Hepatitis b (1)
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Hepatitis is an inflammation of the liver that is most commonly caused by hepatitis viruses. There are several types of hepatitis viruses including hepatitis A, B, C, D, and E. Hepatitis B virus (HBV) is a major global health problem, with 350 million carriers worldwide resulting in 600,000 deaths annually. It is transmitted through body fluids and from mother to child. Symptoms may include jaundice, dark urine, fatigue, and nausea. Diagnosis involves testing for hepatitis B surface antigen and liver enzymes. Treatment options for HBV include interferon, lamivudine, adefovir, entecavir, telbivudine, and tenofovir, with tenofo
Hepatitis b (1)
- 1. HEPATITIS NIDA SEHAR Noman MS (Pharmacology) & MBA (Finance) [email protected]
- 2. what is hepatitis? Cause Anyother cause? Hepatitis viruses are the most common cause of hepatitis in the world Hepatitis is an inflammation of the liver Other infections. Toxic substances (e.g. alcohol, certain drugs) Autoimmune diseases.
- 4. 350 million hepatitis B virus carriers worldwide. 600,000 death due to HBV complications annually. one of the major cause of liver cancer globally. HEPATITIS B
- 5. Transmission • It is transmitted by • body fluids • Hepatitis B exposure • Intravenous drug user • Patient immunocompromised • Fetal or neonatal effect of maternal infection • Surgical procedure • Healthcare Worker, or • Transfusion of blood product.
- 6. • There are three surface antigen HBsAg most abundant persistence past 6 months after initial detection corresponds to chronic infection and indicates an increased risk for cirrhosis and HCC. HBeAg present in an acute infection and is replaced by antibodies (anti-HBeAg ) once an infection is resolved. HBcAgnucleocapsid protein that,when expressed on hepatocytes,promotes immune-mediated cell ldeath.
- 7. Stages of HBV Immunotolerant Immunoactive Seroconversion HBeAg + HBV DNA >20000IU/ml ALT normal HBeAg +,- usually HBV DNA >20000IU/ml ALT elevated HBeAg - Normal ALT Anti HBeAg
- 8. • Loss ofAppetite. • Fatigue. • Nausea and vomiting. • Itching all over the body. • Pain over the location of the liver. • Jaundice (skin and the whites of the eyes turn yellow in color) • Dark urine (the color of cola or tea) • Pale-colored stools SIGN AND SYMPTOMS
- 9. Diagnosis is done by serological assay and liver enzymes test (LFT). Acute HBV infection is characterized by the presence of HBsAg and immunoglobulin M (IgM) antibody to the core antigen, HBcAg. During the initial phase of infection, patients are also seropositive for hepatitis B e antigen (HBeAg). HBeAg is usually a marker of high levels of replication of the virus. The presence of HBeAg indicates that the blood and body fluids of the infected individual are highly infectious. Chronic infection is characterized by the persistence of HBsAg for at least 6 months (with or without concurrent HBeAg). Persistence of HBsAg is the principal marker of risk for developing chronic liver disease and liver cancer (hepatocellular carcinoma) later in life. Diagnosis
- 13. Interferon IFN-alfa therapy was the first approved therapy for treatment of HBV. Improves long-term outcomes and survival. It has antiviral,antiproliferative,and immunomodulatory effects Most effective in pateints with increased ALT and HBV DNA levels,high histologic activity score at biopsy,and being non-Asian. It enhance the host immune system to defense against HBV.
- 14. Lamivudine Lamivudine, a nucleoside analog,work by incorporating into growing HBV DNA chain causing premature chain termination. Nose is 100mg daily orally. No definite duration of therapy And there is chance of resistance It's not recommended as first-line therapy
- 15. Adefovir Adefovir,an analog of adenosine monophosphate,act by inhibiting HBV reverse transcriptase and DNA polymerase. effective in lamivudine resistent patients 30mg/day of adenofovir was found nephrotoxic in clinical trials. serum creatinine monitoring is recommended in patients with risk of renal insuffeincy and, treated with adefovir for more than one year. dose is 10mg daily for one year. the risk of adefovir resistence is high in lamivudine resistenent patients. but no drug resistence has been seen in first year of therapy. not first line therapy for HBV.
- 16. Entecavir Entecavir is a guanosine nucleoside analog that inhibit HBV replication at three stages. More potent than both lamivudine and adefovir. Effective in lamuvidine resistent patients. Dose 0.5 mg daily and 1mg in lamivudine resistent pts. No resistence has been seen but the risk of resistence high in lamuvidine and adefovir resistent patients. Available by the name of Baraclude
- 17. Telbivudine Telbivudine is HBV specific nucloside analog act as competitive inhibitor of viral reverse transcriptase and DNA polymerase. As compare to lamivudine ;telbivudine is more potent suppressor of HBV DNA. Telbivudine resistant mutations are cross-resistant with lamivudine. Because of resistance concerns telbivudine monotherapy has a limited role in the treatment of HBV.
- 18. Tenofovir Tenofovir is a nucleotide analog approved f or HBV in 2008. equally effective in both HBeAg positive and HBeAg negative patients. not nephrotoxic. found effective in both lamuvidine and adefovir resistent patients. Daily dose is 300mg orally. First line therapy.