Hepatitis B natural history: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Hepatitis B}} | {{Hepatitis B}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{JS}} | ||
==Overview== | |||
==Natural History== | |||
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===Reactivation=== | |||
Hepatitis B virus DNA persists in the body after infection, and in some people the disease recurs.<ref name="pmid17981227">{{cite journal |author=Vierling JM |title=The immunology of hepatitis B |journal=[[Clinics in Liver Disease]] |volume=11 |issue=4 |pages=727–59, vii–viii |year=2007 |month=November |pmid=17981227 |doi=10.1016/j.cld.2007.08.001 |url=http://linkinghub.elsevier.com/retrieve/pii/S1089-3261(07)00081-5 |accessdate=2012-02-08}}</ref> Although rare, reactivation is seen most often in people with impaired immunity.<ref name="pmid18184191">{{cite journal |author=Katz LH, Fraser A, Gafter-Gvili A, Leibovici L, Tur-Kaspa R |title=Lamivudine prevents reactivation of hepatitis B and reduces mortality in immunosuppressed patients: systematic review and meta-analysis |journal=[[Journal of Viral Hepatitis]] |volume=15 |issue=2 |pages=89–102 |year=2008 |month=February |pmid=18184191 |doi=10.1111/j.1365-2893.2007.00902.x |url=http://dx.doi.org/10.1111/j.1365-2893.2007.00902.x |accessdate=2012-02-08}}</ref> HBV goes through cycles of replication and non-replication. Approximately 50% of people experience acute reactivation. Males with baseline ALT of 200 UL/L are three times more likely to develop a reactivation than people with lower levels. People who undergo [[chemotherapy]] are at risk for HBV reactivation. The current view is that [[immunosuppressive drugs]] favor increased HBV replication while inhibiting [[cytotoxic T cell]] function in the liver.<ref>{{Cite web|url=http://www.surgery.usc.edu/divisions/hep/livernewsletter-reactivationofhepatitisb.html|title=Hepatitis B Reactivation|accessdate=2009-01-24|last=Bonacini|first=Maurizio, MD|publisher=University of Southern California Department of Surgery}}</ref> | |||
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==Complications== | ==Complications== | ||
While most acute HBV infections in adults result in complete recovery, fulminant hepatitis occurs in about 1% to 2% of acutely infected persons. About 200 to 300 Americans die of fulminant disease each year (case-fatality rate 63% to 93%). Although the consequences of acute HBV infection can be severe, most of the serious complications associated with HBV infection are due to chronic infection. | While most acute HBV infections in adults result in complete recovery, fulminant hepatitis occurs in about 1% to 2% of acutely infected persons. About 200 to 300 Americans die of fulminant disease each year (case-fatality rate 63% to 93%). Although the consequences of acute HBV infection can be severe, most of the serious complications associated with HBV infection are due to chronic infection. | ||
Common complications of Hepatitis are: | Common complications of Hepatitis are: | ||
* | *Fulminant hepatitis | ||
*Chronic hepatitis | *Chronic hepatitis | ||
*Hospitalization | *Hospitalization | ||
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[[Hepatitis D]] (HDV) can occur only with a concomitant hepatitis B infection, because HDV uses the HBV surface antigen to form a [[capsid]].<ref name="pmid16364738">{{cite journal |author=Taylor JM |title=Hepatitis delta virus |journal=[[Virology]] |volume=344 |issue=1 |pages=71–6 |year=2006 |month=January |pmid=16364738 |doi=10.1016/j.virol.2005.09.033 |url=http://linkinghub.elsevier.com/retrieve/pii/S0042-6822(05)00593-3 |accessdate=2012-02-08}}</ref> Co-infection with hepatitis D increases the risk of liver cirrhosis and liver cancer.<ref name="pmid1661197">{{cite journal |author=Oliveri F, Brunetto MR, Actis GC, Bonino F |title=Pathobiology of chronic hepatitis virus infection and hepatocellular carcinoma (HCC) |journal=[[The Italian Journal of Gastroenterology]] |volume=23 |issue=8 |pages=498–502 |year=1991 |month=November |pmid=1661197 |doi= |url= |accessdate=2012-02-08}}</ref> ''[[Polyarteritis nodosa]]'' is more common in people with hepatitis B infection. | [[Hepatitis D]] (HDV) can occur only with a concomitant hepatitis B infection, because HDV uses the HBV surface antigen to form a [[capsid]].<ref name="pmid16364738">{{cite journal |author=Taylor JM |title=Hepatitis delta virus |journal=[[Virology]] |volume=344 |issue=1 |pages=71–6 |year=2006 |month=January |pmid=16364738 |doi=10.1016/j.virol.2005.09.033 |url=http://linkinghub.elsevier.com/retrieve/pii/S0042-6822(05)00593-3 |accessdate=2012-02-08}}</ref> Co-infection with hepatitis D increases the risk of liver cirrhosis and liver cancer.<ref name="pmid1661197">{{cite journal |author=Oliveri F, Brunetto MR, Actis GC, Bonino F |title=Pathobiology of chronic hepatitis virus infection and hepatocellular carcinoma (HCC) |journal=[[The Italian Journal of Gastroenterology]] |volume=23 |issue=8 |pages=498–502 |year=1991 |month=November |pmid=1661197 |doi= |url= |accessdate=2012-02-08}}</ref> ''[[Polyarteritis nodosa]]'' is more common in people with hepatitis B infection. | ||
