HEPATIT

IS B
Tony Darmadi
PERAN “ DOKTER
UMUM”
 What is Hepatitis?
•Hepatitis means “inflammation of the liver”1

•Viral hepatitis is the most common cause of liver

diseas

•The most common types of viral hepatitis are:

–Hepatitis A
–Hepatitis B
–Hepatitis C

1. Centers for Disease Control and Prevention. Hepatitis B FAQs.

http://www.cdc.gov/print.do?url=http%3A//www.cdc.gov/hepatitis/B/bFAQ.htm%23overview. Accessed April 1, 2009.
2. American Liver Foundation. Liver Wellness. http://www.liverfoundation.org/downloads/alf_download_29.pdf. Accessed March 11, 2009.
Causes of hepatitis
• Drugs
• Toxins
• Alkohol
• Viral infections ( A,B,C,D,E )
• Other infections ( parasites ,
bacteria )
• Physical Damage
Liver
• Function
• Stores sugar needed for energy
• Absorbs good nutrients
• Break down poisons ( toxins ) and drugs
• Makes important proteins that help build
new tissue and
• repair broken tissue
• Produce bile , which helps remove waste from
the body
Hepatitis term
• Acute Hepatitis : short term hepatitis.
• Body’s imunne system clears the virus
from the body within 6 months

• Chronic Hepatitis : Long term hepatitis

• Infection lasts longer than 6 months
because the body,s immune system
cannot clear the virus from the body.
Hepatitis B
• Serious disease caused by a virus that
infects the liver
• Can cause lifelong infection , cirrhosis
( liver scarring ), liver cancer, liver
failure and death.
 Hepatitis B is a global problem

HBsAg prevalence

³8% = High
2-7% = Intermediate
<2% = Low
6
Data from 2008
Structure
• Hepadnaviridae family
(DNA)

• Numerous antigenic
components

• Humans are only known

host
Hepatitis B Virus

• May retain infectivity for at

least 1 month at room Image from ICTVdB - The Universal Virus Database, version 4.
http://www.ncbi.nlm.nih.gov/ICTVdb/ICTVdB/

temperature
Hepatitis B
• Epidemic jaundice described by Hippocrates in
5th century BC

• Jaundice reported among recipients of human

serum and yellow fever vaccines in 1930s and
1940s

• Australian antigen described in 1965

• Serologic tests developed in 1970s

 Hepatitis B Virus
HBsAg

HBcAg

HBeAg
Hepatitis B transmission routes

Unprotected sexual
Vertical transmission
contact with HBV+
(Mother to Child)

Contact with Transfusion/

infected fluids organ transplant

Razors/
needles

8
Course of Hepatitis B virus infection

Course of HBV Infection

Adult Infant

90-95% 5-10% 70-90% 10-30%

Acute Infection Virus Persists Virus Persists Acute Infection

Chronic Chronic
Full Recovery Full Recovery
Hepatitis B Hepatitis B

9
CLINICAL OUTCOMES OF HEPATITIS B
Acute Hepatitis B
• Is a short-term disease that occurs when a person is first
infected with the hepatitis B virus (HBV)

–Symptoms may occur in approximately 70% of patients

about 12 weeks after exposure

–The immune system usually suppresses the virus

–Complete recovery may occur within a few months

 Common symptoms of acute Hepatitis B

Yellow eyes and skin Loss of

(jaundice) appetite

Abdominal
pain Nausea and
vomiting

Joint pain
Dark urine

Fatigue Weakness
Chronic Hepatitis B (CHB)
• Is a long-term disease that occurs when your immune
system does not get rid of the virus

–You may not have obvious symptoms

–Patients often find out they are ill when they develop
serious liver damage

–CHB is a serious disease; it can lead to cirrhosis, liver

cancer, and death
 Types of liver disease:
potentially caused by Chronic Hepatitis B (CHB)

Healthy liver Fibrotic liver1 Cirrhotic liver2 Liver cancer3

This is ahealthy The continuous In cirrhosis of the Liver cancer is

liver inflammation of the liver, scar tissue the formation of
liver caused by replaces normal, a malignant
hepatitis B can healthy tissue, tumor inthe liver
leadto fibrosis - a blocking the flow of
formation of scar blood through the
tissue in the liver liver and
preventing it from
working properly
Untreated Hepatitis B can
cause liver cancer
• Hepatitis B virus is second only to tobacco smoke in causing
cancer deaths globally

• The incidence of liver cancer is 9 times

higher in Asian American men than their
white counterparts

Hepatitis B-associated liver cancer

destroying a normal liver
How Is Hepatitis B
Diagnosed?
• A simple blood test is the only way to detect HBV infection

• Screening for hepatitis B is necessary to:

–Identify people who have chronic hepatitis B so they can
receive medical treatment
–Identify those who are unprotected
so they can be vaccinated
Who may be screened for Chronic Hepatitis B?

