Hepatitis B

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  • Created by: z
  • Created on: 20-02-16 16:35

Prevalence, epidemiology and transmission

  • high prevalence/endemic in china, africa, india
  • Globally:
    • causes 40% of liver failure deaths
    • causes 57% of HCC deaths
    • 644,000 deaths/annum
  • Birmingham
    • 0.2-0.8% depending on trust
  • transmission
    • peri-natal infection (~100% of carriage if infected as baby vs 50% as toddler vs 5% adult)
    • sexual contact (MSM)
    • IVDU
    • infected blood products/non sterile inhections (21mill new infections/yr)
    • poor sanitation/overcrowding

Transmission in england and Wales

  • yearly 3000 HBV infections arise
  • 7.5% progress to chronic infection (~200)
  • plus net migration of ~6500 migrants with chronic HBV
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Natural history

(http://www.nature.com/nrgastro/journal/v8/n5/images/nrgastro.2011.33-f1.jpg)

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HBV medication

  • pegylated IFN alpha
  • Antivirals:
    • tenofovir
    • entecavir
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Hepatitis D

  • RNA, blood borne
  • identified 1986
  • requires HBV to complete replication cycle
    • uses HBsAg to encapsulate genome and envelope proteins
  • all HBsAg +ve pts should be testes for anti-Delta Ab
  • more common in Meditteranean, aub-Aharan afrtica, middle east, northern south america
  • Dx
    • +ve for anti-delta ntibody and Delta virus RNA
  • Tx
    • PegIFN 
    • only effcetive in ~20%
  • causes liver disease over time (cirrhosis/HCC)
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