Viral hepatitis in practice - 2012

Hepatitis B, the family and primary care
John O'Malley
pp 1-3
The involvement of primary care in managing hepatitis B virus (HBV) is curious by its very absence at times. Certainly, liver disease as a whole remains low down on the list of priorities for primary care. Primary care, with its proven track record of treating patients with opiate abuse, alongside computer databases that are years ahead of comparable systems in secondary care, should be well placed to be far more involved in all aspects of HBV, including screening, vaccination and even treatment. The especially sad aspect is that the vast majority of new infections could be prevented through vaccination, yet the potential for primary care to have an effect is poorly utilised.
Should minimal disease with high HBV DNA levels be treated?
Matthew Foxton
pp 4-6
Chronic hepatitis B virus (CHB) poses a global health challenge, and is estimated to affect 350 million people worldwide. In the UK, approximately 180,000 people are affected, with roughly 7,700 new cases of CHB annually. Around 30% of patients with CHB will go on to develop cirrhosis during their lifetime, and 5–10% of patients with CHB will develop hepatocellular carcinoma (HCC).The progression of CHB to cirrhosis and HCC is a multi-stage, multifactorial process that involves interactions between the host, environment and virus. The factors that play a role in disease progression include increasing age, male gender, hepatitis B virus (HBV) genotype, alcohol consumption, aflatoxin exposure and, most importantly, HBV DNA levels.
Comment: Back in business
Alastair Miller
pp 5-5
After a short break, it is great to be writing another editorial for Viral hepatitis in practice (VHIP) and I am extremely grateful to Gilead and Roche for their role in supporting the journal. There is a perception that hepatitis B virus (HBV) vaccine is universally effective in preventing mother-tochild (MTC) transmission of HBV infection. In his review, Geoff Dusheiko points out that this is not true and that in some studies nearly a third of women who are e-antigen-positive, with high HBV viral loads, may transmit the virus vertically, despite neonatal vaccination. He goes on to examine the arguments for and against treating pregnant women with oral antivirals to bring down maternal viral load and reduce the risk of MTC transmission. Geoff presents useful guidance as to how oral antivirals could be used, while stressing that there are no formal guidelines, nor any major evidence base, for their use in this situation.
Antiviral prophylaxis to prevent transmission of HBV in pregnancy
Geoffrey Dusheiko
pp 7-8
Prior to the impact of universal vaccination, hepatitis B virus (HBV) was predominantly acquired by perinatal or childhood infection. Infection occurring early in life confers a very high risk of chronicity. The mainstay of prevention remains vaccination to reduce transmission in infancy and childhood. Prevention of transmission relies on the administration of HBV vaccine and, in some countries, concurrent administration of hepatitis B immune globulin (HBIG), to children born to hepatitis B surface antigen (HBsAg)- positive women. HBV vaccination programmes have profoundly reduced the incidence of HBV infection in infancy. Transplacental transmission is less important than the failure of prophylaxis.
Current diagnostics and testing techniques for hepatitis delta
Sarah Hughes and Phillip Harrison
pp 9-11
Hepatitis delta virus (HDV) is the smallest virus known to infect humans. It is composed of a circular ribonucleic acid (RNA) genome complexed with delta antigen (the only protein produced by the virus) and surrounded by an envelope of hepatitis B surface antigen (HBsAg).The provision of its surface proteins is the only identified function served by the so-called ‘helper virus’, hepatitis B, yet without this, delta particles cannot be packaged and released. Hence, HDV will only propagate in the presence of hepatitis B virus (HBV). Replication of the RNA genome is achieved through hijacking host RNAdependent RNA polymerases. There is a high degree of heterogeneity in the genome sequence; so far, eight different genotypes of the virus have been identified,which differ in their geographical distribution and also in their pathogenicity.
FAQs: Which patients with hepatitis B should be tested for delta virus?
Stephen D Ryder
pp 11-11
Delta hepatitis is reasonably well defined geographically, with the highest areas of risk being Turkey and the Asian border, sub-Saharan Africa and some parts of Southern and Eastern Europe. It is very rare in China and the rest of South-East Asia.

Viral hepatitis in practice was previously supported by Gilead Sciences from 2015 to 2016, by Gilead Sciences and Janssen in 2014, by Gilead Sciences and Roche Products in 2013 and by Gilead Sciences from 2009 to 2012.

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