• All patients who have abnormal LFTs or who are HCV +

• All foreign-born persons from areas where the rate of HBV
infection is moderate to high
• Household and sexual contacts of infected persons
• Pregnant women
• HIV-positive people
• Haemodialysis patients
• Injecting drug users
• People with selected medical conditions*
– e.g. requiring chemotherapy, immunosuppressive drugs
(steroids) etc
What do results of Hepatitis B screening mean?

• Hepatitis B Surface Antigen (HBsAg)

– Negative: Normal
– Positive >6 months: Patient has chronic hepatitis B

• Hepatitis B surface antibody (Anti-HBs)

– Negative: Not immune
– Positive: Immunity to hepatitis B from either previous infection or
vaccination
Can Hepatitis B Be
Treated?
What should I do if I am diagnosed
with Chronic Hepatitis B?
• Although there is no cure, chronic hepatitis B can be managed
– Many patients, once treated, can live normal and healthy
lives
• Early detection and proper management can help save lives
– Take care of yourself by scheduling regular doctor
appointments
to monitor your chronic hepatitis B progression
– Protect your family by avoiding transmission of the virus
– Receive treatments to help delay and prevent liver damage
from chronic hepatitis B
Medications used to treat
Chronic Hepatitis B
• Oral medications:
–Adefovir dipivoxil
–Entecavir
–Lamivudine
–Telbivudine
–Tenofovir disoproxil fumarate

• Two injectable medications:

–Interferon alfa-2b
–Peginterferon alfa-2a
 Treatment for Hepatitis B may reduce the risk of cirrhosis
and liver cancer

Treatment Cirrhosis

Hepatitis B Virus
Liver Cancer

Iloeje UH, et al. Gastroenterol. 2006;130:678-686.

Chen CJ, et al. JAMA. 2006;295:65-73.
Can Hepatitis B Be
Prevented?
 Hepatitis B Can Be Prevented
• Vaccination is the best way to protect yourself and others

• Some other ways to guard against infection include:

– Learn more about hepatitis, its prevention and treatment
– Use condoms during intimate contact
– Don’t share razors or toothbrushes with an infected person
– Prevent transmission to infants by making sure the infant
receives vaccination
– Consider the risks before getting a tattoo or body piercing,
shaving
– If you have had hepatitis B, don’t donate blood, organs or
semen
Pregnancy is a time for Hepatitis B
screening and prevention
• Pregnant women can be tested for chronic hepatitis B at an early pre-
natal visit

• Infants born to women with chronic hepatitis B should receive hepatitis B

vaccination +/- hepatitis B immune globulin (HBIG)

• After giving birth, women with chronic hepatitis B should talk to their
doctors about managing their chronic hepatitis B
What Are The
Common Myths
About Hepatitis B?
 Common myths about
hepatitis B transmission

Hepatitis B is Not transmitted by

Sharing food, water,

utensils or drinking Mosquitoes Tears, sweat, urine
glasses or stools
Common myths about hepatitis B transmission

Hepatitis B is Not transmitted by

Hugging or kissing Breastfeeding Coughing or sneezing

Asian Liver Center. 2007 Physician’s Guide to Hepatitis B: A Silent Killer .

http://liver.stanford.edu/Education/2007Handbook.pdf. Accessed April 1, 2009.
Conclusions
•Globally, about 1 in 20 people (400
million) are living with chronic hepatitis
B

•Hepatitis B is a silent disease; many

people
with chronic hepatitis B feel perfectly
healthy and do not have symptoms
 Conclusions
• People in risk groups should be tested
• Chronic hepatitis B can be a manageable
disease
–Early detection and proper management
may help save lives
–Available treatments can help delay and may
prevent liver damage from chronic hepatitis B
–Travelling - Get yourself and your family
vaccinated for Hepatitis B
 HEPATITIS B VACCINATIONS

• IF YOU HAVE HEPATITIS B, YOU WILL NOT

REQUIRE THE VACCINATION.
• HEPATITIS B VACCINATION WILL BE OFFERED IF
YOU ARE AT RISK.
• GET VACCINATED AGAINST HEPATITIS B.
Thank You