Hepatitis B (HBV)

SOURCE

Source: Deming P. Viral hepatitis. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=132516044. Accessed April 10, 2017.

DEFINITION

• Acute or chronic viral infection of liver.

• Associated with development of:

  • Chronic cirrhosis.

  • Hepatocellular carcinoma (HCC)

ETIOLOGY

• DNA virus, Hepadnaviridae family.

PATHOPHYSIOLOGY

• Virion attaches to hepatocyte cell surface receptors and replicates.

• HBV is not pathogenic to cells.

  • Immune response to virus cytotoxic to hepatocytes.

  • Destruction of heptocytes releases alanine transaminase (ALT), thus increasing levels.

• Liver attempts to regenerate in environment of persistent inflammation, resulting in cirrhosis.

• HCC develops after years of inflammatory processes provoked by ongoing HBV infection.

EPIDEMIOLOGY

• Infection transmitted through activities that involve percutaneous or mucosal contact with infectious blood or body fluids.¹

  • Parenterally (injection drug use; needle sticks, or sharp instrument exposures)

  • Perinatally.

  • Sexually.

PREVENTION AND SCREENING

• Prophylaxis with:

  • HBV vaccine for active immunity (Tables 1 and 2)

  • Hepatitis B immune globulin (HBIG) for temporary passive immunity in postexposure cases²

• Common vaccine side effects include (lasting ~1–2 days)³

  • Soreness at injection site (3–29% most common)⁴

  • Fever (1–6% most common)⁴

  • Headache.

  • Fatigue.

  • Irritability.

• Immunization goals:

  • Prevention of short-term viremia to limit:

    • Transmission of infection.

    • Clinical disease.

    • Chronic HBV infection.