13. Chronic Viral Hepatitis in Adults and Children: Hepatitis B

  1. E. Jenny Heathcote MB, BS, MD, FRCP, FRCP(C)2,3,4,5
  1. Jordan J. Feld MD, MPH1,3

Published Online: 4 SEP 2012

DOI: 10.1002/9781118314968.ch13

Hepatology: Diagnosis and Clinical Management

Hepatology: Diagnosis and Clinical Management

How to Cite

Feld, J. J. (2012) Chronic Viral Hepatitis in Adults and Children: Hepatitis B, in Hepatology: Diagnosis and Clinical Management (ed E. J. Heathcote), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118314968.ch13

Editor Information

  1. 2

    Francis Family Chair in Hepatology Research, Toronto, Ontario, Canada

  2. 3

    University of Toronto, Toronto, Ontario, Canada

  3. 4

    Patient Based Clinical Research Division, Toronto Western Research Institute, Toronto, Ontario, Canada

  4. 5

    University Health Network/Toronto Western Hospital, Toronto, Ontario, Canada

Author Information

  1. 1

    Liver Centre, Division of Gastroenterology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada

  2. 3

    University of Toronto, Toronto, Ontario, Canada

Publication History

  1. Published Online: 4 SEP 2012
  2. Published Print: 12 OCT 2012

ISBN Information

Print ISBN: 9780470656174

Online ISBN: 9781118314968

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Keywords:

  • chronic;
  • immunotolerant;
  • immune active;
  • immunosuppression;
  • nucleoside analogue

Summary

Hepatitis B virus (HBV) infection is a major global public health problem with over 400 million people chronically infected worldwide. Most infections are acquired at a young age and start with an immunotolerant period, characterized byhigh levels of viral replication but minimal or no liver damage. Eventually the immune system reacts to the virus, leading to liver damage, which, if left untreated, may progress to cirrhosis and ultimately to liver cancer. Alternatively, many individuals will eventually control viral replication with HBeAg (e-antigen) seroconversion. They may remain with inactive disease or develop HBeAg-negative chronic HBV with progressive liver damage. Treatment for HBV has improved significantly over the past two decades with well-tolerated oral nucleoside analogues as well as peginterferon. Treatment endpoints are still evolving but the ultimate goal is to achieve HBsAg (surface antigen) clearance, which results in excellent long-term outcome. HBV replication is controlled by the immune system and therefore immune suppression, particularly cancer chemotherapy, can lead to HBV flares, The chapter addressed the natural history and goals of therapy of HBV infection