Hepatitis B overview and clinical management

Hep B

Hepatitis B

This is brief review of a case study for a 39-year-old Asian-American man originally from China who was discovered to be a chronic carrier of the hepatitis B virus (HBV). Over the course of the past 2 years he received treatment with the antiviral drug lamivudine. Once he followed up with a healthcare provider for basic disease management, it appeared as though he was anicteric. His lab work included normal levels of aspartate aminotransferase (ast), alanine aminotransferase (ALT), y=glutamyltransferase (GGT), alkaline phosphatase, INR (International Normalized Ratio, a coagulation test that depends on the liver's biosynthietic ability), and direct and total bilirubin. His HBV serologic studies demonstrated a positive hepatitis B surface antigen (HbsAg) that was confirmed by neutralization and a negative antibody to HbsAg, a positive hepatitis B core antibody, a positive hepatitis Be antigen (HbeAg) and a negative assay for antibody to HbeAg. Thus, the report aims to answer how HBV infection is transmitted from person to person and does the epidemiology of the infection differ between Asians and Western individuals. A second point is to use the serological results to understand if a person did not have a history of chronic infection with HBV, what additional serologic test would help determine if the patient has an acute HBV infection or if the person is a chronic carrier.

Hepatitis B or HBV infection can be transmitted from person to person through when blood or body fluids from an infected person enters the body of a person who is not immune. Thus, HBV is spread through the process of sexual contact with an infected person without the protection of a condom. The efficacy of latex condoms has not been completely proven to effectively prevent infection with HBV, but proper use of condoms may reduce transmissions. In addition sharing drugs, needles, or 'works' while injecting drugs, needlesticks or sharps exposures in a healthcare setting or from direct infection from an infected mother to a baby during birth arte all possible transmission concerns. This implies that high risk groups are individuals that have multiple sex partners or have diagnosis of some other sexually transmitted disease, men who have sex with other men, sex contact with infected people, injection drug users, household contacts of chronically infected persons, infants born to infected mothers, infants or children of immigrants from areas with high rates of HBV infection, health care and public safety workers and hemodialysis patients. Although the majority of the nearly thirty percent of persons who have Hepatitis B show no signs or symptoms and the signs or symptoms are even less common in children than in adults, searching out the symptoms is a possible indicator to help diagnose the disease. The symptoms include: jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting and joint pain. Based on information released by the CDC, the number of new infections annually has declined from approximately 260,000 in the 1980's to around 73,000 in 2003. The highest rate of the disease occurs in those that are in the 20 to 49-year-old range and that the biggest decline has occurred among children and adolescents who are now regularly screened and take the hepatitis B vaccination. Nonetheless, there is still an estimated one and quarter million chronically infected Americans of whom almost 30% acquired their infection during childhood.

The epidemiology of the infection does differ between Asians and Western individuals. Some estimates have up to 10% of Asian-Americans being chronically infected with hepatitis B and not being aware of don't know it. This implies a crisis for the Asian community in proportion to the AIDS epidemic. The medical community erroneously has been the typical Caucasian model for the diagnosis and treatment which entails that Asians are the same make up as Caucasians. The hepatitis B virus has been rampant in Asia and a large percentage of mothers pass it on to their children during birth. Although the virus infects males and females equally, it usually kills Asian males more often through the inherent cancer or liver disease. Asian children grow up healthy because the dormant virus hides in the liver and unleashes its destructive power during young adulthood. Therefore, Asian men in their 20's or 30's are at a high risk for liver cancer. Unfortunately, being born in the United States as opposed to Asia has not made a difference in the Asian population.

The serological results presented help to provide insights into the history of typical chronic infected male. Other serologic tests could help determine if and when patients have an acute HBV infection or if the person is a chronic carrier. Diagnosis should be based on clinical, laboratory, and epidemiologic findings. The fact is that HBV infection cannot be differentiated on a basis of clinical symptoms alone so more definitive diagnosis would depend on serologic testing results. The Serologic markers of HBV infection would be the key fro distinguishing if the infection is acute or chronic. These serologic tests include:

HBsAg - this is the most commonly used test for diagnosing acute HBV infections and therefore detecting carriers. HBsAg can be detected as early as 1 or 2 weeks or as late as 11 or 12 weeks after exposure to HBV if sensitive assays are utilized. The presence of HBsAg indicates that a person is infectious, regardless of whether the infection is acute or chronic.

Anti-HBc (core antibody) develops in all HBV infections and appear shortly after HBsAg in the acute disease. This indicates that the HBV infection was undefined in the past. Anti-HBc only occurs after HBV infection, and does not develop in persons whose immunity to HBV is from vaccine. Anti-HBc generally persists for life and is not a serologic marker for acute infection.