== References == | == References == | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{STD/STI}} | {{STD/STI}} | ||
[[Category:Hepatitis|B]] | [[Category:Hepatitis|B]] | ||
[[Category:Viruses]] | [[Category:Viruses]] |
Revision as of 20:53, 29 July 2014
Hepatitis B |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Natural History
Complications
While most acute HBV infections in adults result in complete recovery, fulminant hepatitis occurs in about 1% to 2% of acutely infected persons. About 200 to 300 Americans die of fulminant disease each year (case-fatality rate 63% to 93%). Although the consequences of acute HBV infection can be severe, most of the serious complications associated with HBV infection are due to chronic infection. Common complications of Hepatitis are:
- Fulminant hepatitis
- Chronic hepatitis
- Hospitalization
- Cirrhosis
- Hepatocellular carcinoma
- Death
Chronic Infection
Approximately 5% of all acute HBV infections progress to chronic infection, with the risk of chronic HBV infection decreasing with age. As many as 90% of infants who acquire HBV infection from their mothers at birth become chronically infected. Of children who become infected with HBV between 1 year and 5 years of age, 30% to 50% become chronically infected. By adulthood, the risk of acquiring chronic HBV infection is approximately 5%.
Persons with chronic infection are often asymptomatic and may not be aware that they are infected; however, they are capable of infecting others and have been referred to as carriers. Chronic infection is responsible for most HBV-related morbidity and mortality, including chronic hepatitis, cirrhosis, liver failure, and hepatocellular carcinoma. Approximately 25% of persons with chronic HBV infection die prematurely from cirrhosis or liver cancer. Chronic active hepatitis develops in more than 25% of carriers and often results in cirrhosis. An estimated 3,000 to 4,000 persons die of hepatitis B-related cirrhosis each year in the United States. Persons with chronic HBV infection are at 12 to 300 times higher risk of hepatocellular carcinoma than noncarriers. An estimated 1,000 to 1,500 persons die each year in the United States of hepatitis B-related liver cancer.
Prognosis
Hepatitis B virus infection may be either acute (self-limiting) or chronic (long-standing). Persons with self-limiting infection clear the infection spontaneously within weeks to months.
Children are less likely than adults to clear the infection. More than 95% of people who become infected as adults or older children will stage a full recovery and develop protective immunity to the virus. However, this drops to 30% for younger children, and only 5% of newborns that acquire the infection from their mother at birth will clear the infection.[1] This population has a 40% lifetime risk of death from cirrhosis or hepatocellular carcinoma.[2] Of those infected between the age of one to six, 70% will clear the infection.[3]
Hepatitis D (HDV) can occur only with a concomitant hepatitis B infection, because HDV uses the HBV surface antigen to form a capsid.[4] Co-infection with hepatitis D increases the risk of liver cirrhosis and liver cancer.[5] Polyarteritis nodosa is more common in people with hepatitis B infection.
References
- ↑ Bell, S J; Nguyen, T (2009). "The management of hepatitis B" (Free full text). Aust Prescr. 23 (4): 99–104.
- ↑ Dienstag JL (2008). "Hepatitis B virus infection". The New England Journal of Medicine. 359 (14): 1486–500. doi:10.1056/NEJMra0801644. PMID 18832247. Retrieved 2012-02-08. Unknown parameter
|month=
ignored (help) - ↑ Kerkar N (2005). "Hepatitis B in children: complexities in management". Pediatric Transplantation. 9 (5): 685–91. doi:10.1111/j.1399-3046.2005.00393.x. PMID 16176431. Retrieved 2012-02-08. Unknown parameter
|month=
ignored (help) - ↑ Taylor JM (2006). "Hepatitis delta virus". Virology. 344 (1): 71–6. doi:10.1016/j.virol.2005.09.033. PMID 16364738. Retrieved 2012-02-08. Unknown parameter
|month=
ignored (help) - ↑ Oliveri F, Brunetto MR, Actis GC, Bonino F (1991). "Pathobiology of chronic hepatitis virus infection and hepatocellular carcinoma (HCC)". The Italian Journal of Gastroenterology. 23 (8): 498–502. PMID 1661197. Unknown parameter
|month=
ignored (help);|access-date=
requires|url=
(help)