Hepatitis B virus infection is a major global health issue. Hepatitis B is a potentially fatal hepatic infection caused by the hepatitis B virus. It is frequently spread through bodily fluids such as blood, sperm, and vaginal secretions. Most immunocompetent individuals infected with HBV can eradicate the infection independently.
Patients may arrive with acute clinical disease, or an asymptomatic infection discovered during HBV screening. HBV infection manifests clinically differently in acute and chronic illnesses.
Patients may develop icteric hepatitis, anicteric or subclinical hepatitis, or, less commonly, fulminant hepatitis in acute infection. Patients with chronic infection and liver damage may develop an asymptomatic carrier state, ascites, cirrhosis, chronic hepatitis, hepatic encephalopathy, or hepatocellular cancer.
Epidemiology
Following the start of the hepatitis B vaccination campaign, the prevalence of the disease has decreased. Due to the potential for development into a chronic condition and the associated morbidity and death, HBV infection poses a concern to global public health. Although there are hepatitis B vaccinations, poor access to healthcare and inadequate health education contribute to the disease’s increasing incidences worldwide.
Since Americans have better access to healthcare and use immunizations and other preventive measures, hepatitis B cases are less in the United States than in Asia and Africa. Around 350–400 million people worldwide have chronic hepatitis B, Asian Pacific Islanders, Eskimos from Alaska, and native Australians. Central Asia, sub-Saharan Africa, and the Indian subcontinent are the geographical areas with the highest prevalence.
Children born to infected mothers, intravenous drug users, men who engage in heterosexual sex, hemodialysis patients, healthcare professionals, and household members of known chronic Hepatitis B patients are among the high-risk populations for infection. Vertical transmission is responsible for most of the Hepatitis disease burden worldwide.
Anatomy
Pathophysiology
The Hepatitis B virus is spread through percutaneous inoculation or mucosal contact with contagious bodily fluids. An oral-fecal transfer is attainable but relatively uncommon. HBV infection typically has an incubation period of 30-180 days, and recovery is expected in immunocompromised individuals; a small proportion can develop to a chronic state, characterized serologically as the presence of HBsAg for more than six months.
HBsAg is spread through blood contact or bodily secretions, and individuals with close contact with HBsAg-positive patients are at a much higher risk of contracting hepatitis B. The pathophysiology of liver disease in Hepatitis B infection is primarily immune-mediated, although it can cause direct cytotoxic harm to the liver in some conditions.
HBsAg and nucleocapsid proteins found on cell membranes aid T cells-induced cellular damage of HBV-infected cells. The cytotoxic T cell response to HBV-infected hepatocytes is rather ineffectual; most HBV DNA is removed from the hepatic system prior to peak T cell infiltration, implying that the immune response is likely healthier early in infection. The immune response may not be the only cause of hepatic damage in patients with hepatitis B.
Etiology
Horizontal transmission: refers to the spread of hepatitis B via sexual intercourse or contact with mucous surfaces. In places with low to moderate prevalence, unprotected intercourse and intravenous drug abuse are the primary transmission methods.
Vertical transmission: This type of transmission involves the perinatal transmission of the virus from the mother to the unborn child. In regions where the prevalence is high, it is the primary method of transmission.
Mucosal contact is any contact with an infected patient’s saliva, semen, vaginal fluid, or blood. Sexual contact includes unprotected intercourse (oral, vaginal, or anal).
Genetics
Prognostic Factors
Treatment for acute HBV infection might be symptomatic, and in immunocompromised individuals, it may resolve independently. Individuals who advance to the chronic stage are more likely to develop cirrhosis, hepatocellular cancer, or fulminant liver failure.
The risk depends on the specific genotype and the transfer mode, as vertical transmission has a more significant risk of long-term complications than horizontal transmission.
