Over 350 million people worldwide are infected with hepatitis B virus (HBV), and patients with HBeAg-negative chronic hepatitis B constitute a major proportion of this population. Mutant varieties of HBV resulting from mutations in the precore or core promoter region of the viral genome give rise to HBeAg-negative CHB, and these cases must be differentiated from the inactive carrier state. These patients with HBeAg-negative CHB must 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 to proceed to irreversible and progressive liver disease. This article provides an overview of the management of HBeAg-negative chronic hepatitis B.

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Background: Hepatitis B is a major health problem in India. To prevent transmission and progression of the disease in the community, proper community awareness about the disease, including prevention, is necessary. Our objective was to study the awareness amongst the general population about hepatitis B virus, including knowledge regarding vaccine. Materials and Methods: The study was conducted in Department of Gastroenterology of SCB Medical College. The patients attending the OPD and their attendants were subjected to a questionnaire about different aspects of hepatitis B. Binary logistic regression analysis (SPSS 16) was employed to assess the statistical importance of the observations. Results: In all, 682 individuals (65% patients, 35% non-patients) were studied; 78% were males while 22% were females. Majority were in the age group of 31-40 years. 65% hailed from rural area; 65% were poor. About half of the subjects attended state run medical centers for medical attention; only 17% preferred medical colleges. Awareness about the disease and the vaccine among the subjects was 38% and 32%, respectively. 50% of those who were aware had no knowledge about route of transmission, infectivity, or importance of vaccination. Educated individuals were more aware about hepatitis B vaccine (P < 0.05). Those who read newspaper and listened to radio were more aware about hepatitis B (P < 0.05), and its vaccine (P < 0.05). The percentage of vaccination was 20% among study subjects, but in 30%, their children were vaccinated. The common reason for non-vaccination was lack of awareness (50%); of them, 60% blamed government/doctors/media for their ignorance. Majority (56%) received the vaccine from government hospitals or health centers. Only (10%) obtained vaccination from private centers. Reasons cited for non-vaccination included ignorance (50%), carelessness (12%), high cost (10%), and nonavailability (6%). Source of information regarding hepatitis B included television (75%), newspapers (55%), and radio (26%). Conclusions: Only about one-third of the population in coastal Eastern India are aware about hepatitis B and its vaccine. Less than a third of the population are vaccinated for hepatitis B. The educated, especially those who read newspapers and listened to radio, were more aware about the disease/vaccine. The government health agencies and physicians should work together to educate the masses about hepatitis B and its vaccine.

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Patients with Hepatitis B virus infection may present to the treating clinicians at various stages of natural history of hepatitis B infection, including acute viral hepatitis, chronic active hepatitis, incidental hepatitis B s antigen-positive patients and those with decompensated cirrhosis and hepatocellular carcinoma. Management of chronic hepatitis B patients, especially those with e antigen-negative disease poses the biggest challenge today. There are various treatment options available and choosing the correct drug according to the patient profile is important both for optimum response and preventing drug resistance. This article reviews an exciting new molecule tenofovir, which has been approved in August 2008 by the US Food and Drug Administration for treatment of chronic hepatitis B.

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The anti-tumor necrosis factor (TNF) agents are a class of medications which have given clinicians a new level of control over inflammatory illnesses that was previously unattainable with older disease modifying agents. Though each medication has unique molecular differences, they all have as their specific target the proinflammatory cytokine TNF-α. With the great improvements provided by the anti-TNF agents though has come a new spectrum of side effects. On the basis of the importance of TNF-α in granuloma formation, neutralization of TNF-α has led to reactivation of latent infections, the most notable being Mycobacterium tuberculosis. Another infectious agent that can elude eradication and enter a latent state, reactivating when the immune system is depressed, is the hepatitis B virus (HBV). Inhibition of TNF-α could also lead to immune suppression and reactivation of the virus much like that experienced with the reactivation of TB. The purpose of this article is to review the current medical literature for cases where anti-TNF agents were used to treat an inflammatory illness such as rheumatoid arthritis or Crohn's disease in patients chronically infected with HBV. Additionally, the role of TNF-α in HBV infection is explored, the differences in the anti-TNF agents are examined, and guidelines regarding the screening for and prophylaxis of HBV are discussed.

