2. INMUNOEPIDEMIOLOGÍA SITUACIÓN DE SALUD ¿QUÉ?¿CÓMO?,¿ CUANDO?,¿DÓNDE? ¿POR QUÉ?(INVESTIGACIÓN) POBLACIÓN>MOLÉCULA (INTEGRACIÓN BÁSICO- CLÍNICA)

8. Dose regimen – HBIG is a polyclonal preparation of human anti-HBs purified from pooled donor plasma. It is usually given intravenously as a 10,000 IU bolus dose during the anhepatic phase followed by daily doses during the first week. Subsequent doses are either given monthly or in accordance with anti-HBs titers. A trough anti-HBs titer of at least 100 IU/ L is thought to be protective. However, some studies have suggested that the rate of reinfection can be reduced further in patients with anti-HBs titers consistently above 500 IU/l [13,24]. We use a fixed dose schedule that routinely results in anti-HBs titers of >500 IU/L. Copyright© 2002 UpToDate® www.uptodate.com

9. Anti-HBs titers vary not only from patient to patient but also within the same patient even when HBIG is administered as fixed doses [1, 2]. This observation underscores the difficulties in dose adjustments based upon previous titers. In addition, it is not clear if patients who were reinfected had low anti-HBs titers due to inadequate HBIG administration or reinfection with binding of HBIG to circulating virions. 1. McGory, RW, et al. Improved outcome of orthotopic liver transplantation for chronic hepatitis B cirrhosis with aggressive passive immunization. Transplantation 1996; 61:1358. 2. Terrault, NA, et al. Prophylaxis in liver transplant recipients using a fixed dosing schedule of hepatitis B immunoglobulin. Hepatology 1996; 23:1327.

12. MEDICINA POR EVIDENCIAS: CARÁCTER INDIVIDUAL Superficie Corporal Volemia Carga hepática Bioequivalencia: Núcleo/ Partícula/Molécula de superficie VHB= 10 6 1μg= 10 13 Moléculas 1U.I. de Ac Neutraliza 1μg de Antígeno

14. CASE FOUR, DENTAL STUDENT WITH ACTIVE REPLICATION The patient is a 24 year old who has recently been admitted to dental school. He is HBsAg (+), HBeAg (+), HBeAb (-). His HBV DNA is 400 million copies/mL and serum ALT is 45 (upper limit of normal 40 IU/L). His liver biopsy shows macrovesicular fat, no portal fibrosis. The Dean of the dental school has denied his matriculation pending your advice.

15. Comment – I would advise this patient to reconsider his plans to enter dental school. Under current CDC recommendations, health care workers who are HBsAg and HBeAg positive are restricted in their abilities to perform invasive procedures, an unavoidable element of dental practice. Because he has high HBV DNA and low ALT levels, the likelihood of him responding (HBeAg loss) to current treatment is low and the chance of him clearing HBsAg is even more remote. An earlier switch in career is the best advice for this young man. The situation is somewhat different for medical students who can choose career paths that do not involve performance of invasive procedures.

28. INMUNOGLOBULINA EN TERAPÉUTICA. INMUNOCOMPLEJO EN EXCESO DE ANTICUERPOS  ACTIVACIÓN DE CPA (MACRÓFAGOS Y CÉLULAS B)  ACTIVACIÓN DE CÉLULAS NK  CITOTOXICIDAD MEDIADA POR COMPLEMENTO

29. CUANTIFICACIÓN DE HBsAg oCLASIFICACIÓN DE RESERVORIOS oPRONÓSTICO PRE Y POST- TERAPÉUTICO oPROFILAXIS EN TRANSPLANTE HEPÁTICO

30. RESERVORIO TRANSPLANTADO  INMUNODEFICIENTE  TOLERANTE  ANERGIA-DELECIÓN ?

32. CARACTERÍSTICAS EVOLUTIVAS DE LOS PACIENTES NOV/DIC 2002 A ENERO 2003 Rango: desde 2 ng / ml a 200x 10 3 ng/ml Aumento de [HBsAg]: Mal Pronóstico

36. GRACIAS POR ESTAR ENTRE USTEDES, GRACIAS AL GRUPO DE JÓVENES QUE ME ACOMPAÑAN EN ESTA MARAVILLOSA TAREA