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mrazanaqve
Re: Re: Hepatitis B
Just would like to clarify few points.
There are various terminologies used while referring to HBV infections.
Diagnosis of chronicity is clinical ie cannot be just established on blood testing. Persistance of HBsAg in the blood for more than 6 months is termed chronic infection. Most of the cases you will come across will be chronic but it is important to keep this point in mind. Its differentiation from acute infections is important for a number of reasons: the marker to look for in acute infections is HBcIgM Ab.
Once diagnosis of chronic infection has been established, the decision whether to treat or not is based on number of factors: virological, biochemical, histopathological and clinical. This can be expanded as HBV DNA levels (anything above 100,000 is significant on its own), ALT levels, clinical chronic liver disease and presence of cirrhosis on histology of biopsy. You cannot let a person go untreated if the biopsy shows evidence of advanced cirrhois even if the ALT/viral load is otherwise acceptable. So for the sake of treatment, a formal initial assesment is required. If treatment is not deemed necessary, it is important to keep patient under regular followup (six monthly to yearly ) to make sure the disease does not flare up going unnoticed.
Unfortunately majority (95%+) of chronic infection will never clear their virus and will remain infected (HBsAg+) DESPITE treatment. The aim of treatment is to suppress the viral load (DNA) at undetectable levels so that virus cannot lead to cirrhosis. Because of the side effects of anti HBV drugs and the increasing chances of drug resistance (with increasing duration of therapy), treatment is not given in all cases of detectable DNA levels. The reason is that by starting treatment prematurely you may deplete the antiviral options by developing resistance eg 25% of cases will develop resistance after one year of therapy with lamivudine and after 4 years about 60-70% will.
All chronic infections are carriers ie they carry the virus so these terms are used interchangingly. Carriers should not imply these are only the ones with e Ag negative. Chronic infections can either be chronic active (usaully e Ag +ve with high DNA) or inactive (what we call the immune tolerant phase). It is important to recognise the concept of a pre-core mutant. c Ag (not used n diagnostic practise but important for virus survival) is produced by part of the HBV virus genome which is called the core region. Just before the core region is the pre-core region which is responsible for producing the e Ag. e Ag is not necessary for virus survival. In pre-core mutants (upto 40%of cases) the virus mutates and is not able to produce e Ag but still replicates actively, with high DNA levels and progress earlier to cirrhosis. In such cases the serological profile of the person will show a negative e Ag (e Ab maybe +ve or negative) but a very high viral load (DNA).
Serological Profiles:
Chronic infections:
HBsAg+
HBeAg + or -
HBeAb - or +
HBcIgM Negative (or low positive: small print)
HBcTotal Ab +ve
HBV DNA high or low or negative
Acute infection:
HBsAg+
HBeAg + or -
HBeAb - or +
HBcIgM (Strong +ve usually >5x cut-off)
HBcTotal Ab +ve
HBV DNA (positive, then variable course)
Pre-core mutant:
HBsAg+
HBeAg-
HBeAb (+ or -)
HBcIgM -
HBcTotal +
HBV DNA very high (usually>100,000 copies/ml)
Past infection
HBsAg -
HBcTotal +
HBsAb +
HBV DNA negative
Hope this helps
Dr M Raza MRCP (UK) FRCPath
Consultant Clinical Virologist
UK
PS HBV serology results give lot of difficulties in interpretations and may require repeat testing even with the best assay available. All HBsAg should be confirmed by a neutralisation test as if it does not neutralise, it may not be HBV infection.
[Edited by mrazanaqve on 27-05-2008 at 12:38 PM GMT]
[Edited by mrazanaqve on 27-05-2008 at 12:39 PM GMT]
[Edited by mrazanaqve on 27-05-2008 at 12:40 PM GMT]
[Edited by mrazanaqve on 27-05-2008 at 12:43 PM GMT]
docamna
Re: Re: Hepatitis B
Your questions are answered well by Dr Osama and Dr Yasir. I would just add some points.
For Chronin hepatitis B, one has to avoid Alocohol ingestion as it could lead to further damage of liver in such situation.
For carrier one needs intermittent follow-ups, at least yearly ultrasound of liver and few blood tests like alfa feto protein, SGPT. It is preferred to test for hepatitis D one in such patients. Family members especially spouse sould be vaccinated.
yasir
Re: Hepatitis B
Well, if the chronic hepatitis is confirmed and viral load (HBV DNA) is sufficient, then needs treatment. A good balanced diet is necessary for every disease no matter its hepatitis B or something else.
If the viral load is less and normal liver enzymes, then one option is to wait and follow the patients. I dont see any special change in nutrition here.
aftabac
Re: Hepatitis B
AoA
I asked that in some cases of chronic Hepatitis B, doctors ask that you should not go for medicine and improve your nutrients,
what is reason for it??
regards
aftab
aftabac
Re: Hepatitis B
thanks for reply
well some doctors suggests that in chronic Hepatitis B you should not go for medicine and try to be careful in nutrition.
what do people suggest in this regard
regards
aftab