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There is a high global prevalence of hepatitis B. 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. Perinatal transmission of hepatitis B can be reduced by early identification of hepatitis B virus (HBV) carrier mothers. High maternal viral loads and maternal serum HBeAg positivity increase the risk of perinatal transmission of hepatitis B. Passive and active immunoprophylaxis at birth reduces the risk of perinatal transmission of hepatitis B in approximately 95%. Failure of immunoprophylaxis has been related to possible in utero transmission of HBV. Reducing maternal HBV DNA levels by treatment with lamivudine in the last trimester of pregnancy in high viremic mothers may help reduce the risk of perinatal transmission of hepatitis B.

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Hepatitis B is a global healthcare problem. An estimated one third of the global population have been infected with the hepatitis B virus (HBV). Various guidelines have been proposed for management of chronic hepatitis B. These guidelines have similarities and differences and are changed from time to time. Here, we have reviewed the management guidelines of chronic hepatitis B published after 2007 and highlighted the similarities and differences between their different recommendations.

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Hepatitis B virus (HBV) cross-infection during endoscopy is rare. Most of the reported cases have occurred when the endoscope reprocessing was inadequate. Standard reprocessing of endoscopes and accessories is sufficient to prevent HBV transmission.

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Managing chronic hepatitis B (CHB) during pregnancy remains a challenging task as there is no information on the consequences to the fetus. Telbivudine, an oral nucleoside analog (NA), is a potential therapeutic option during pregnancy, but clinical experience is lacking. We report on the safety and efficacy of telbivudine 600 mg/day administered to a 20-year-old Indian woman with hepatitis B e antigen negative CHB, who became pregnant during treatment. Telbivudine was continued with monitoring of maternal hepatitis B virus (HBV) DNA and alanine aminotransferase (ALT) levels during pregnancy and after delivery. The patient maintained polymerase chain reaction (PCR) undetectable HBV DNA and normal ALT levels with telbivudine throughout pregnancy. At birth, HBV DNA was undetectable by PCR in the newborn. No congenital abnormalities were noted. In conclusion, telbivudine therapy during pregnancy was effective in maintaining undetectable viremia, and no safety concerns were noted in the mother and child. Additional clinical studies are warranted.

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In the management of HBV related cirrhosis of the liver, viral suppression with safe and effective antiviral agents is essential. Besides, antiviral therapy for long term use in cirrhotics should be safe and affordable with low risk of drug resistance. Treatment of compensated HBV cirrhosis can diminish the risk of hepatic decompensation and progression to hepatocellular carcinoma [HCC]. Regression of fibrosis and reversal of cirrhosis have also been reported with antiviral therapy. Further, 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. These patients while on antiviral therapy need close monitoring for viral resistance and adverse events, besides continued surveillance for HCC. This article reviews the literature on the role of nucleoside analogues in the management of HBV related chronic liver disease.

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Hepatitis B virus (HBV) infection is an important indication for liver transplantation worldwide. The most important concern is the prevention of viral recurrence in the post transplant period. With the introduction of Hepatitis B immunoglobulin, there has been a significance reduction in the rate of HBV recurrence with improved patient & graft survival rates. The combination of oral nucleosides along with Hepatitis B immunoglobulin has further reduced the rate of HBV recurrence, and currently the outcome of liver transplantation for HBV infection is comparable to other indications for liver transplantation.

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Despite the development of an effective vaccine, hepatitis B is still the leading cause of chronic viral hepatitis across the world, especially in developing countries, with over 400 million people across the world estimated to be harboring the infection. This section of the journal highlights a few important articles on hepatitis B viral infection published recently and discusses the significance of their results and conclusions. We do hope that this review would enable treating hepatologists, physicians and students to comprehend the significance of these specially selected articles better, which would result in better comprehension and management of different aspects of chronic hepatitis B viral infection encountered in clinical practice.

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