Healthcare personnel, especially medical students, represent a high risk population for Hepatitis B Virus (HBV) infection. Hepatitis B is the most important infectious occupational hazard which Indian medical students and healthcare workers (HCWs) encounter. The medical students and HCWs all over the world do not practice universal precautions on a routine basis and there exists the widely prevalent problem of under reporting of percutaneous and mucocutaneous exposures and a lack of awareness about the disease transmission, its consequences and the importance of adhering to universal precautions at all times. This further compounds the issue of safety of student HCWs. This article highlights the dismal scenario vis-ΰ-vis awareness about these risks and HBV prophylaxis amongst medical students from a student's perspective and suggests how to tackle the situation to protect the unfortunate medical students from an unwarranted predicament.

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Hepatitis B virus is a microorganism formed in the excess of surface antigen which is devoid of nucleic acid. Surface antigen of HBV was from the beginning the natural candidate for the vaccine which was thus produced by isolation of plasma HBsAg and later substituted by recombinant protein(s). The Extended Program of Immunization was beneficial for the reduction of HBV incidence in the populations of many participating countries. It is further postulated that HCC incidence in the world was also reduced at least in the portion caused by hepatitis B virus. Persistence of anti-HBV immunity was first measured by quantitative anti-HBs assay determined at 1 month post vaccination cycle, and then at different time points, even up to 12-15 years. The frontier of 10 IU/L (mIU/ml) is a mark of sustained immunity. However, cellular immunity studies revealed that this kind of response is very important in the defense against the virus and may last longer than the detectable antibodies. It was shown that 'full' surface vaccines, i.e. preS+S, may give stronger immunity and are good even for neonates. The next generation vaccines are DNA-based and plant-based HBV vaccines. This last category raises many hopes and with sufficient immunogenicity could ensure the most comfortable route of administration.

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In the nineties, lamivudine (LMV) was the first nucleoside analog to be marketed for the treatment of patients with chronic hepatitis B virus (HBV). Following the advent of LMV, the management of patients with chronic hepatitis B, particularly those with advanced liver disease was markedly improved, with a substantial reduction in the rates of liver-related complications and mortality. In the face of excellent safety profile records of the drug, hepatologists had to face for the first time the issue of high rates of HBV resistance to therapy as the result of years of treatment of large cohorts of patients in the West and East. Initially considered no more than a virological problem, LMV resistance was later recognized to be a relevant clinical issue whose management requires specific therapeutic strategies. New, more active oral analogs have been marketed since, and new agents are to appear in the market scenario in the near future; however, LMV is still the number one prescribed anti-HBV agent worldwide for the treatment of chronic HBV patients, due to its limited cost, excellent safety and well predicted resistance profile.

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Delta hepatitis or hepatitis D leads to acute and chronic liver disease in humans. The causative agent, the hepatitis delta virus (HDV), is a defective virus which leads to hepatitis in humans in the presence of the hepatitis B virus. This helper function of HBV is required for transmission and propagation of HDV infection but not for replication. HDV RNA replication occurs through the double-rolling circle model and does not possess a reverse transcription step. Hepatitis D-induced liver disease is immune-mediated and occurs either as co-infection of both viruses or as superinfection of a hepatitis B carrier with hepatitis D. Based on a sequence variation of 19-38%, to date seven genotypes of HDV have been described. HDV infection has declined significantly in many endemic areas in the last decades, however, due to migration to industrialized countries, this decline appears to have reached a plateau in western countries. The clinical course of delta hepatitis in general is associated with rapid progression. Delta hepatitis may be an additional risk factor for the development of hepatocellular carcinoma. The only established management for delta hepatitis consists of treatment with interferon for a period of at least one year. For those unresponsive to interferon treatment and patients with advanced disease new therapies are an urgent need. Such therapies may be on the horizon but translation of bench work to clinical practice is required.

