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Source: Deming, P. Viral Hepatitis. In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7979809. Accessed May 31, 2012.

  • Acute or chronic viral infection of liver
  • Associated with development of:
    • Chronic cirrhosis
    • Hepatocellular carcinoma (HCC)

  • DNA virus, Hepadnaviridae family

  • Virion attaches to hepatocyte cell surface receptors and replicates.
  • HBV 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.

  • Infection transmitted:
    • Parenterally (injection drug use)
    • Perinatally
    • Sexually

  • Prophylaxis with:
    • HBV vaccine for active immunity (Table 1)
    • HBV Ig for temporary passive immunity in postexposure cases
  • Vaccine side effects include:
    • Soreness at injection site
    • Headache
    • Fatigue
    • Irritability
    • Fever
  • Immunization goals:
    • Prevention of short-term viremia to limit:
      • Transmission of infection
      • Clinical disease
      • Chronic HBV infection

Table 1. Recommendations for Hepatitis B Virus (HBV) Vaccination

  • No risk factors identified in majority of acute infections.
  • Sexual contact
    • Multiple partners
    • Men who have sex with men
    • Known HBV-positive person
  • Injection-drug users
  • Household contact with HBV-positive person

  • Incubation period
    • 4–10 weeks
    • Highly infective
    • Usually asymptomatic
  • Immunoactive (symptomatic) phase
    • Intermittent hepatitis
    • Marked increases in ALT
    • Infants generally asymptomatic
    • 85–95% of children ages 1–5 years asymptomatic
  • Seroconversion to anti-hepatitis B core antigen (anti-HbcAg)
    • Chronic HBV (Table 2) diagnosed when detect hepatitis B surface antigen (HbsAg) and HbcAg and high serum titer of HBV DNA for >6 months (Table 3).
    • Age most predictive factor for developing chronic HBV.
      • Perinatal infections almost always result in chronic HBV.
      • Chronic HBV risk
        • Infants: 30%
        • Adults: <5%
    • 20% ...

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