الفهرس | Only 14 pages are availabe for public view |
Abstract Hepatitis B infection iscausedbythehepatitis B virus (HBV) causing hepato–cellular necrosis andinflammation. HBVinfectioncanbeeitheracuteorchronic, andtheassociatedillnessranges in severity from asymptomatic to symptomatic, progressive disease. chronic hepatitis B (CHB) isa majorpublichealthproblem. Worldwide, thereareanestimated 240 millionchronicallyinfected persons. The Major complications of CHB arecirrhosisandhepato-cellular carcinoma (HCC). Between 20% and 30% of thosewhobecomechronicallyinfectedwilldevelopthesecomplications, and an estimated 650 000 people will die annually due to CHB. Guidelinesrecommendtheuseofsimple, non-invasivediagnosticteststoassessthestage of liver diseaseandeligibilityfortreatment; prioritizetreatmentforthosewithmost advanced liver disease and at greatest risk of mortality; and recommendthe preferreduseofnucleos(t)ideanalogueswitha highbarriertodrug resistance (tenofovirandentecavirinchildrenaged2–11years)for first and second linetreatment. ThepreventionofHBVtransmission include prevention of perinatal and early childhood HBV infection through infant hepatitis B vaccination; catch upvaccinationandotherpreventionstrategiesinkeyaffected populations, includingpersonswhoinjectdrugs, menwhohavesexwithmen, and sex workers; as well as prevention of HBV transmission in health-care settings. Universal hepatitis B immunizationprogramsthattarget infants, withthefirstdoseatbirth, havebeenhighlyeffective in reducingthe incidenceand PrevalenceofhepatitisBinmanyendemiccountries. However, theseProgramswillnothavean impact on HBV relateddeaths until several decades after theirintroduction. Guidelinesalsorecommendlifelongtreatmentin thosewithcirrhosis; andregularmonitoringfordiseaseprogression, toxicityof drugsandearlydetectionof HCC. Anti-viral agents active against HBV are available, and have been shown to suppressHBVreplication,preventprogressiontocirrhosis, and reducetherisk ofHCCand liver relateddeaths. However, currentlyavailabletreatmentsfailto eradicate thevirusinmostofthosetreated, necessitatingpotentiallylifelong treatment. Now there are therapeutic strategies and drugs under clinical trials for HBV, Many of these drugs might theoretically overcome the limitation of current HBV therapies and some encouraging results are being accumulated. |