Hepatitis-B Virus (HBV)

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Hepatitis-B Virus (HBV) by Mind Map: Hepatitis-B Virus (HBV)

1. Pathogenesis

1.1. HBV attacks the liver

1.1.1. Infection itself does not lead to death of infected hepatocytes

1.1.1.1. Immune system’s cytotoxic T lymphocytes cause liver damage when attempting to clear the infection

1.1.1.1.1. Strength of cytotoxic lymphocyte response determines the course of the infection

1.2. HBV causes persistent infection, chronic hepatitis, liver cirrhosis, hepatocellular carcinoma, and immune complex disease

2. Risk Factors

2.1. Job risk factors

2.1.1. Handling blood or body fluid as a routine part of your job (i.e. healthcare workers)

2.1.2. Working at an institution for people who have developmental disabilities

2.1.3. Working at a prison

2.2. Lifestyle risk factors

2.2.1. Being in a country where HBV is common

2.2.2. Being sexually active

2.2.3. Being a man who has sex with men

2.2.4. Having more than one sex partner

2.2.5. Living with someone who has chronic Hepatitis B infection

2.2.6. Getting body piercings or tattoos with non sterile equipment

2.2.7. Sharing needles or other equipment to inject illegal drugs

2.3. Other risk factors

2.3.1. Being born to a woman infected with HBV

2.3.1.1. Breastfeeding does not spread the virus to the child

2.3.2. Having a blood-clotting disorder that requires you to receive clotting factors from donors

2.3.3. Having severe kidney disease

3. Incidence/Prevalence

3.1. An estimated 257 million people are living with HBV

3.2. In 2015, HBV was the cause of 887,000 deaths

3.3. Highest prevalence in the Western Pacific and African regions

3.3.1. 6.2% of adult population infected in the Western Pacific population

3.3.2. 6.1% of adult population infected in the African region

3.4. 3.3% of general population infected in the Eastern Mediterranean region

3.5. 2.0% of general population infected in the Southeast-Asia region

3.6. 1.6% of general population infected in the European region

3.7. 0.7% of population in America’s is infected

4. Diagnostics

4.1. Not possible to differentiate HBV from hepatitis caused by other viral agents on clinical grounds so you must be lab tested

4.2. Lab diagnosis focuses on the detection of hepatitis B surface antigen (HBsAg)

4.3. Initial Testing

4.3.1. Hepatitis B surface antigen

4.3.1.1. HBsAg

4.3.1.2. Detects protein present on surface of the virus

4.3.2. Hepatitis B surface antibody

4.3.2.1. anti-HBs

4.3.2.2. Detect antibody produced in response to HBV surface antigen

4.3.3. Total anti-Hepatitis B core

4.3.3.1. anti-HBc, IgM, IgG

4.3.3.2. Detects IgM and IgG antibodies to Hepatitis B core antigen

4.4. Follow-Up Testing

4.4.1. Anti-Hepatitis B core

4.4.1.1. anti-HBc and IgM

4.4.1.2. Detects only IgM antibody to the hepatitis B core antigen

4.4.2. Hepatitis B e-antigen

4.4.2.1. HBeAG

4.4.2.2. Detects protein produced and released into the blood

4.4.3. Anti-Hepatitis B e-antibody

4.4.3.1. Anti-HBe

4.4.3.2. Detects antibody produced by the body in response to the hepatitis B “e” antigen

4.4.4. Hepatitis B viral DNA

4.4.4.1. Detects hepatitis B viral genetic material in the blood

4.4.5. Hepatitis B virus resistance mutations

4.4.5.1. Detects mutations in the particular virus causing a person’s infection that allows them to be resistant to treatments

5. Treatment

5.1. Acute HBV

5.1.1. It is short-lived and will go away on its own and may not need treatment

5.1.2. Doctor will likely recommend rest, proper nutrition, and plenty of fluids

5.1.3. In severe cases antiviral drugs may be prescribed

5.2. Chronic HBV

5.2.1. Most people need treatment for the rest of their lives

5.2.2. Interferon injections

5.2.2.1. Interferon alfa-2b

5.2.2.1.1. Man made version of of substance produced by the body to fight off infection

5.2.2.1.2. For young people who don’t want long-term treatment or women who want to get pregnant in the near future

5.2.2.1.3. Side effects include nausea, vomiting, dyspnea and depression

5.2.3. Antiviral medications

5.2.3.1. Several types

5.2.3.1.1. Entecavir (Baraclude)

5.2.3.1.2. Tenofovir (Viread)

5.2.3.1.3. Lamivudine (Epvir)

5.2.3.1.4. Adefovir (Hepsera)

5.2.3.1.5. Telbivudine (Tyzeka)

5.2.3.2. Help fight virus and slow its ability to damage the liver

5.2.4. Liver transplant

5.2.4.1. Most come from deceased donors but some come from live donors that donate a portion of their own

5.2.4.2. May be an option if liver is severely damaged

5.3. Other drugs and treatments are being developed and are on trial to treat Hepatits B

6. Clinical manifestations

6.1. Abdominal pain

6.2. Dark urine

6.3. Fever

6.4. Joint pain

6.5. Loss of appetite

6.6. Nausea and vomiting

6.7. Weakness and fatigue

6.8. Jaundice

6.9. Clay-colored stool

7. Sources

7.1. www.who.int/mediacentre/factsheets/fs204/en/

7.2. http://www.webmd.com/hepatitis/hepb-guide/hepatitis-b-what-increases-your-risk

7.3. http://labtestsonline.org/understanding/analytes/hepatitis-b/tab/test/

7.4. https://www.mayoclinic.org/diseases-conditions/hepatits-b/diagnosis-treatment/drc-20366821

7.5. https://www.medicalnewstoday.com/articles/306288.php