For adults and ≥16 years:
H/o of hepatitis B viremia using refractory lamivudine/known lamivudine/telbivudine resistance substitutions rtM204I/V w/wo rtL180M, rtV173L, or rtL80I/V
1 mg orally daily
For adults and ≥16 years:
Decompensated Liver Disease
1 mg orally daily
Indicated for Chronic Hepatitis B Take 600 mg one time daily by oral route Renal Dose Adjustments Range of CrCl 30-49 mL/min For Tablets- For every two days, take 600 mg by oral route Oral solution-Take 400 mg daily once by oral route CrCl<30 mL/min (dialysis not required) For Tablets- Take 600 mg every three days by oral route For Oral solution- Take 200 mg daily once by oral route
When taken by patients with chronic hepatitis B infection, lamivudine will work by stopping the multiplication of the hepatitis B virus, which reduces the amount of viral load in the body
Recommended dosage of 100 mg daily once orally
Dose Adjustments
Renal dose adjustment In adult patients with HBV infection, when CrCl falls in the range of 30 and 49 mL/min, first start with a dose of 100 mg orally followed by 50 mg orally one time a day from day 2 When the levels of CrCl fall in the range of 15 and 29 mL/min, start with a 100 mg oral dose followed by an oral dose of 25 mg daily from day 2 When CrCl falls between 5 and 14 mL/min, start with an oral dose of 35 mg followed by an oral dose of 15 mg daily from day 2 If CrCl is lower than 5 mL/min, start with the dose of 35 mg orally, followed by an oral dose of 10 mg daily from day 2
Chronic hepatitis B infection is treated with tenofovir DF alone with an oral dose of 300 mg once a day
Dose Adjustments
Renal dose adjustments In Renal impairment patients, dosage adjustment should be considered when Crcl falls between 10 and 50
If Crcl is between 30 and 49 mL/min, an oral dose of 300 mg is once every two days if Crcl is between 10 and 29 mL/min, an oral dose of 300 mg is once every 3 to 4 days
Dosage adjustment is not required in patients with CrCl below ten and above 50 mL/min, in which an oral dose of 300 mg once daily is recommended
Indicated for hepatitis A recent study highlighted synergistic effects between bupleurum and scutellaria (skullcap), demonstrating their ability to effectively target and treat liver disorders by enhancing penetration into the liver Standard doses range from 100 to 500 mg once daily to twice daily However, these are commonly blended at 50 to 200 mg in multiherb formulations taken once daily to twice daily
Hepatitis B virus infection is a major global health issue. Hepatitis B is a potentially fatal hepatic infection caused by the hepatitis B virus. It is frequently spread through bodily fluids such as blood, sperm, and vaginal secretions. Most immunocompetent individuals infected with HBV can eradicate the infection independently.
Patients may arrive with acute clinical disease, or an asymptomatic infection discovered during HBV screening. HBV infection manifests clinically differently in acute and chronic illnesses.
Patients may develop icteric hepatitis, anicteric or subclinical hepatitis, or, less commonly, fulminant hepatitis in acute infection. Patients with chronic infection and liver damage may develop an asymptomatic carrier state, ascites, cirrhosis, chronic hepatitis, hepatic encephalopathy, or hepatocellular cancer.
Following the start of the hepatitis B vaccination campaign, the prevalence of the disease has decreased. Due to the potential for development into a chronic condition and the associated morbidity and death, HBV infection poses a concern to global public health. Although there are hepatitis B vaccinations, poor access to healthcare and inadequate health education contribute to the disease’s increasing incidences worldwide.
Since Americans have better access to healthcare and use immunizations and other preventive measures, hepatitis B cases are less in the United States than in Asia and Africa. Around 350–400 million people worldwide have chronic hepatitis B, Asian Pacific Islanders, Eskimos from Alaska, and native Australians. Central Asia, sub-Saharan Africa, and the Indian subcontinent are the geographical areas with the highest prevalence.
Children born to infected mothers, intravenous drug users, men who engage in heterosexual sex, hemodialysis patients, healthcare professionals, and household members of known chronic Hepatitis B patients are among the high-risk populations for infection. Vertical transmission is responsible for most of the Hepatitis disease burden worldwide.
The Hepatitis B virus is spread through percutaneous inoculation or mucosal contact with contagious bodily fluids. An oral-fecal transfer is attainable but relatively uncommon. HBV infection typically has an incubation period of 30-180 days, and recovery is expected in immunocompromised individuals; a small proportion can develop to a chronic state, characterized serologically as the presence of HBsAg for more than six months.
HBsAg is spread through blood contact or bodily secretions, and individuals with close contact with HBsAg-positive patients are at a much higher risk of contracting hepatitis B. The pathophysiology of liver disease in Hepatitis B infection is primarily immune-mediated, although it can cause direct cytotoxic harm to the liver in some conditions.
HBsAg and nucleocapsid proteins found on cell membranes aid T cells-induced cellular damage of HBV-infected cells. The cytotoxic T cell response to HBV-infected hepatocytes is rather ineffectual; most HBV DNA is removed from the hepatic system prior to peak T cell infiltration, implying that the immune response is likely healthier early in infection. The immune response may not be the only cause of hepatic damage in patients with hepatitis B.
Horizontal transmission: refers to the spread of hepatitis B via sexual intercourse or contact with mucous surfaces. In places with low to moderate prevalence, unprotected intercourse and intravenous drug abuse are the primary transmission methods.
