Clinical Review

Preventing and treating hepatitis B infection

BMJ 2004; 329 doi: http://dx.doi.org/10.1136/bmj.329.7474.1080 (Published 04 November 2004) Cite this as: BMJ 2004;329:1080

This article has a correction. Please see:

  1. Rakesh Aggarwal ([email protected]), additional professor1,
  2. Piyush Ranjan, senior research associate1
  1. 1 Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226 014, India
  1. Correspondence to: R Aggarwal

    Introduction

    Hepatitis B virus infection is a global public health problem, with approximately 400 million people chronically infected.1 2 Each year it causes more than 500 000 deaths worldwide. Outcome of acute hepatitis B virus infection ranges from asymptomatic subclinical infection (70%) and symptomatic acute hepatitis (30%) to fulminant hepatic failure (0.1-0.5%).3 A proportion of people infected with hepatitis B virus (5%-10% among adults) progress to chronicity, defined as persistence of infection for more than six months.4 The rate of chronicity is much higher among neonates and children. The spectrum of chronic hepatitis B virus infection ranges from the asymptomatic carrier state to chronic hepatitis B, liver cirrhosis, and hepatocellular carcinoma. The clinical course of hepatitis B virus infection is complex and is influenced by several factors (box 1). Overall, chronic hepatitis progresses to end stage liver disease in 15-40% of patients.5 The pathophysiology of chronic hepatitis B virus infection has been reviewed elsewhere.6

    The magnitude and clinical consequences of chronic hepatitis B make a strong case for its prevention and treatment. This review, based on a Medline search and the authors' knowledge arising from their interest in the subject, summarises current knowledge about these aspects of hepatitis B virus infection.

    Prevention of hepatitis B virus infection

    Several strategies have been shown to prevent hepatitis B virus infection (box 2). Vaccination is the mainstay of prevention. Specific hepatitis B immunoglobulin (HBIg) and lamivudine are useful in specific settings.

    Box 1: Factors influencing outcome of chronic hepatitis B virus infection

    Viral factors:

    • Level of hepatitis B virus replication

    • Hepatitis B virus genotype

    • Mutations in viral genome

    Host factors:

    • Age at acquisition of infection

    • Immune status

    • Concurrent infection with other hepatotropic viruses

    • Alcohol intake

    Box 2: Prevention strategies for hepatitis B

    Hepatitis B vaccination:

    • High risk groups

    • All newborn infants

    Screening of blood and blood products

    Using universal precautions in healthcare settings

    Avoiding needle sharing among injecting drug users

    Promoting safe sex …

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