Viral Hepatits: B

• Double-stranded DNA (Hepadnavirus)

• Blood borne, sexual, vertical transmission: 350 million worldwide, 250,000 deaths anuually

• Serology:

• Acute: + Heb B Surface Ag -anti Hep B Surface + IgM anti core + HepB DNA

• Resolved: - Hep B Surface Ag +anti Hep B Surface +/- IgG anti core – HepB DNA

• Chronic: + Hep B Surface Ag -anti Hep B Surface + IgG ant icore + HepB DNA

• (> 6 months) (+anti HepB: 24%)

• + Hep B e Ag: Highly infectious (30% post needle stick) HepB DNA>20 K

• - Hep B e Ag: Persistent/Intermittent elevation AST/ALT biopsy CAH

• Inactive carrier: Normal AST/ALT HepB DNA < 20 K biopsy negative CAH

• Isolated IgG anti core: 0-20% + Hepb DNA

• Chronic States: Early childhood 90%, Adult 5%

• Complications:

• Acute Fulminant Hepatitis

• HCC 100 fold increase risk cirrhosisdoes not have to be present

• PAN

• Glomerulonephritis, Arthralgias, Rash

• Treatment: Pegylated Alpha Interferon, Lamivudine 69% resistance 5 years),

• Adefovir, Entacevir, Telbuvidine

• Response: HepBDNA loss 21-67%; HepB sAG 2%; HepB e loss 22-30%;

• Normal AST/ALT 39-68%; Histological improvement 38-72%

• Liver Transplant: Acute Fulminat, Cirrhosis