic hepatitis B. National Institute for Clinical Excellence (NICE) ngc-guideline: [26]
    - Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. Centers for Disease Control and Prevention ngc-guideline: [27]
    - Entecavir for the treatment of chronic hepatitis B. National Institute for Health and Clinical Excellence (NICE) ngc-guideline: [28]
    - Telbivudine for the treatment of chronic hepatitis B. National Institute for Health and Clinical Excellence (NICE) ngc-guideline: [29]
    - Screening for hepatitis B virus infection in pregnancy: U.S. Preventive Services Task Force reaffirmation recommendation statement. United States Preventive Services Task Force ngc-guideline: [30]
    - National Institutes of Health Consensus Development Conference statement: management of hepatitis B. National Institutes of Health Consensus Development Conference ngc-guideline: [31]

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