A: The shoe salesman reinforced a common misconception that a tight shoe will eventually become loose. By the time that occurs though, you may have corns and calluses on your feet. If the shoe is tight, there may not be enough space for the second toe. After wearing the shoe, press down with your finger and see. If the toe is jammed up against the front of the shoe, the nail may be damaged during exercise.
Always buy shoes in the evening as your feet are then slightly swollen from the day’s activity. The shoes should be comfortable the minute you try to walk.
Q: I had jaundice last month. I am worried since my wife is pregnant. Do I need to take any precautions?
A: Jaundice is a generic term, which means that the yellow pigment (bilirubin) in your blood has increased and is probably being excreted in your urine, discolouring that too. From your letter I think you meant that you had infective viral hepatitis. This too is of several types A, B, E etc. Hepatitis E is dangerous for pregnant women while hepatitis B can be passed on to the baby. You can prevent hepatitis A and B with immunisation. Consult your physician and your wife’s obstetrician so that steps can be taken to safeguard her health and that of your baby.
In mom mode
Q: I delivered a baby three months ago and have not had my periods as yet. When can I expect to start menstruating again?
A: Menstruation can start one and a half months after delivery or be delayed for a year. Mothers who breastfeed their children tend to start menstruation later. However, ovulation can occur even without it. If you do not wish to become pregnant, use contraception regularly even if you are feeding the baby and have not yet had your periods.
Q: I have diabetes and am on medication. Sometimes my blood sugar is very low and on other days it is very high. Is there a way to control this?
A: Once you have been diagnosed with diabetes and started medication, it is important that you make a few lifestyle changes. You should not abandon your prescribed diet. You need to avoid fasting even on auspicious days. The tablets will work provided your food intake is regular and according to the diet chart provided by your doctor. You need to exercise for 40 minutes a day to increase your body’s efficiency in reducing blood sugar.
Q: Is it safer to chew tobacco instead of smoking it?
A: The harmful chemicals in tobacco are released into the mouth when you chew it. In fact, the risk increases when tobacco combines with the acidic lime in paan. It causes cancer of the throat, mouth, esophagus and stomach. Tobacco in any form — chewed, smoked or as snuff — is harmful.
Hepatitis C is an infectious disease affecting the liver, caused by the hepatitis C virus (HCV). The infection is often asymptomatic, but once established, chronic infection can progress to scarring of the liver (fibrosis), and advanced scarring (cirrhosis) which is generally apparent after many years. In some cases, those with cirrhosis will go on to develop liver failure or other complications of cirrhosis, including liver cancer or life threatening esophageal varices and gastric varices.
Because it can take years, even decades, for symptoms to appear, many people (possibly 100,000 or more) remain unaware they have a problem. By the time they become ill and seek help, considerable damage has been done to the liver. This might have been prevented if the person had been diagnosed earlier.
The hepatitis C virus is spread by blood-to-blood contact. Most people have few, if any symptoms after the initial infection, yet the virus persists in the liver in about 85% of those infected. Persistent infection can be treated with medication, peginterferon and ribavirin being the standard-of-care therapy. Overall, 51% are cured. Those who develop cirrhosis or liver cancer may require a liver transplant, and the virus universally recurs after transplantation.
An estimated 270-300 million people worldwide are infected with hepatitis C. Hepatitis C is not known to cause disease in other animals. No vaccine against hepatitis C is currently available. The existence of hepatitis C (originally “non-A non-B hepatitis“) was postulated in the 1970s and proven in 1989. It is one of five known hepatitis viruses: A, B, C, D, and E.
Elsewhere in the world, hepatitis C is even more common – the World Health Organization estimates that three per cent of the world’s population (about 170 million people) have chronic hepatitis C and up to four million people are newly infected each year.
Hepatitis C is one of several hepatitis viruses and is generally considered to be among the most serious of these viruses. Hepatitis C is passed through contact with contaminated blood — most commonly through needles shared during illegal drug use.
Although there is no vaccine to protect against infection, there is effective treatment available.
In most cases, the initial infection doesn’t cause any symptoms. When it does, they tend to be vague and non-specific.