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Malnutrition is prevalent in all forms of liver diseases. A number of factors contribute to malnutrition in patients with hepatic failure. Early diagnosis of malnutrition is essential to allow appropriate treatment, since malnutrition is an important predictor of complications of liver disease and mortality. Disease-specific nutritional therapy should be considered for acute liver failure, sepsis, transplantation, and encephalopathy. This article provides an overview of the nutritional management of acute and chronic liver disease and discusses the need for further intervention studies before appropriate rational treatment guidelines can be formulated.

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Approximately 400 million people worldwide are chronically infected with the hepatitis B virus (HBV). Chronic infection with HBV can lead to progressive liver diseases including cirrhosis, liver failure, and hepatocellular carcinoma. During treatment of chronic hepatitis B (CHB) patients, flares of inflammatory activity are a well known phenomenon. Flares can be life threatening but have also been associated with virological response. While, interferon induced flares have been attributed to the stimulatory effect of IFN, and may precede HBeAg seroconversion, Lamivudine related flares are seen during treatment and after withdrawal of lamivudine, which are probably caused by reoccurrence of HBV replication, and have been associated with decompensation of liver disease. These flares play an important role in the treatment with Peg-IFN α-2b alone or in combination with lamivudine, and patients with pre-existing cirrhosis are at greater risk for experiencing a flare. Furthermore, host induced flares but not virus induced flares may herald a response to therapy. For optimisation of treatment, it is necessary to understand the virological and immunological mechanisms which induce the specific flare patterns. This article reviews the pathogenesis, significance and management of flares encountered during and after cessation of treatment of patients with chronic HBV infection.

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The literature on hepatitis B virus (HBV) in immunocompromised patients is heterogeneous and refers mainly to the pre-antivirals era. Today a rational approach to the problem of hepatitis B in these patients provides for: a) the evaluation of HBV markers and of liver condition in all subjects starting immunosuppressive therapies (baseline), b) the treatment with antivirals (therapy) of active carriers, c) the pre-emptive use of antivirals (prophylaxis) in inactive carriers, especially if they are undergoing immunosuppressive therapies judged to be at high risk, d) the biochemical and HBsAg monitoring (or universal prophylaxis, in case of high risk immunosuppression) in subjects with markers of previous contact with HBV (HBsAg-negative and antiHBc-positive), in order to prevent reverse seroconversion. Moreover it is suggested a strict adherence to the criteria of allocation based on the virological characteristics of both recipients and donors in the general setting of transplants, and in liver transplantation the universal prophylaxis with nucleos(t)ides analogues (frequently combined with specific anti-HBV immunoglobulins) in HBsAg-positive candidates and in HBsAg-negative recipients of antiHBc-positive grafts should be adopted.

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Hepatitis B virus [HBV] affects almost five per cent of the total population worldwide and majority of the affected population are detected incidentally without any symptoms. This mammoth pool of Hepatitis B virus infected population needs to be properly assessed and followed up to minimize morbidity and mortality in them. This article reviews literature related to this subset of HBV patients and attempts to provide a rational guideline to approach and manage them.

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The currently available options for the treatment of chronic hepatitis B virus (HBV) infection include standard and pegylated interferon alfa and four oral antiviral agents (lamivudine, adefovir, entecavir, and telbivudine). These treatment strategies are either therapies of finite duration which 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. Pegylated interferon alfa may offer higher sustained off-therapy responses after one year, but most patients do not respond. Oral antivirals are the only candidates for long term treatment of patients with chronic HBV infection. Viral suppression has favorable effects on outcome outcome and modifies the natural history of the disease. The oral nucleos(t)ide analogues are generally better tolerated than interferon. This article attempts to provide an overview of the data available on the two new drugs entecavir and telbivudine.

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Hepatitis B is the leading cause of chronic viral hepatitis across the world, especially in developing countries. Over 400 million people across the world are estimated to be harboring the infection. This section highlights a few important published articles on hepatitis B viral infection and discusses the significance of the results and conclusions of these articles. It is hoped that this review would enable treating physicians and students to comprehend the significance of these specially selected articles better, which should result in better understanding and management of patients with chronic hepatitis B viral infection.

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