HBV

Overview of the Epidemiology of Hepatotropic Viruses

Global Prevalence of Hepatitis B Infection

F A, B C, D F A D D D D D E A C C Bj Ba F A, B, C, D H Fung et al.: Hepatology 2004 HBV genotypes

Routes of HBV Transmission Vary Depending on Prevalence of Infection

Hepatitis B immunization I programm of common hepatitis B vaccination in Taiwan % reducing risk of deaths due to HF in children 75% decrease of the rate of HCC 1991 – recommendation of common hepatitis B vaccination countries had introduced hepatitis B vaccination 2008 – 177 countries had introduced hepatitis B vaccination szczepień p/wzw B Chien Y.C. i wsp. Epidemiol. Rev. 2006

HBV Immunization is Associated With a Reduction in Cases Of Acute Hepatitis B in the United States

Benefis of Hepatitis B Vaccination

Immunization Strategy to Eliminate Hepatitis B Virus (HBV)

Adults Who Should Receive Hepatitis B Vaccination (1)

Adults Who Should Receive Hepatitis B Vaccination (2)

Adults Who Should Receive Hepatitis B Vaccination (3)

Worldwide, HBV is a Major Contributor to Death From Cirrhosis and Hepatocellular Carcinoma

In the United States, Hepatitis B is a Less Common Cause of Cirrhosis and Hepatocellular Carcinoma

How to Screen for Hepatitis B Infection?

Who Should Be Screened for HBV Infection? CDC Screening Recommendations (1)

Who Should Be Screened for HBV Infection? CDC Screening Recommendations (2)

Who Should Be Screened for HBV Infection? CDC Screening Recommendations (3)

Summary

Serological Tests for Hepatitis B and Their Interpretation

Interpretation of HBV Serological Markers

acute hepatitis chronic hepatitis liver cirrhosis death liver failure (ESLD) >30% patients with CHB 2 >90% children <5% adults 23% patients with liver cirrhosis HCC Liver transplantation 1. Fattovich G et al. Hepatology Ikeda K et al. J Hepatol HBV natural history 5-10% patients with CHB

Acute HBV infection

Outcomes of Acute HBV Infection Vary by Age of Exposure

Risk of HBV Chronic Infection Varies by Age at Time of Infection

Five-Year Complication Rate in Chronic HBV Infection

Factors Associated With Risk of Cirrhosis in Patients With Chronic HBV

HBV DNA Testing

High HBV DNA Levels Associated with Risk of Cirrhosis and HCC

Summary

Algorithm to Identify Treatment Candidates

Reactivation of Hepatitis B: Definition

HBV Reactivation Occurs in Different Situations

Patients on Immunosuppressive Therapy

HCV

Hepatitis C milion infected 3% of world population mortality will increase 2-3 Times during follow years Europe 7,3-8,8 mln infected deaths – annually the main reason of liver transplantation Uwe Siebert, Nicolai Muhlberger, Stefan Zeuzem 2008 Hepatitis C WHO 2002; HO/CDS/CSR/LYO/2003 Report WHO 2000

Global Hepatitis C Burden is Large and Highest in Asia and Africa

Hepatitis C Poland 4%? examined volunteers 1000 hospitalyzed children 320 diabetics Poland 1,9%? 496/ addmitted to hospital 72% HIV infected c(n=278) 12% hemodialyzed (n=13 680) 7,25% prisoners (n=1860) 0,4% pregnant women (n=1600) Tyczyńska-Hoffmann. Hepatol. Pol., 1996 Muszyńska. Med. Sci. Monitor, 2002 Bielawski i wsp. Arch. Med. Res., 2000 Grąbczewska, HIV&AIDS Rev., 2003 Durlik, 2008

Hepatitis C Virus Has Multiple Genotypes Which Affect Treatment Choice and Therapeutic Response

Potential Consequences of Hepatitis C

Unsafe Injections Are the Major Risks for HCV Transmission

Other Exposures Are Associated with Transmission of HCV

The Tip of the Iceberg

CDC Recommendations for HCV Testing Are Based on Birth Cohort, Risk, and Medical Indications

Diagnostic Tests: Anti-HCV

Diagnostic Tests: HCV RNA

Diagnosis of HCV: Requires Both Anti-HCV (Antibody) and HCV RNA (Viral Load)

Acute HCV Infection

Acute HCV infection

Factors Associated with Higher Rates of Spontaneous Clearance of HCV

Extrahepatic Manifestations of HCV

Hepatitis C Virus Infection: Natural History

Risk Factors Associated with Faster Fibrosis Progression in Chronic HCV

Hepatitis C and Alcohol

Recommended Baseline Studies in Persons with Chronic HCV Infection

Summary

All Patients with HCV Should Be Considered for Treatment Based on Individual Risk/Benefit

Benefit of HCV Eradication (SVR)