Possible symptoms of hepatitis C infection include:
*Nausea or poor appetite
*Muscle and joint pains
*Loss of appetite
*Flu-like symptoms (fever, headaches, sweats)
*Alcohol intolerance and pain in the liver area
The most common symptom experienced is fatigue, which may be mild but is sometimes extreme. Many people initially diagnosed with chronic fatigue syndrome are later found to have hepatitis C.
Unlike hepatitis A and B, hepatitis C doesn’t usually cause people to develop jaundice.
About 20-30 per cent of people clear the virus from their bodies – but in about 75 per cent of cases, the infection lasts for more than six months (chronic hepatitis C). In these cases, the immune system has been unable to clear the virus and will remain in the body long term unless medical treatment is given. Most of these people have a mild form of the disease with intermittent symptoms of fatigue or no symptoms at all.
About one in five people with chronic hepatitis C develops cirrhosis of the liver within 20 years (some experts believe that, with time, everyone with chronic hepatitis C would develop cirrhosis but this could take many decades).
Hepatitis C virus is usually transmitted through blood-to-blood contact. One common route is through sharing needles when injecting recreational drugs – nearly 40 per cent of intravenous drug users have the infection and around 35 per cent of people with the virus will have contracted it this way.
Similarly, having a tattoo or body piercing with equipment that has not been properly sterilised can lead to infection.
Before 1991, blood transfusions were a common route of infection. However, since then all blood used in the UK has been screened for the virus and is only used if not present.
Hepatitis C can be sexually transmitted, but this is thought to be uncommon. It can be passed on through sharing toothbrushes and razors. It is not passed on by everyday contact such as kissing, hugging, and holding hands – you can’t catch hepatitis C from toilet seats either.
A very small percentage of pregnant women infected with hepatitis C pass the virus onto their babies. There is a small percentage of hepatitis C positive cases where no identifying risk factor can be determined.
If someone needs a blood transfusion or medical treatment while staying in a country where blood screening for hepatitis C is not routine, or where medical equipment is reused but not adequately sterilised, the virus may be transmitted.
Most people diagnosed with hepatitis C can identify at least one possible factor which may have put them at risk but for some, the likely origin of the infection isn’t clear. Because it can remain hidden and symptomless for so many years, it may be very difficult to think back through the decades to how it might have begun.
The following are the most common risk factors of Hepatitis C:
*Are a health care worker who has been exposed to infected blood
*Have ever injected illicit drugs
*Received a piercing or tattoo in an unclean environment using unsterile equipment
*Received a blood transfusion or organ transplant before 1992
*Received clotting factor concentrates before 1987
*Received hemodialysis treatments for a long period of time
*Were born to a woman with a hepatitis C infection
Hepatitis C infection that continues over many years can cause significant complications, as follows:
*Scarring of the liver tissue (cirrhosis). After 20 to 30 years of hepatitis C infection, cirrhosis may occur. Scarring in your liver makes it difficult for your liver to function.
*Liver cancer. A small number of people with hepatitis C infection may develop liver cancer
*Liver failure. A liver that is severely damaged by hepatitis C may be unable to function.
The diagnosis of hepatitis C is rarely made during the acute phase of the disease, because the majority of people infected experience no symptoms during this phase. Those who do experience acute phase symptoms are rarely ill enough to seek medical attention. The diagnosis of chronic phase hepatitis C is also challenging due to the absence or lack of specificity of symptoms until advanced liver disease develops, which may not occur until decades into the disease.
Chronic hepatitis C may be suspected on the basis of the medical history (particularly if there is any history of IV drug abuse or inhaled substance usage such as cocaine), a history of piercings or tattoos, unexplained symptoms, or abnormal liver enzymes or liver function tests found during routine blood testing. Occasionally, hepatitis C is diagnosed as a result of targeted screening, such as blood donation (blood donors are screened for numerous blood-borne diseases including hepatitis C) or contact tracing.
