Hepatitis B virus (HBV) infection is very common, with over 350 million chronically infected people worldwide. This review plans to answer some key questions regarding hepatitis B infection during pregnancy, in order to provide healthcare professionals with updated information on the current knowledge in this field. The focus is on the following topics: the main risk factors associated with vertical transmission of HBV in pregnant women who are chronically infected, the influence of pregnancy on HBV viral load, and the effect of pregnancy on the clinical course of chronic hepatitis B. Some recommendations have also been made that may be effective in decreasing the vertical transmission rates of chronic viral hepatitis.

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Hepatitis B is a well-recognized global public health problem. It is estimated that nearly 2 billion people around the world have serologic evidence of past or present hepatitis B virus (HBV) infection, while 350 million people are chronically infected. This worldwide burden of hepatitis B mandates accurate and timely diagnosis of patients infected with HBV and the use of treatment strategies derived from evidence-based guidelines. HBV is a DNA virus that produces a series of viral protein products. Serologic and nucleic acid testing are critical to disease prevention and treatment objectives. Information from such testing helps determine patients' infectivity and immune status, appropriate monitoring strategies, and the efficacy of treatment, as well as providing data that contributes to a better understanding of the natural history and epidemiology of the disease. This article reviews the clinical use of serologic and nucleic acid tests as markers of disease activity.

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Hepatitis B virus (HBV) infects approximately more than 350 million people worldwide, especially in Asia, Africa, southern Europe and Latin America. Except for interferon-α, most anti-HBV drugs are derived from the anti-herpes and anti-HIV drugs. Because of the high cost of hepatitis B medications, herbs-also called 'complementary and alternative therapies' in modern Western science-are widely used for treatment of chronic hepatitis B in developing countries. Herbals confer their activities not only by inhibiting HBV secretion but also by building up immunity against viruses. After studying the anti-HBV mechanism of herbs, scientists were encouraged to find that novel anti-HBV drugs target viral secretion, whereas nucleoside analogues target viral polymerase. The complementary and alternative anti-HBV therapies published in scientific peer-reviewed journals are reviewed and discussed in this article.

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Hepatitis B vaccine can induce transient hepatitis B surface antigen positivity not only in adult hemodialysis patients but also in normal adults and children. Hence hepatitis B vaccinees may be mistaken for confirmed hepatitis B surface antigen-positive carrier. Hence blood donors should not donate blood in this early post-vaccination period and renal dialysis patients should not be screened for hepatitis B surface antigen for at least 21 to 28 days after hepatitis B vaccination. These guidelines could prevent individuals in the early post-inoculation period from being erroneously labeled as having hepatitis B viral infection.

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HBV infection is a major public health problem. Acute viral hepatitis B is successfully cleared in more than 95% of immunocompetent patients. HBV infection can cause severe acute hepatitis which can progress to acute liver failure. The purpose of this review is to discuss the immune response in acute hepatitis B and the possible role of HBV genotypes in development of severe acute HBV related hepatitis, define severe acute hepatitis B and to look at the role of the available antivirals in this clinical setting.

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Hepatitis B is the leading cause of viral hepatitis in the developing world; about 400 million people are infected with chronic hepatitis B worldwide. Continuing research on hepatitis B over the last few decades has added considerably to our understanding of its replication, pathology, natural history, diagnosis and treatment. This section highlights a few selected landmark research articles published during the past year in the field of Hepatitis B. These articles enhance our understanding of the basic nature of this infection and help us to treat patients with chronic infection better. Comments have been added after each abstract to highlight the reasons for selecting these articles.

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Drug resistance can be considered as a natural response to the selective pressure of the drug. An increase in HBV DNA can be a good indicator of the presence of a resistant HBV mutant population. The nucleoside analogues Lamivudine, Adefovir, Entecavir etc. are oral drugs used for Hepatitis B viral infection. Resistance to HBV drugs arises due to mutations in the polymerase gene. The HBV polymerase can be divided into 4 domains: 1) the terminal protein, 2) the variable spacer domain, 3) the polymerase/reverse transcriptase and 4) the RNase. Drug resistance to Lamivudine is associated with mutations in the very conserved catalytic polymerase /reverse transcriptase domain, located specifically at a locus of four amino acids consisting of tyrosine-methionine-aspartate-aspartate, termed the YMDD motif at position 204:M204V/I. Adefovir resistance mutations are at amino acid residues 181,236/238:A181T/V and N236T/N238D. The Entecavir resistance mutations are at amino acid residues 184, 202 and 250 of the polymerase: T184X, S202I/G/L and M250L/V. There are several assays available that identify resistance mutation like polymerase chain reaction, real time PCR with specific probes, hybridization methods (line probe assay) and restriction fragment length polymorphism (RFLP).The best approach for patients with Lamivudine resistance is to continue Lamivudine and add Adefovir. Lamivudine is effective in suppressing serum HBV DNA levels in patients with Adefovir resistance. Entecavir resistance mutations are sensitive to Adefovir and Tenofovir. The careful selection of a first-line agent is essential to avoid the occurrence of resistance and the development of cross resistance to other agents. The most effective therapy of antiviral-resistant HBV is prevention through judicious use of nucleos(t)ide analogue therapy.

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Currently available options for the treatment of chronic hepatitis B virus (HBV) infection include standard and pegylated interferon alfa and Thymosin alpha, four oral antiviral agents (lamivudine, adefovir, entecavir, and telbivudine), two agents Tenofovir and emtricitabine approved in the HIV HBV co-infection are likely to be approved for HBV infection in immediate future. These treatment strategies are either therapies of finite duration that aim to achieve sustained off-therapy responses, or long-term treatments that aim to maintain on-therapy remission. Most agents designed to target hepatitis B are hindered by the development of resistance, poor tolerability or limited efficacy; therefore, new agents and treatment strategies are needed. Although therapy of hepatitis B is evolving, which between single and/or combined agents are most effective, how long therapy should last, which criteria should be used to start or continue and switch or stop therapy are to be defined. This paper provides a review of management with the available treatment options for HBV associated liver diseases.

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Assessment of fibrosis is important in chronic hepatitis B for a number of reasons including decision-making regarding treatment and predicting prognosis.Currently liver biopsy is considered the gold standard for assessing liver histology. However, since liver biopsy has significant limitations,the quest for a non-invasive alternative to assess hepatic fibrosis continues. A review of published literature reveals that extensive research has been carried out in this field, and several simple to complicated alternatives to liver biopsy for assessing hepatic fibrosis have been evaluated. A few have shown promise too, but we are still short of an ideal alternative to liver biopsy. Despite the fact that much has been done, we still have a long way to go before we can finally say farewell to liver biopsy.

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