Preventing and treating hepatitis B infection

Abstract

Introduction Hepatitis B virus infection is a global public health problem, with approximately 400 million people chronically infected.1 2 Each year it causes more than 500 000 deaths worldwide. Outcome of acute hepatitis B virus infection ranges from asymptomatic subclinical infection (70%) and symptomatic acute hepatitis (30%) to fulminant hepatic failure (0.1-0.5%).3 A proportion of people infected with hepatitis B virus (5%-10% among adults) progress to chronicity, defined as persistence of infection for more than six months.4 The rate of chronicity is much higher among neonates and children. The spectrum of chronic hepatitis B virus infection ranges from the asymptomatic carrier state to chronic hepatitis B, liver cirrhosis, and hepatocellular carcinoma. The clinical course of hepatitis B virus infection is complex and is influenced by several factors (box 1). Overall, chronic hepatitis progresses to end stage liver disease in 15-40% of patients.5 The pathophysiology of chronic hepatitis B virus infection has been reviewed elsewhere.6 The magnitude and clinical consequences of chronic hepatitis B make a strong case for its prevention and treatment. This review, based on a Medline search and the authors' knowledge arising from their interest in the subject, summarises current knowledge about these aspects of hepatitis B virus infection. Additional educational resourcesInformation for patients Hepatitis B Foundation (www.hepb.org)-Provides information for patients and families, and for healthcare professionals (in English and several other languages) British Columbia Centre for Disease Control. Hepatitis (www.bccdc.org/topic.php?item=59)-Educational material on hepatitis B for patients National Center for Infectious Diseases, Centers for Disease Control and Prevention. Viral hepatitis B (www.cdc.gov/ncidod/diseases/hepatitis/b/index.htm)-Educational material for patients and healthcare professionals on prevention guidelines for hepatitis B National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Hepatitis publications (http://digestive.niddk.nih.gov/ddiseases/pubs/hepatitis/index.htm)-Information for patients on treatment and prevention of various forms of hepatitis. (Some documents are also available in Spanish) About.com. Hepatitis (www.hepatitis.about.com/cs/hepatitisb)-Comprehensive information about hepatitis B treatment, with web links Singapore Ministry of Health. Clinical Practice Guidelines. Chronic hepatitis B infection. April 2003. (www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=3749)-Evidence based information about hepatitis B treatment and prevention Everson GT, Weinberg H . Living with hepatitis B: a survivor's guide. Long Island City, NY: Hatherleigh Press. 2002.-Explains hepatitis B virus, disease associated with this infection, and its prevention and treatment Green WF, Conjeevaram H . The first year-hepatitis B: an essential guide for the newly diagnosed. Emeryville, CA: Marlowe, 2002-Provides current and empathetic information for those wishing to take an active role in their hepatitis B treatment Footnotes A comparison of lamivudine and interferon for initial treatment is on bmj.com Editorial by Beeching Contributors RA helped with literature review, revised drafts, and approved the final manuscript; PR did the literature search, prepared the first draft, revised drafts, and approved the final manuscript. RA is guarantor. Funding None. Competing interests RA has conducted a postmarketing surveillance study of a combined hepatitis A and B vaccine for GlaxoSmithKline and has participated in a drug trial for interferon in hepatitis B and C for Shantha Biotechnics, Hyderabad, India. PR has no competing interests.