Year : 2009 | Volume
: 6 | Issue : 1 | Page : 9--13
Hepatitis B viral infection: From aborting transmission to liver transplantation - Awareness is the key
Shivaram Prasad Singh1, Yogesh Kumar Chawla2,
1 Department of Gastroenterology, SCB Medical College, Cuttack, India
2 Postgraduate Institute of Medical Education and Research, Chandigarh, India
Shivaram Prasad Singh
Head, Department of Gastroenterology, SCB Medical College, Cuttack-753 007, Orissa
|How to cite this article:|
Singh SP, Chawla YK. Hepatitis B viral infection: From aborting transmission to liver transplantation - Awareness is the key.Hep B Annual 2009;6:9-13
|How to cite this URL:|
Singh SP, Chawla YK. Hepatitis B viral infection: From aborting transmission to liver transplantation - Awareness is the key. Hep B Annual [serial online] 2009 [cited 2023 Nov 29 ];6:9-13
Available from: https://www.hepatitisbannual.org/text.asp?2009/6/1/9/76900
In this issue of Hepatitis B Annual, we have made major changes in the format of the journal. We have started the new sections of "Original Articles" and "Case Reports" in this issue. However, the important mission of this journal would still be to provide authoritative reviews on the major problems related to hepatitis B virus (HBV) infection, which continues to be a major health hazard across the globe despite all the research and advances accomplished in the field of HBV management.
Although research on HBV infection over the last few decades has added considerably to our understanding of this infection including diagnosis and treatment, ongoing research continues to generate new knowledge that helps us to understand this infection and produce novel agents that assist us to treat this infection with greater success. However, to prevent transmission and progression of the disease in the community, proper community awareness about the disease including prevention is necessary. The original article published in this issue, "Study on awareness about hepatitis B viral infection in coastal Eastern India" was designed to study the awareness amongst the general population about HBV, including knowledge regarding the vaccine for hepatitis B. The results were appalling; only about one-third of the population in coastal Eastern India are aware about hepatitis B and its vaccine, while less than a third of the population are vaccinated for hepatitis B. The study has rightly emphasized the need for awareness campaigns to educate the public about the ravages of this viral infection and the fact that hepatitis B is a vaccine preventable disease, and that it could be easily prevented by three simple, easily available, inexpensive shots of hepatitis B vaccine.
This issue also publishes a case report "Efficacy and safety of telbivudine during pregnancy in a patient with HBeAg-negative chronic hepatitis B" on the contentious issue of treatment of HBV infection during pregnancy. Dr. AT Mohan and Dr. M Hariharan have discussed in this case report their experience in managing such a case and reviewed the relevant literature.
In the developed countries, HBV is not a leading indication for liver transplantation (LT). In contrast, HBV infection is one of the most important indications for LT in the Indian subcontinent. Besides, results of LT for HBV have improved significantly during the past two decades. In the essay, "Management of hepatitis B in peri-transplant period", Dr. Sanjiv Saigal, Dr. Amit Basnotra, and Dr. AS Soin have elegantly discussed the issues relating to improving the lot of these patients by optimally controlling HBV infection during the peritransplant period. These include refinements made in antiviral prophylaxis and treatment of HBV infection, particularly, the recent introduction of nucleoside analogues alone or in combination for treatment of established graft infection. It is hoped that hepatologists involved in LT and others who are likely to come across such patients in the peritransplant period should benefit from this article.
The future of chronic hepatitis B (CHB) management appears to be promising with novel therapeutic options currently available, new drugs in development, and different on-treatment strategies for optimizing the use of current agents. Among the nucleoside and nucleotide agents, Tenofovir is a potential first-line drug against treatment naοve HBV, Lamivudine resistant HBV and HIV/HBV co-infections. It has the advantage of good antiviral efficacy, rapid and durable virological response, excellent safety and absence of resistance. The article "Tenofovir for HBV: The beginning of the end or the end of the beginning?" by Dr. Naresh Bhat and Dr. Amit Yelsangikar reviews this exciting new molecule which has been approved recently by the USFDA for treatment of CHB.
With the advent of newer molecules for hepatitis B, the need has arisen for tailoring treatment to suit the different hepatitis B infection scenarios. Hence, guidelines have been developed to assist healthcare providers in the recognition, diagnosis and optimal management of patients with CHB. These guidelines which are not designed to be prescriptive, permit significant flexibility in interpretation, are evidence-based and incorporate expert medical opinion in addition to published information.
