Viral Hepatitis
Causes of Acute Hepatitis
Causes of Chronic Hepatitis
Hepatitis A
Global Prevalence of Hepatitis A Infection HAV Prevalence High Intermediate Low Very Low Global Prevalence of Hepatitis A Infection 16 6
Hepatitis B
Hepatitis B Virus HBsAg HBV DNA HBcAg 42 nm Hepadnaviridae ; Genus : orthohepadnavirus : member that primarily infects liver cells 50 to 100 times more infective than HIV Multiple genotypes exist (A-H) DNA virus found in blood and body fluids Able to survive in dried blood for longer than 1 week 8
Geographic Distribution of Chronic HBV Infection > 350 million carriers (HBsAg + > 6 months) 10th cause of death (1 million / year) Cirrhosis in 20% (75 - 100 million) HCC in 5 - 10% (20 - 40 million) HBsAg Prevalence 8% - High 2-7% - Intermediate <2% - Low
HBV Sources of Infection Household, 3% MSM, 23% Other, 23% Sex contact, 23% IDU, 20% Multiple sex partners, 24% Many patients do not reveal IDU as source of infection Centers for Disease Control and Prevention. Hepatitis B. In: Atkinson W et al, eds. Epidemiology & Prevention of Vaccine-Preventable Diseases. 8th ed Washington DC: Public Health Foundation; 2005:191-212. 10
Hepatitis B: Disease Progression Liver Cancer (HCC) 5%-10% 1 2-6% Acute Infection Chronic Infection Liver Transplantation Death Cirrhosis 10-30% 1 90% in perinatal 30-90% in children<5yrs old 5% in healthy adults Higher in HIV, immune suppressed Chronic HBV is the 6th leading cause of liver transplantation in the US4 Liver Failure (Decompensation) 23% within 5 years 1. Torresi J et al. Gastroenterology. 2000. 2. Fattovich G et al. Hepatology. 1995. 3. Moyer LA et al. Am J Prev Med. 1994. 4. Perrillo R et al. Hepatology. 2001. 11
Typical Serologic Course Progression to Chronic Hepatitis B Virus Infection Typical Serologic Course Acute (6 months) Chronic (Years) HBeAg anti-HBe HBsAg Total anti-HBc Titer HBV DNA IgM anti-HBc 4 8 12 16 20 24 28 32 36 52 Years Weeks after Exposure
Course of Acute HCV Infection 1000 HCV RNA positive Anti-HCV 800 Symptoms 600 ALT (IU/L) 400 200 Normal ALT 2 4 6 8 10 12 24 1 2 3 4 5 6 7 Weeks Months Time After Exposure Hoofnagle JH. Hepatology. 1997;26:15S. Carithers RL Jr, et al. Semin Liver Dis. 2000;20:159-171. Pawlosky JM. Hepatology. 2002;36(suppl 1):S65-S73. NIH Management of Hepatitis C Consensus Conference Statement. June 10-12, 2002. Available at: http://consensus.nih.gov/2002/2002HepatitisC2002116html. Accessed April 10, 2007. 13 13
Symptoms, or Lack of, in Chronic HCV Infection Symptomatic 37% 100 Cirrhosis 7% 80 80 60 Patients (%) 40 20 Fatigue 56% Asymptomatic 14 14
Prevalence of HCV Dependant on Risk Factors Hemophilia 74-90% IVDA 72-89% Prison 40% HIV 30-40% Blood transfusion prior to 90 5-9% Infants to HCV+ Mothers 5% Sexual Partner 0.5-3% General Population 1.8% Adapted from MMWR.1998;47:5.
HCV: Disease Progression Time: 20-30 years HCV infection 60-85%1 Chronic HCV Cirrhosis Hepatic Failure 20%-50%2 ~ 20%3 ~20%4 Liver Transplant Candidates Liver Cancer 1. NIH Consensus Development Conference Statement; March 24-26, 1997. 2. Davis GL et al. Gastroenterol Clin North Am. 1994;23:603-613. 3. Koretz RL et al. Ann Intern Med. 1993;119:110-115. 4. Takahashi M et al. Am J Gastroenterol. 1993;88:240-243. 36 16