Hepatitis B infection: what the primary care doctors should know
Hepatitis B infection is a global public health problem and causes significant morbidity and mortality. The worldwide prevalence of chronic hepatitis B infection is about 400 million people, and it causes 500 thousand deaths each year.1,2 The prevalence of chronic HBV infection is high (>8%) in certain part of Asia and Southeast Asia, including China, Korea, Indonesia, and the Philippines.1-3 In Malaysia about 1.1 million people are thought to be chronically infected with hepatitis B virus. The estimated prevalence of HBsAg among the population is approximately 4.7%. These data are obtained from Malaysian Liver Foundation in 1998.8
Hepatitis B infection is caused by the hepatitis B virus (HBV). The clinical manifestations of HBV infection (Figure 1) range in severity from asymptomatic subclinical infection (70%), symptomatic hepatitis (30%) to fulminant severe hepatitis with liver failure (0.10-0.5%).1,2 Following the exposure to HBV, up to about 10% of the patient will progress to chronic hepatitis B, which is defined as persistence of the infection for more than 6 months duration.5,6 The chronic hepatitis B then progress to liver cirrhosis and hepatocellular carcinoma in about 15-40% of the patients. (copied from article)
Aggarwal R, Ranjan P. Preventing and treating hepatitis B infection. BMJ. 2004 Nov 6;329(7474):1080-6.
Lin KW, Kirchner JT. Hepatitis B. Am Fam Physician. 2004 Jan 1;69(1):75-82.
Lee WM. Hepatitis B virus infection. N Engl J Med. 1997 Dec 11;337(24):1733-45.
Maddrey WC. Hepatitis B: an important public health issue. J Med Virol. 2000 Jul;61(3):362-6.
Ganem D, Prince AM. Hepatitis B virus infection. Natural history and clinical consequences. N Engl J Med. 2004 Mar 11;350(11):1118-29.
Marsano LS. Hepatitis. Prim Care. 2003 Mar;30(1):88-93.
Kao JH, Chen DS. Global control of hepatitis B virus infection. Lancet Infect Dis. 2002 Jul;2(7):395-403.
Lim V, et al. Clinical Practice Guideline on Adult Vaccination. Dec 2003. MOH/P/PAK/67.03(GU).
Liaw YF, Leung N, Guan R, et al. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2005 update. Liver Int. 2005;25(3):472-89.
Perrillo PR, Schiff ER, DavisGL, et al. A randomized, controlled trial of interferon alfa-2b alone and after prednisone withdrawal for the treatment of chronic hepatitis B. N Eng J Med. 1990 Aug 2;323(5):295-301.
Benhamou Y, Katlama C, Lunel F, et al. Effects of lamivudine on replication of hepatitis B virus in HIV-infected men. Ann Intern Med.1996 Nov 1;125(9):705-12.
Lai CL, Chien RN, Leung NW, et al. A one-year trial of lamivudine for chronic hepatitis B. N Eng J Med. 1998 Jul 9;339(2):61-8.
Marcellin P, Chang TT, Lim SG, et al. Adefovir dipivoxil for the treatment of hepatitis B e antigen–positive chronic hepatitis B. N Eng J Med. 2003 Feb 27;348(9):808-16.
Hadziyannis SJ, Tassopoulos NC, Heathcote EJ, et al. Adefovir dipivoxil for the treatment of hepatitis B e antigen–negative chronic hepatitis B. N Eng J Med. 2003 Feb 27;348(9):800-7.
Consensus on the screening for hepatocellular carcinoma and its treatment. Academy of Medicine Malaysia, Ministry of Health Malaysia, 1999.