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Chronic Hepatitis B

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Clinical Cases in Hepatology

Abstract

Hepatitis B is a DNA virus (HBV) that causes an acute and chronic infection. The HBV is transmitted vertically from mother to child, from child to child, via sexual contacts, and through percutaneous exposure to blood or other infectious body fluids. Vaccination is fundamental in the prevention of HBV infection.

Chronic hepatitis B is defined by the presence of serum HBV surface antigen for at least 6 months. Chronic hepatitis B can be divided into e antigen-negative and e antigen-positive. The hepatic inflammatory activity can be indirectly reflected by the serum activity of alanine transaminase. It is used to decide on treatment, combined with active viral replication, evaluated by the serum concentration of HBV DNA, considered meaningful if greater than 2000 IU/ml. Follow-up is crucial to identify indications for treatment.

The treatment of chronic hepatitis B with interferon, preferably the pegylated form, recommended for 48 weeks, and the oral antiviral medications, for a prolonged and undefined duration, is associated with suppression of viral replication, seroconversion from e antigen-positive to e antibody status seen with interferon regimes occasionally, and uncommonly with oral drugs. The duration of e antigen-negative chronic hepatitis B treatment is long; no guidelines on treatment specific duration exist. Treatment is associated with regression of liver damage and compensation of liver disease.

Hepatocellular carcinoma is a complication of chronic hepatitis B with and without cirrhosis; thus, screening for this tumor is necessary.

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Acknowledgments

The author acknowledges Dr. Cesar del Rosario for having contributed Figures 7.1 and 7.2.

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  1. Department of Medicine, H+H/Metropolitan, New York, NY, USA

    Nora V. Bergasa

  2. New York Medical College, Valhalla, NY, USA

    Nora V. Bergasa

  3. Hepatology, H+H/Woodhull, Brooklyn, NY, USA

    Nora V. Bergasa

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  1. Department of Medicine, H+H/Metropolitan Physician Affiliate Group of New York, New York, NY, USA

    Nora V. Bergasa

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Bergasa, N.V. (2022). Chronic Hepatitis B. In: Bergasa, N.V. (eds) Clinical Cases in Hepatology. Springer, London. https://doi.org/10.1007/978-1-4471-4715-2_7

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