Hepatitis C testing begins with serological blood tests used to detect antibodies to HCV. Anti-HCV antibodies can be detected in 80% of patients within 15 weeks after exposure, in >90% within 5 months after exposure, and in >97% by 6 months after exposure. Overall, HCV antibody tests have a strong positive predictive value for exposure to the hepatitis C virus, but may miss patients who have not yet developed antibodies (seroconversion), or have an insufficient level of antibodies to detect. Immunocompromised individuals infected with HCV may never develop antibodies to the virus and therefore, never test positive using HCV antibody screening. Because of this possibility, RNA testing (see nucleic acid testing methods below) should be considered when antibody testing is negative but suspicion of hepatitis C is high (e.g. because of elevated transaminases in someone with risk factors for hepatitis C). However, liver function tests alone are not useful in predicting the severity of infection and normal results do not exclude the possibility of liver disease.
Anti-HCV antibodies indicate exposure to the virus, but cannot determine if ongoing infection is present. All persons with positive anti-HCV antibody tests must undergo additional testing for the presence of the hepatitis C virus itself to determine whether current infection is present. The presence of the virus is tested for using molecular nucleic acid testing methods, such as polymerase chain reaction (PCR), transcription mediated amplification (TMA), or branched DNA (b-DNA). All HCV nucleic acid molecular tests have the capacity to detect not only whether the virus is present, but also to measure the amount of virus present in the blood (the HCV viral load). The HCV viral load is an important factor in determining the probability of response to interferon-based therapy, but does not indicate disease severity nor the likelihood of disease progression.
In people with confirmed HCV infection, genotype testing is generally recommended. HCV genotype testing is used to determine the required length and potential response to interferon-based therapy.
People with chronic hepatitis C infection should be seen by a hospital liver specialist who may recommend antiviral drug treatments either as single drug therapy or as combination therapy.
Whether treatment is needed, and if so which type, depends on a number of factors. These include blood tests to identify which strain of hepatitis C infection is present and how well the liver is functioning, and a liver biopsy to establish whether cirrhosis is occurring.
Hepatitis C can be treated with pegylated interferon alpha and ribavirin. These drugs offer the best chance to clear the virus from the body, and are often used together as dual or combination therapy which has been shown to be effective in 55 per cent of cases. Some strains or genotypes of the hepatitis C virus are more likely to respond than others. Even if the virus isn’t completely cleared, the treatments can reduce inflammation and scarring of the liver. They may, however, cause side effects that some people find difficult to tolerate.
Many people also find that complementary and lifestyle approaches help. There is little evidence these can reduce levels of the virus, but they may help to deal with symptoms and improve quality of life.
Several alternative therapies are claimed by their proponents to be helpful for hepatitis C, or are being researched to see if they can be effective treatments. Among them are milk thistle, ginseng, Thymus extract, colloidal silver, licorice root (or its extract glycyrrhizin), lactoferrin, TJ-108 (a mixture of herbs used in Japanese Kampo medicine), schisandra, and oxymatrine (an extract from the sophora root).
In March 2011, the United States National Center for Complementary and Alternative Medicine (NCCAM) wrote:
A review of the scientific evidence on CAM and hepatitis C found the following:
*No CAM treatment has been scientifically proven to successfully treat hepatitis C.
*A 2003 analysis of results from 13 clinical trials testing the effects of various medicinal herbs on hepatitis C concluded that there is not enough evidence to support using herbs to treat the disease.
*Two other reviews that covered a variety of CAM modalities for hepatitis C concluded that conventional therapies are the only scientifically proven treatments for the disease.
*In a 2002 NIH consensus statement on the management of hepatitis C, a panel of medical and scientific experts concluded that “alternative and nontraditional medicines” should be studied. Participants in a 2001 NIH research workshop on the benefits and risks of CAM therapies for chronic liver disease recommended research support for related laboratory and clinical studies.
Current guidelines strongly recommend that hepatitis C patients be vaccinated for hepatitis A and B if they have not yet been exposed to these viruses, as infection with a second virus could worsen their liver disease.
Alcoholic beverage consumption accelerates HCV associated fibrosis and cirrhosis, and makes liver cancer more likely; insulin resistance and metabolic syndrome may similarly worsen the hepatic prognosis. There is also evidence that smoking increases the fibrosis (scarring) rate.
