hepatitis

Importance: Hepatitis B virus (HBV) infection affects an estimated 254 million people worldwide and causes approximately 1.1 million deaths annually. In 2022, there were approximately 1.2 million new HBV infections worldwide and 14 000 in the US.

Observations: HBV is a DNA virus transmitted through percutaneous or mucosal exposure to infected blood, semen, or body fluids. Mother-to-child transmission, which is the principal cause of chronic HBV infection globally, occurs in 70% to 90% of infants born to mothers who are hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) positive and in 5% to 20% of those born to HBsAg-positive/HBeAg-negative mothers. However, HBV vaccination and administration of hepatitis B immune globulin within 12 to 24 hours of birth prevent approximately 94% of perinatal infections, and adding antiviral therapy in pregnant women with high HBV DNA reduces transmission to less than 1%. Although universal birth-dose HBV vaccination is the most effective strategy for eliminating HBV infection, global birth-dose HBV vaccine coverage was only 45% in 2024. The risk of developing chronic infection (HBsAg positive for more than 6 months) is 90% if HBV infection occurs during infancy, 30% in children aged 1 to 5 years, and less than or equal to 5% in immunocompetent adolescents and adults. HBV infection is diagnosed by serologic testing: HBsAg indicates ongoing infection, antibody to HBsAg indicates immunity, and antibody to hepatitis B core antigen indicates ongoing or past infection. Serum HBV DNA levels quantify virus-replication activity. Assessment of liver inflammation and fibrosis with alanine aminotransferase (ALT) and noninvasive tests such as Fibrosis-4 index and liver elastography guide treatment decisions. Chronic HBV infection may progress to cirrhosis and hepatocellular carcinoma (HCC); the 5-year cumulative risk of cirrhosis is 8% to 15% in untreated chronic HBV infection, and annual HCC incidence is 3% to 5% among patients with cirrhosis. Antiviral therapies-pegylated interferon alfa and nucleos(t)ide analogues (entecavir or tenofovir)-suppress HBV DNA replication and reduce the risk of HCC by approximately 50%. Antiviral treatment is recommended for all patients with chronic HBV and cirrhosis and for those without cirrhosis who have high HBV DNA with elevated ALT or significant inflammation/fibrosis. Patients at high risk of HCC should undergo surveillance with ultrasonography and alpha-fetoprotein testing every 6 months.

Conclusions and relevance: HBV infection causes approximately 1.1 million deaths annually worldwide. Universal HBV vaccination, particularly birth-dose administration, is the most effective strategy to prevent HBV infection. Among patients with HBV infection, antiviral therapy decreases progression to cirrhosis and liver failure and reduces the risk of HCC.

Author/s:

Wen-Juei Jeng, Terry Cheuk-Fung Yip, Anna S. Lok

Management of Hepatitis C in 2019.

Brian Desmarais — Sat, 18 May 2019 05:00:00 +0000

Date Added:

May 18, 2019

Journal/Publication:

Journal of the American Medical Association

Publisher:

American Medical Association

Publication Date:

May 17, 2019

URL:

https://www.ncbi.nlm.nih.gov/pubmed/31099822

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2019.5353

Keywords

A concise summary of current treatments available for Hep C and their indications, cost, and adverse effects. James W. Mold, MD, MPH

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In the United States, hepatitis C virus (HCV) infection affects more than 2 million adults and is the leading cause of liver-related mortality. Therapies that eradicate HCV may prevent progression to cirrhosis, liver decompensation, hepatocellular carcinoma, need for liver transplant, and death. HCV eradication also appears to reduce the risk of extrahepatic diseases, including cryoglobulinemic vasculitis and cardiovascularevents. Direct-acting antivirals (DAAs), oral drugs that target multiple mechanisms of the HCV lifecycle, have been usedincombination since 2013. Because of their efficacy and safety, the use of DAAshas substantiall yimproved HCV treatment and made HCV eradication possible for most patients, including patients with HIV infection, severe renal and hepatic impairment, and history of organ transplantation. Individuals living with HCV should be treated to reduce liver-related and all-cause morbidity and mortality and to prevent HCV transmission...

Author/s:

Kristen, Naggie, Susanna

Hepatitis (and Other Liver Diseases)

Jeffrey Wilson — Sat, 06 Apr 2019 18:28:04 +0000

Date Added:

April 6, 2019

Journal/Publication:

American Family Physician

Publisher:

American Academy of Family Physicians

Publication Date:

March 1, 2019

URL:

Hepatitis (and Other Liver Diseases)

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Web Page

Keywords

MeSH

A single link to content related to various types of hepatitis previously published in the American Family Physician. James W. Mold, MD, MPH

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This collection features the best content from AFP, as identified by the AFP editors, on hepatitis and other liver disease and related issues, including cirrhosis, chronic liver failure, hemochromatosis, hepatitis A, hepatitis B, hepatitis C, jaundice, and nonalcoholic fatty liver disease. New research may affect the interpretation and application of this material. Clinical judgment is advised. Note that AFP content published within the past 12 months is accessible to AAFP members and paid subscribers only.