However, with the rapid advances over the recent years, the guidelines have been revised periodically. The review "Comparison of different hepatitis B guidelines" by Dr. Pradeepta Kumar Sethy and Dr. Mahesh Goenka has highlighted the salient features of the significant recommendations from international and national guidelines on hepatitis B, particularly those published 2007 onward, and has critically appraised the clinically relevant similarities and differences between these recommendations.
Perinatal transmission of hepatitis B is the predominant mode of transmission in high prevalence areas. The risk of progression to chronic liver disease and development of hepatocellular carcinoma in individuals who acquire the infection at birth is high. In "Perinatal transmission of hepatitis B", Dr. Sudipta Dhar Chowdhury and Prof. C. E. Eapen have discussed the different relevant modes of perinatal transmission and the methods to reduce perinatal transmission of hepatitis B including early identification of HBV carrier mothers. In this review, the authors have stressed the importance of surveillance of the expectant mother, with active and passive immunization of the child at birth which should go a long way in prevention of HBV infection.
Anti-TNF agents are a potent new class of medications available for the treatment of rheumatologic, dermatologic, and gastrointestinal inflammatory illnesses. With this new potency came several side effects, the most prominent of which is the reactivation of latent infections including HBV infection. In "Safety of anti-tumor necrosis factor (anti-TNF) therapy in patients with chronic hepatitis B", Dr. Matthew B. Carroll and Dr. Robert Holmes have summarized the available data on this problem and highlighted the importance of screening prior to starting anti-TNF agents in patients at risk for chronic infection with HBV. Additionally, for patients who are HBsAg positive and need an anti-TNF agent for the treatment of an inflammatory illness, they have reviewed the recommendation of different authors and information gathered from trials using other immunosuppressive agents, and have finally recommended that an antiviral agent be started prior to and continued for up to 6 months after therapy. However, long-term trials with larger cohorts of patients and information gathered from liver biopsies are needed to elucidate the potential impact long-term anti-TNF therapy will have on the progression of HBV infection to cirrhosis and hepatocellular carcinoma.
Rapid technological strides have widened the array of diagnostic and therapeutic procedures which can be performed endoscopically, and this has resulted in a dramatic increase in the number of endoscopies performed, and along with it, the potential for complications. Transmission of infection including HBV infection is an important concern as the surface and channels of the endoscopes are exposed to body fluids and blood during endoscopy, especially therapeutic procedures. In the review "Hepatitis B virus transmission and reprocessing of endoscopes", Dr. AK Dutta and Prof. Ashok Chacko have highlighted the importance of the standard measures including meticulous cleaning and disinfection of endoscopes and accessories in preventing cross-infection.
There is high prevalence of HBeAg-negative chronic hepatitis B in South Asia. It is very important to distinguish chronic, inactive HBsAg carriers from HBeAg-negative CHB, as there is vast difference between the behavior and outcome of these entities. Patients with HBeAg-negative CHB have to be managed judiciously, and in certain situations kept under close follow-up instead of rushing to treatment. However, this does not mean advocating adoption of a too conservative approach, allowing many patients to proceed to irreversible and progressive liver disease. In "HBeAg negative chronic hepatitis B: An overview", Prof. Mamun-Al-Mahtab and Dr. SM Fazle Akbar have succinctly reviewed the subject of HBeAg-negative chronic hepatitis B and have endeavored to provide a practical approach to the management of these patients.
Viral suppression with safe and effective antiviral agents is essential in the management of HBV related cirrhosis. The ideal antiviral therapy in cirrhotics should be safe and affordable for long-term use and should have a low risk of drug resistance. Treatment of compensated HBV cirrhosis can reduce the risk of hepatic decompensation and development of HCC; regression of fibrosis and reversal of cirrhosis have also been reported. In patients with compensated cirrhosis and normal liver synthetic function, the outcome of antiviral therapy is similar in patients with and without cirrhosis. In decompensated cirrhosis, although liver transplantation is considered as the definitive therapy, inhibition of viral replication before transplantation can delay the need for liver transplant and also prevent HBV recurrence in the post-transplantation period.
In "Management of HBV related cirrhosis: Role of nucleoside analogues", Dr. Pazhanivel Mohan and Prof. V Jayanthi have reviewed the literature on the role of nucleoside analogues in the management of HBV related chronic liver disease. The authors have recommended close monitoring for viral resistance and adverse events during medical management of cirrhosis, with continued surveillance for HCC.
We trust that the reviews in this issue of the journal would enlighten the students, researchers and physicians on these different areas related to HBV infection. Besides, we are optimistic that the new changes incorporated in this issue would be welcomed by the readers. Finally, we believe that the crucial message that this issue of the journal aims to disseminate is that with regard to HBV infection - from viral transmission to liver transplantation - awareness is the key.