The drug viramidine, which is a prodrug of ribavirin that has better targeting for the liver, and therefore may be more effective against hepatitis C for a given tolerated dose, is in phase III experimental trials against hepatitis C. It will be used in conjunction with interferons, in the same manner as ribavirin. However, this drug is not expected to be active against ribavirin-resistant strains, and the use of the drug against infections which have already failed ribavirin/interferon treatment, is unproven.
There are new drugs under development, like the protease inhibitors (including telaprevir/VX 950), entry inhibitors (such as SP 30 and ITX 5061) and polymerase inhibitors (such as RG7128, PSI-7977 and NM 283), but development of some of these is still in the early phase. VX 950, also known as Telaprevir is currently in Phase III trials. One protease inhibitor, BILN 2061, had to be discontinued due to safety problems early in the clinical testing. Some more modern new drugs that provide some support in treating HCV are albuferon and Zadaxin. Antisense phosphorothioate oligos have been targeted to hepatitis C. Antisense Morpholino oligos have shown promise in preclinical studies however, they were found to cause a limited viral load reduction.
Some studies have shown that HCV viral replication is dependent upon the host factor miR-122. As a result, pharmaceutical companies are developing potential HCV drugs that target miR-122. HCV therapies that target this host factor necessary for viral replication, rather than the virus itself, are promising, as they show little to no potential for viral resistance. One such drug is miravirsen, developed by Santaris Pharma a/s, a locked nucleic acid based miR-122 antagonist in Phase II clinical trials as of late 2010.
Immunoglobulins against the hepatitis C virus exist, and newer types are under development. Thus far, their roles have been unclear, as they have not been shown to help in clearing chronic infection or in the prevention of infection with acute exposures (e.g. needle sticks). They do have a limited role in transplant patients.
In addition to the standard treatment with interferon and ribavirin, some studies have shown higher success rates when the antiviral drug amantadine (Symmetrel) is added to the regimen. Sometimes called “triple therapy”, it involves the addition of 100 mg of amantadine twice a day. Studies indicate this may be especially helpful for “nonresponders” — patients who have not been successful in previous treatments using interferon and ribavirin only. Currently, amantadine is not approved for treatment of hepatitis C, and studies are ongoing to determine when it is most likely to benefit the patient and when it is a risk due to their liver deterioration. Prognosis:-
Most people with hepatitis C infection have the chronic form.
Patients with genotypes 2 or 3 are more likely to respond to treatment than patients with genotype 1.
The chance of removing the hepatitis C virus from the blood with treatment is over 90% for some people. Even if treatment does not remove the virus, it can reduce the chance of severe liver disease.
Many doctors use the term “sustained virologic response” rather than “cure” when the virus is removed from the blood, because it is not known whether this will last a person’s entire life.
Hepatitis C is one of the most common causes of chronic liver disease in the United States today. People with this condition may have:
•Cirrhosis of the liver
•Liver cancer (also called hepatocellular cancer) — may develop in a small number of people with liver cirrhosis
Hepatitis C usually comes back after a liver transplant, which can lead to cirrhosis of the new liver. Prevention:-
There are a number of ways to reduce the risk of the infection being transmitted. Some of them are mentioned below:-
*People with hepatitis C infection should not be allowed to register as an organ or blood donor.
*Stop using illicit drugs. If you use illicit drugs, seek help. If you can’t stop, don’t share needles or other drug paraphernalia.
*Be cautious about body piercing and tattooing. If you choose to undergo piercing or tattooing, look for a reputable shop. Ask questions beforehand about how the equipment is cleaned. Make sure the employees use sterile needles. If employees won’t answer your questions, look for another shop.
*Practice safer sex if you choose to have sex. Don’t engage in unprotected sex with multiple partners or with any partner whose health status is uncertain. Sexual transmission between monogamous couples may occur, but the risk is low.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose
Hepatitis A is a liver disease caused by the hepatitis A virus (HAV).
This form of viral hepatitis also known as infectious hepatitis, due to its ability to be spread through personal contact. Hepatitis A is a milder liver disease than hepatitis B, and asymptomatic infections are very common, especially in children.
