Acute hepatitis B Treatment
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MedicYatra provides the safe & best Acute Hepatitis B treatment and procedure at its affiliate & trusted hospitals & clinics in various metro cities of India, like Mumbai, Delhi, Bangalore, Chennai, Pune etc.Our Associate Board certified doctors are extensively trained and vastly experienced and have performed hundreds of such cases at our state of the art JCI accredited hospitals & Clinics. Our aim is to provide you the best of the services at the most affordable costs. Don't forget to say hi at info@medicyatra.com
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Acute hepatitis B Treatment
- 1. Email: enquiry@medicyatra.com Acute Hepatitis B . Copyright @ Forever Medic Online Pvt. Ltd
- 2. Email: enquiry@medicyatra.com Epidemiology Incidence declined in US from 1990 to 2005 70,000 acute Hepatitis B infections in US in 2005 Risk factors: sexual exposure, IVDU <5% of acute infections in immunocompetent adults progress to chronic hepatitis B Copyright @ Forever Medic Online Pvt. Ltd
- 3. Email: enquiry@medicyatra.com Clinical Manifestations Incubation period 1-4 mos Prodromal period w/ serum sickness like symptoms Then constitutional sx, anorexia, nausea, jaundice and RUQ discomfort Only 30% develop icteric hepatitis. 70% subclinical or anicteric hepatitis. More severe infections in patients coinfected w/ other hepatitis viruses or underlying liver disease Copyright @ Forever Medic Online Pvt. Ltd
- 4. Email: enquiry@medicyatra.com Diagnosis To diagnose acute infection: HBSAg + IgM anti- HBc (also suggestive is +HBeAg) Recovery: Normalization of ALT, disappearance of HBV DNA, transition from HBSAg to anti-HBs and transition from IgM anti-HBc to IGG Chronic: persistence of HBSAg > 6 months Copyright @ Forever Medic Online Pvt. Ltd
- 5. Email: enquiry@medicyatra.com Diagnosis Copyright @ Forever Medic Online Pvt. Ltd
- 6. Email: enquiry@medicyatra.com Laboratory Testing Elevated transaminases-values up to 1000-2000 IU/L with ALT > AST Serum bilirubin may be normal Prothrombin time best indicator of prognosis Normalization of transaminases within 1-4 months in patients who recover ALT elevated > 6 months indicates progression to chronic hepatitis Copyright @ Forever Medic Online Pvt. Ltd
- 7. Email: enquiry@medicyatra.com Fulminant Hepatic Failure rapid development of severe acute liver injury with impaired synthetic function and encephalopathy in a person who previously had a normal liver or had well- compensated liver disease unusual in Hep B infections-occurs in 0.1 to 0.5% of pts due to massive immune-mediated lysis of infected hepatocytes Copyright @ Forever Medic Online Pvt. Ltd
- 8. Email: enquiry@medicyatra.com Treatment mostly supportive avoid interferon due to increased risk of hepatic necroinflammation consider antiviral therapy with lamivudine, telbivudine, adefovir, or entecavir as monotherapy for short duration discontinue treatment after two consective tests 4 weeks apart confirm patient has cleared HBSAg Copyright @ Forever Medic Online Pvt. Ltd
- 9. Email: enquiry@medicyatra.com Treatment RCT of lamivudine to treat acute Hep B: 71 pts. 31 pts received lamivudine 100 mg daily for 3 mo (group 1), 40 received placebo (group 2) At wk 4, HBV DNA levels significantly lower in treated group (p=0.037), but thereafter levels were similar Improvement in serum bili, ALT, INR values similar in 2 groups Hepatology. 2007 Jan;45(1):97-101 Copyright @ Forever Medic Online Pvt. Ltd
- 10. Email: enquiry@medicyatra.com Treatment After 1yr, 93.5% of pts in lamivudine group and 96.7% of pts in placebo group lost HBsAg After 1yr, 21 pts (67.7%) in treatment group and 34 pts (85%) in placebo developed protective anti-HBs titers No deaths in either group Conclusion: No significant biochemical or clinical improvement with lamivudine compared to placebo Hepatology. 2007 Jan;45(1):97-101 Copyright @ Forever Medic Online Pvt. Ltd
- 11. Email: enquiry@medicyatra.com Consider Treatment in: Pts w/ a coagulopathy (INR >1.5) Those w/ a protracted course (persistent symptoms or marked jaundice w/ bilirubin >10 mg/dl for more than four weeks) Pts with fulminant hepatitis B (to reduce the likelihood of reinfection post-liver transplant) Immunocompromised patients Those with concomitant infection with hepatitis C or D virus or preexisting liver disease Elderly patients Copyright @ Forever Medic Online Pvt. Ltd
- 12. Email: enquiry@medicyatra.com Prevention Hepatitis B vaccination! Series of three doses at months 0, 1 to 2, and then 6 to 12 In US, universal vaccination of all newborns is recommended Copyright @ Forever Medic Online Pvt. Ltd
- 13. Email: enquiry@medicyatra.com Prevention Vaccinate high risk adults: Healthcare workers IV drug users Household contacts of people w/ Hep B Pts w/ multiple sexual partners Men who have sex with men HD patients Pts who require repeated transfusions of blood products Pts w/ chronic liver disease Copyright @ Forever Medic Online Pvt. Ltd
- 14. Email: enquiry@medicyatra.com Efficacy positive immune response is defined as development of anti-HBs at a titer of >10 IU/L 95% seroconversion in healthy adults Post-vaccination testing in healthcare workers/HD pts/pts who are at risk for recurrent exposure 1-2 mos after completion of vaccination. Nonresponders complete a second 3-dose vaccination series Copyright @ Forever Medic Online Pvt. Ltd
Notas del editor
- Rate of progression in perinatally acquired infections is 90%, 20-50% for infections between age 1 and 5
- Window period: The disappearance of HBsAg (hepatitis B surface antigen) is followed by the appearance of anti-HBs. In some patients, however, anti-HBs may not be detectable until after a window period of several weeks to months. At this time, when neither HBsAg nor anti-HBs can be detected, the serologic diagnosis may be made by the detection of IgM antibodies against hepatitis B core antigen (IgM anti-HBc).
- Time course: development of encephalopathy within 8 weeks of the onset of symptoms, or within two weeks of developing jaundice. Liver failure is considered “subfulminant” if development of encephalopathy within 6 months but outside the 2 week/8 weeks. Case control study evaluated risk factors for a fulminant course in an outbreak among injection drug users. Compared with control patients, case patients were more likely to have used acetaminophen during their illness (p=.08) and had lost significantly more weight in the six months before illness, used more alcohol, and methamphetamine. Furthermore, all nine isolates were genotype D.
- Efficacy decreases to 86% in 4 th decade, 47% in sixth decade. response rate is slightly lower in obese individuals, smokers, and men, and significantly lower in patients with cirrhosis or chronic renal failure, organ transplant recipients, children with celiac disease, and immunosuppressed patients.