Wednesday, February 26, 2014

Hepatitis B

Hepatitis is a general term meaning inflammation of the liver and can be caused by a variety of different viruses such as hepatitis A, B, C, D and E. Since the development of jaundice is a characteristic feature of liver disease, a correct diagnosis can only be made by testing patients’ sera for the presence of specific anti-viral antigens or antibodies.

Hepatitis B is a serious and common infectious disease of the liver, affecting millions of people throughout the world. Infection occurs very often in early childhood when it is asymptomatic and often leads to the chronic carrier state. More than 2 000 million people alive today have been infected with HBV at some time in their lives. Of these, about 350 million remain infected chronically and become carriers of the virus. Three quarters of the world’s population live in areas where there are high levels of infection.

Susceptibility is general. Only people who have been vaccinated successfully or those who have developed anti-HBs antibodies after HBV infection are immune to HBV infection. Persons with congenital or acquired immunodeficiency including HIV infection, and those with immunosuppression including those with lymphoproliferative disease, and patients treated with immunosuppressive drugs including steroids and by maintenance haemodialysis are more likely to develop persistent infection with HBV.

Following acute HBV infection, the risk of developing chronic infection varies inversely with age. Chronic HBV infection occurs among about 90% of infants infected at birth, 25-50% of children infected at 1-5 years of age and about 1-5% of persons infected as older children and adults. Chronic HBV infection is also common in persons with immunodeficiency.

There is no specific treatment for acute viral hepatitis B. Hepatitis B is a viral disease, and as such, antibiotics are of no value in the treatment of the infection.

The use of adrenocorticosteroids in the management of acute, uncomplicated hepatitis B is not indicated because they have no effect on the resolution of the underlying disease process, and may increase the rate of relapse. Early treatment of acute hepatitis B with anabolic steroids may result in the development of persistent infection. Corticosteroid therapy is only to be used in patients with chronic active hepatitis who are symptomatic, HBsAg negative, and who have severe histologic lesions in liver biopsies.

High endemicity areas include south-east Asia and the Pacific Basin (excluding Japan, Australia, and New Zealand), sub-Saharan Africa, the Amazon Basin, parts of the Middle East, the central Asian Republics, and some countries in eastern Europe. In these areas, about 70 to 90% of the population becomes HBV-infected before the age of 40, and 8 to 20% of people are HBV carriers.

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