According to the World Health Organisation, there are an estimated 1.5 million new cases of illness due to hepatitis A each year worldwide, and many more people become infected without developing symptoms. It’s particularly common in less developed countries where poverty or poor sanitation are important factors.
Africa, northern and southern Asia, parts of South America, and southern and eastern Europe all have high rates of the disease. In these countries almost every adult carries antibodies to hepatitis A suggesting that it is quite usual for people to be exposed to the infection, usually in childhood, and to develop immunity.
The infection isn’t common in the UK, although it’s still the main type of infective hepatitis seen. (There are several other types of viral hepatitis, such as hepatitis B and hepatitis C.) In 2005, for example, there were 457 laboratory reports of confirmed hepatitis A virus (HAV) infection in England and Wales.
The majority of people from the UK who become infected with hepatitis A contract it when abroad in a country where it is very common.
Hepatitis A is an acute infection, rather than chronic (long-term). Rarely, it can cause life-threatening liver damage.Hepatitis A does not cause a carrier state or chronic liver disease. Once the infection ends, there is no lasting phase of illness. However, it is not uncommon to have a second episode of symptoms about a month after the first; this is called a relapse.
The incubation period of the virus before symptoms develop is between two and six weeks. How severely someone is affected varies from person to person. Some may not have any symptoms at all, while others may have just mild symptoms similar to those of a flu-like illness. This is particularly common among infants and young children.
The older someone is, the more severe the infection and symptoms are likely to be.
Possible symptoms include weakness, tiredness, headache, fever, loss of appetite, nausea and vomiting, abdominal pain and diarrhoea and dehydration. These may all occur for a week or more before jaundice appears.
Jaundice occurs in hepatitis infections because the liver becomes unable to remove a substance called bilirubin from the blood. This is a pigment that builds up in the body, causing the skin and whites of the eyes to turn yellow.
HAV is found in the stool (feces) of persons infected with hepatitis A. HAV is usually spread from person to person by putting something in the mouth that has been contaminated with the stool of a person infected with hepatitis A. This is called fecal-oral transmission. Thus, the virus spreads more easily in areas where there are poor sanitary conditions or where good personal hygiene is not observed. Most infections result from contact with a household member who has hepatitis A. Blood-borne infection has been documented but is rare in the United States. The common modes of transmission of hepatitis A are as follows:
•consuming food made by someone who touched infected feces
•drinking water that is contaminated by infected feces (a problem in communities with poor sewage treatment facilities)
•touching an infected person’s feces, which may occur with poor hand washing
•having direct contact in large daycare centers, especially where there are children in diapers
•being a resident of states in which hepatitis A is more common
•sexual contact with an infected person.
*Eating food that was prepared by someone who is infected with hepatitis A and poor hygiene.
*Consuming raw or undercooked shellfish (like oysters or clams).
*Eating raw foods (such as unpeeled fruits or vegetables) and drinking tap water or well water while traveling to countries where hepatitis A is common.
*Living in a community where hepatitis A is common and outbreaks occur (largely a risk factor for young children).
*Living in a house with someone who has hepatitis A.
Lifestyle factors that increase the risk of hepatitis A include:
* Travel to countries where hepatitis A is common.
* Be a man having sex with men.
Hepatitis A symptoms often go unrecognized because they are not specific to hepatitis A, thus a blood test (IgM anti-HAV) is required to diagnose HAV infection. This test detects a specific antibody, called hepatitis A IgM, that develops when HAV is present in the body.
No specific treatment is available for hepatitis A. However, the following guidelines are often recommended:
•Fluids and diet. The best treatment is to make sure that the child drinks a lot of fluids and eats well.
•Rest. The child should rest while he or she has fever or jaundice. When fever and jaundice are gone, activity may be gradually increased as with the healthcare provider’s approval.
•Medications. The body’s immune system fights the HAV infection. Once the child recovers from hepatitis A, the virus leaves the body. Medications, prescription or nonprescription, should not be given without consulting the doctor.
About 15% of people will have a prolonged or relapsing illness lasting up to 9 months. Tragically, a small number of people die when the infection overwhelms the body. This is more likely to happen to people over the age of 60.
A person with hepatitis A should avoid drinking alcohol until their liver is completely back to normal, as alcohol is toxic to liver cells and will slow its recovery.
