Hepatitis BEtiology Hepatitis B is an infectious disease acquired from the hepat
Hepatitis BEtiology
Hepatitis B is an infectious disease acquired from the hepatitis B virus (HBV), which belongs to the Hepadnaviridae family. This virus has a pyrimidine-containing partially double-stranded DNA genome; it also has a nucleocapsid core and a lipid envelope housing crucial antigens that aid in detecting and advancing the disease. HBV is transmitted mainly through exposure to infectious body fluids such as blood, semen, and vaginal secretions; hence the main modes of transmission are through sexual practices, sharing of needles, and from mother to child (Pyrsopoulos, 2022). The pathophysiology of the disease reflects the virus infection and its outcome on the host immune system, which inflicts injury to the liver tissue and its inflammation, which may lead to cirrhosis and HCC.
Epidemiology
Hepatitis B is also a significant health issue that affects millions of people across the world, particularly in developing nations. It is estimated that about one-third of the world’s population has been infected with HBV, and 250-350 million worldwide are chronically infected. Chronic HBV infection incidence is not constant in all regions, particularly in sub-Saharan Africa, east Asia, and the Pacific Islands, where the rates rise to 20% (Conners et al., 2023). Currently, in the United States of America, new cases of acute HBV are significantly reducing due to vaccination. Yet, around 2 million people are suffering from chronic hepatitis B (SHB), particularly foreign-born individuals coming from highly endemic countries (Pyrsopoulos, 2022). Some of the other risk factors associated with infection with HBV are multiple sexual partners, use of infected needles, or direct exposure to blood at the workplace.
Clinical Features
The symptoms of hepatitis B vary from mild to severe and include jaundice, anorexia, nausea, weight loss, abdominal pain, fatigue, fever, chills, and dark urine. Most people get acute HBV infection, which can have symptoms or be asymptomatic; symptoms include jaundice, fatigue, abdominal pain, and dark urine (Pyrsopoulos, 2022). In some circumstances, acute liver failure can be an outcome of the disease. HBV infection can be safe for years with few or no symptoms and may progress to cirrhosis or HCC. Chronic hepatitis B is usually classified into three phases depending on viral replication and the liver enzyme levels of the patients, namely, the immune-tolerated phase, the immune-reactive phase, and the inactive phase. The immune-active phase is especially troublesome since there are higher rates of liver inflammation and disease progression to cirrhosis and HCC.
Diagnosis
The routine tests used to diagnose hepatitis B include serology, biochemical, and imaging. The key serological markers for the hepatitis B virus include hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), and antibodies for these antigens: anti-HBs and anti-HBe (Conners et al., 2023). HBsAg is present during an acute HBV infection, while anti-HBs are present when the persons have been infected or received the hepatitis B vaccine. Some of the biochemical tests used to check liver function include Serum Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, Bilirubin levels, and Albumin levels (Pyrsopoulos, 2022). Diagnostic procedures like abdominal ultrasound and MRI can be used to assess the degree of liver injury and diagnose complications like cirrhosis or HCC. Liver biopsies may be done in order to determine the severity of the liver disease in patients with chronic HBV infection (Pyrsopoulos, 2022).
Complementary Exams
Complementary exams for hepatitis B are integrated with advanced imaging techniques to evaluate liver function and disease progression. Liver biopsy is replaced by FibroScan, an invasive free method that determines the stiffness of the liver to evaluate fibrosis and cirrhosis in patients with HBV (Pyrsopoulos, 2022). Further, the known photoelasticity method, magnetic resonance elastography (MRE), depicts the intensity of the fibers and signs of early fibrosis in the liver. These tests are essential when caring for patients with chronic hepatitis B virus infection since they can predict treatment and possible outcomes. Monitoring HBV DNA levels in patients regularly to assess antiviral response and resistance development is also pivotal.
Treatments
The main aims of hepatitis B treatment are to halt the disease progression, suppress virus replication, and decrease the risk of developing cirrhosis and HCC. Lifestyle change and antiviral therapy are some accepted approaches to treating the illness. Standard agents, which include tenofovir disoproxil fumarate, entecavir, and pegylated interferon-alpha, have been observed to have a high efficiency in the reduction of HBV DNA and improvement of the liver (Pyrsopoulos, 2022). Also, it is documented that for patients with decompensated cirrhosis, liver transplantation is the only curative approach. Additionally, there are counsels like sticking to low-sodium products and not consuming any alcohol to minimize liver injury and aspire for an enhanced standard of health (Pyrsopoulos, 2022). The guidelines of appropriate and efficient antiviral treatments and follow-up can make chronic HBV infection control easier.
References
Conners, E. E., Panagiotakopoulos, L., Hofmeister, M. G., Spradling, P. R., Hagan, L. M., Harris, A. M., Rogers-Brown, J. S., Wester, C., Nelson, N. P., Rapposelli, K., Sandul, A. L., Choi, E., Coffin, C., Marks, K., Thomas, D. L., & Wang, S. H. (2023). Screening and testing for hepatitis B virus infection: CDC recommendations — United States, 2023. MMWR. Recommendations and Reports, 72(1), 1–25. https://doi.org/10.15585/mmwr.rr7201a1
Pyrsopoulos, N. M. (2022, October 20). Hepatitis B. Practice Essentials, Background, Pathophysiology.https://emedicine.medscape.com/article/177632-overview?form=fpf#showall
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