Vertical transmission: This type of transmission involves the perinatal transmission of the virus from the mother to the unborn child. In regions where the prevalence is high, it is the primary method of transmission.
Mucosal contact is any contact with an infected patient’s saliva, semen, vaginal fluid, or blood. Sexual contact includes unprotected intercourse (oral, vaginal, or anal).
Treatment for acute HBV infection might be symptomatic, and in immunocompromised individuals, it may resolve independently. Individuals who advance to the chronic stage are more likely to develop cirrhosis, hepatocellular cancer, or fulminant liver failure.
The risk depends on the specific genotype and the transfer mode, as vertical transmission has a more significant risk of long-term complications than horizontal transmission.
https://www.ncbi.nlm.nih.gov/books/NBK555945/
medtigo
Hepatitis B
Updated :
February 6, 2024
Hepatitis B virus infection is a major global health issue. Hepatitis B is a potentially fatal hepatic infection caused by the hepatitis B virus. It is frequently spread through bodily fluids such as blood, sperm, and vaginal secretions. Most immunocompetent individuals infected with HBV can eradicate the infection independently.
Patients may arrive with acute clinical disease, or an asymptomatic infection discovered during HBV screening. HBV infection manifests clinically differently in acute and chronic illnesses.
Patients may develop icteric hepatitis, anicteric or subclinical hepatitis, or, less commonly, fulminant hepatitis in acute infection. Patients with chronic infection and liver damage may develop an asymptomatic carrier state, ascites, cirrhosis, chronic hepatitis, hepatic encephalopathy, or hepatocellular cancer.
Following the start of the hepatitis B vaccination campaign, the prevalence of the disease has decreased. Due to the potential for development into a chronic condition and the associated morbidity and death, HBV infection poses a concern to global public health. Although there are hepatitis B vaccinations, poor access to healthcare and inadequate health education contribute to the disease’s increasing incidences worldwide.
Since Americans have better access to healthcare and use immunizations and other preventive measures, hepatitis B cases are less in the United States than in Asia and Africa. Around 350–400 million people worldwide have chronic hepatitis B, Asian Pacific Islanders, Eskimos from Alaska, and native Australians. Central Asia, sub-Saharan Africa, and the Indian subcontinent are the geographical areas with the highest prevalence.
Children born to infected mothers, intravenous drug users, men who engage in heterosexual sex, hemodialysis patients, healthcare professionals, and household members of known chronic Hepatitis B patients are among the high-risk populations for infection. Vertical transmission is responsible for most of the Hepatitis disease burden worldwide.
The Hepatitis B virus is spread through percutaneous inoculation or mucosal contact with contagious bodily fluids. An oral-fecal transfer is attainable but relatively uncommon. HBV infection typically has an incubation period of 30-180 days, and recovery is expected in immunocompromised individuals; a small proportion can develop to a chronic state, characterized serologically as the presence of HBsAg for more than six months.
HBsAg is spread through blood contact or bodily secretions, and individuals with close contact with HBsAg-positive patients are at a much higher risk of contracting hepatitis B. The pathophysiology of liver disease in Hepatitis B infection is primarily immune-mediated, although it can cause direct cytotoxic harm to the liver in some conditions.
HBsAg and nucleocapsid proteins found on cell membranes aid T cells-induced cellular damage of HBV-infected cells. The cytotoxic T cell response to HBV-infected hepatocytes is rather ineffectual; most HBV DNA is removed from the hepatic system prior to peak T cell infiltration, implying that the immune response is likely healthier early in infection. The immune response may not be the only cause of hepatic damage in patients with hepatitis B.
Horizontal transmission: refers to the spread of hepatitis B via sexual intercourse or contact with mucous surfaces. In places with low to moderate prevalence, unprotected intercourse and intravenous drug abuse are the primary transmission methods.
Vertical transmission: This type of transmission involves the perinatal transmission of the virus from the mother to the unborn child. In regions where the prevalence is high, it is the primary method of transmission.
Mucosal contact is any contact with an infected patient’s saliva, semen, vaginal fluid, or blood. Sexual contact includes unprotected intercourse (oral, vaginal, or anal).
Treatment for acute HBV infection might be symptomatic, and in immunocompromised individuals, it may resolve independently. Individuals who advance to the chronic stage are more likely to develop cirrhosis, hepatocellular cancer, or fulminant liver failure.
The risk depends on the specific genotype and the transfer mode, as vertical transmission has a more significant risk of long-term complications than horizontal transmission.
https://www.ncbi.nlm.nih.gov/books/NBK555945/
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