Ensuring good personal hygiene practices – washing your hands after using the toilet and maintaining good food preparation – is essential in avoiding infection with hepatitis A, especially if you visit a high risk area.
When visiting high-risk countries, it’s a good idea to avoid eating raw or inadequately cooked salads and vegetables, ice cream, unpeeled fruit and shellfish. Also avoid unpasteurised milk and drinks with ice, and check whether tap water is safe to drink before you go.
There’s an effective vaccination to protect people from hepatitis A infection. It’s available from your GP or high street travel centres, who will be able to advise you whether you need it for the country you are visiting. It’s recommended for anyone travelling to the high-risk regions of the world.
Those people who have already had hepatitis A usually have life long immunity.
Viral hepatitis symptoms usually last three weeks to two months but may last up to six months. Children may return to daycare one week after symptoms first appear, with the doctor’s permission. Most children with hepatitis get better naturally without liver problems later in life. However, some children do have subsequent liver problems. For this reason, it is important to keep in close touch with the treating physician and to keep all followup appointments. Chronic, or relapsing, infection does not occur with hepatitis A. In the United States, serious complications are infrequent, and deaths are very rare.
According to the Centers for Disease Control and Prevention (CDC), routine vaccination of children is the most effective way to lower the incidence of hepatitis A nationwide. The CDC encourages implementation of routine hepatitis A vaccination programs for children in the 17 states which have the highest rates of hepatitis A. Hepatitis A vaccine has been licensed in the United States for use in persons two years of age and older. The vaccine is recommended (before exposure to hepatitis A virus) for persons who are more likely to get hepatitis A virus infection or are more likely to get seriously ill if they do get hepatitis A. The vaccines licensed in the United States as of 2004 were HAVRIX(r) (manufactured by Glaxo SmithKline) and VAQTA(r) (manufactured by Merck & Co., Inc).
Parents should teach their children always to wash their hands with soap and water after using the bathroom and before preparing and eating food. Travelers should avoid water and ice if unsure of their purity, or they can boil water for one minute before drinking it.
Short-term protection against hepatitis A is available from immune globulin, a preparation of antibodies that can be given before exposure for short-term protection against hepatitis A and for persons who have already been exposed to HAV. It can be given before and within two weeks after suspected contact with the virus.
The best way to prevent exposure to HAV is good habits in washing hands. Children should wash their hands every time they go to the bathroom. Good handwashing should be enforced at home and at daycare facilities. It is also very important to keep a clean environment, such as clean toilets, bathrooms, and clothing. If a child is diagnosed with HAV, other family members should be treated to prevent spread of the disease. The healthcare provider can help parents to plan treatment for the entire family.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Patients of chronic hepatitis C, who drink three or more cups of coffee daily, have a 53 percent lower risk of liver disease progression than non-coffee drinkers, says a new study
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The study, led by Neal Freedman of National Cancer Institute (NCI), found that patients with hepatitis C related cirrhosis who did not respond to treatment benefited from increased coffee intake. No effect on liver was observed in patients who drank black or green tea.
Hepatitis C virus (HCV) infects approximately 2.2 percent of the world’s population, including three million Americans. A centre for Disease Control and Prevention (CDC) cites HCV as the leading cause of liver transplantation in US, accounting for 8,000 to 10,000 deaths, annually.
This study included 766 participants enrolled in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C) trial who had hepatitis C-related cirrhosis and failed to respond to standard treatment of the anti-viral drugs peginterferon and ribavirin, according to an NCI release.
Participants were seen every three months during the 3.8-year study period to assess clinical outcomes. Liver biopsies were also taken at 1.5 and 3.5 five years to determine the progression of liver disease.
“Results from our study suggest that patients with high coffee intake had a lower risk of disease progression,” said Freedman.
These findings will appear in the November issue of Hepatology
Hepatitis B is the most common serious liver infection in the world. It is thought to be the leading cause of liver cancer.The World Health Organization estimates that hepatitis B infections lead to more than one million deaths every year.
Virus classification:- Group: Group VII (dsDNA-RT) Family: Hepadnaviridae Genus: Orthohepadnavirus Species: Hepatitis B virus
Hepatitis B virus infects the liver of hominoidae, including humans, and causes an inflammation called hepatitis. It is a DNA virus and one of many unrelated viruses that cause viral hepatitis. The disease was originally known as “serum hepatitis” and has caused epidemics in parts of Asia and Africa. Hepatitis B is endemic in China and various other parts of Asia. The proportion of the world’s population currently infected with the virus is estimated at 3 to 6%, but up to a third have been exposed. Symptoms of the acute illness caused by the virus include liver inflammation, vomiting, jaundice, and rarely, death. Chronic hepatitis B may eventually cause liver cirrhosis and liver cancer, a fatal disease with very poor response to current chemotherapy. The infection is preventable by vaccination.
The virus can cause a range of problems, including fever, fatigue, muscle or joint pain, loss of appetite, nausea and vomiting.
Chronic carriers have an increased risk of developing liver disease such as cirrhosis or liver cancer, because the hepatitis B virus steadily attacks the liver.
Chronic carriers will usually have on going inflammation of the liver and may eventually develop cirrhosis and liver cancer.
About 1% of people who are infected develop an extreme form of disease called acute fulminant hepatitis.
This condition can be fatal if not treated quickly. Sufferers may collapse with fatigue, have yellowing of the skin and eyes (jaundice) and develop swelling in their abdomen.
Children are less likely than adults to clear the infection. More than 95% of people who become infected as adults or older children will stage a full recovery and develop protective immunity to the virus. However, only 5% of newborns that acquire the infection from their mother at birth will clear the infection. Of those infected between the age of one to six, 70% will clear the infection.
Acute infection with hepatitis B virus is associated with acute viral hepatitis – an illness that begins with general ill-health, loss of appetite, nausea, vomiting, body aches, mild fever, dark urine, and then progresses to development of jaundice. It has been noted that itchy skin has been an indication as a possible symptom of all hepatitis virus types. The illness lasts for a few weeks and then gradually improves in most affected people. A few patients may have more severe liver disease (fulminant hepatic failure), and may die as a result of it. The infection may be entirely asymptomatic and may go unrecognized.
Chronic infection with Hepatitis B virus may be either asymptomatic or may be associated with a chronic inflammation of the liver (chronic hepatitis), leading to cirrhosis over a period of several years. This type of infection dramatically increases the incidence of hepatocellular carcinoma (liver cancer). Chronic carriers are encouraged to avoid consuming alcohol as it increases their risk for cirrhosis and liver cancer. Hepatitis B virus has been linked to the development of Membranous glomerulonephritis (MGN).
Hepatitis D infection can only occur with a concomitant infection with Hepatitis B virus because the Hepatitis D virus uses the Hepatitis B virus surface antigen to form a capsid. Co-infection with hepatitis D increases the risk of liver cirrhosis and liver cancer. Polyarteritis nodosa is more common in people with hepatitis B infection.
Causes:The disease is caused by the hepatitis B virus (HBV) that attacks the liver. The virus is transmitted through blood and bodily fluids that contain blood.This can occur through direct blood-to-blood contact, unprotected sex, and illicit drug use. It can also be passed from an infected woman to her new-born during the delivery process.
Risk Factor:It is thought that about one in three of the world’s population is infected by HBV.However, about 50% of those who carry the virus never develop any symptoms.
About nine out of ten people infected with HBV will eventually clear the virus from their bodies. But about 5-10% of infected adults will become chronic hepatitis B carriers, often without even knowing it.
Diagnosis:The tests, called assays, for detection of hepatitis B virus infection involve serum or blood tests that detect either viral antigens (proteins produced by the virus) or antibodies produced by the host. Interpretation of these assays is complex.
The hepatitis B surface antigen (HBsAg) is most frequently used to screen for the presence of this infection. It is the first detectable viral antigen to appear during infection. However, early in an infection, this antigen may not be present and it may be undetectable later in the infection as it is being cleared by the host. The infectious virion contains an inner “core particle” enclosing viral genome. The icosahedral core particle is made of 180 or 240 copies of core protein, alternatively known as hepatitis B core antigen, or HBcAg. During this ‘window’ in which the host remains infected but is successfully clearing the virus, IgM antibodies to the hepatitis B core antigen (anti-HBc IgM) may be the only serological evidence of disease.
Shortly after the appearance of the HBsAg, another antigen named as the hepatitis B e antigen (HBeAg) will appear. Traditionally, the presence of HBeAg in a host’s serum is associated with much higher rates of viral replication and enhanced infectivity; however, variants of the hepatitis B virus do not produce the ‘e’ antigen, so this rule does not always hold true. During the natural course of an infection, the HBeAg may be cleared, and antibodies to the ‘e’ antigen (anti-HBe) will arise immediately afterwards. This conversion is usually associated with a dramatic decline in viral replication.
If the host is able to clear the infection, eventually the HBsAg will become undetectable and will be followed by IgG antibodies to the hepatitis B surface antigen and core antigen, (anti-HBs and anti HBc IgG). A person negative for HBsAg but positive for anti-HBs has either cleared an infection or has been vaccinated previously.
Individuals who remain HBsAg positive for at least six months are considered to be hepatitis B carriers. Carriers of the virus may have chronic hepatitis B, which would be reflected by elevated serum alanine aminotransferase levels and inflammation of the liver, as revealed by biopsy. Carriers who have seroconverted to HBeAg negative status, particularly those who acquired the infection as adults, have very little viral multiplication and hence may be at little risk of long-term complications or of transmitting infection to others.
More recently, PCR tests have been developed to detect and measure the amount of viral nucleic acid in clinical specimens. These tests are called viral loads and are used to assess a person’s infection status and to monitor treatment.
Treatment:-Acute hepatitis B infection does not usually require treatment because most adults clear the infection spontaneously. Early antiviral treatment may only be required in fewer than 1% of patients, whose infection takes a very aggressive course (“fulminant hepatitis”) or who are immunocompromised. On the other hand, treatment of chronic infection may be necessary to reduce the risk of cirrhosis and liver cancer. Chronically infected individuals with persistently elevated serum alanine aminotransferase, a marker of liver damage, and HBV DNA levels are candidates for therapy.
There are several drug treatments available to treat hepatitis B.Patients may be put on a four month course of injections of the drug interferon.
An alternative treatment is a drug called lamivudine which is taken orally once a day. Treatment is usually for one year. Sometimes lamivudine is combined with interferon.
Although none of the available drugs can clear the infection, they can stop the virus from replicating, and prevent liver damage such as cirrhosis and liver cancer. Treatments include antiviral drugs such as lamivudine, adefovir and entecavir, and immune system modulators such as interferon alpha. However, some individuals are much more likely to respond than others and this might be because of the genotype of the infecting virus or the patient’s heredity. The treatment works by reducing the viral load, (the amount of virus particles as measured in the blood), which in turn reduces viral replication in the liver.
On March 29, 2005, the US Food and Drug Administration (FDA) approved Entecavir for the treatment of Hepatitis B. On February 25, 2005, the EU Commission approved Peginterferon alfa-2a (Pegasys). On October 27, 2006, telbivudine gained FDA approval. It is marketed under the brand name Tyzeka in the US and Sebivo outside the US. It is approved in Switzerland.
Infants born to mothers known to carry hepatitis B can be treated with antibodies to the hepatitis B virus (hepatitis B immune globulin or HBIg). When given with the vaccine within twelve hours of birth, the risk of acquiring hepatitis B is reduced 95%. This treatment allows a mother to safely breastfeed her child.
Prevention:It can be prevented by the use of a safe and effective vaccine.However, for the 400 million people world-wide who are already carriers of HBV, the vaccine is of no use.
Vaccination: Several vaccines have been developed for the prevention of hepatitis B virus infection. These rely on the use of one of the viral envelope proteins (hepatitis B surface antigen or HBsAg). The vaccine was originally prepared from plasma obtained from patients who had long-standing hepatitis B virus infection. However, currently, these are more often made using recombinant DNA technology, though plasma-derived vaccines continue to be used; the two types of vaccines are equally effective and safe.
Following vaccination Hepatitis B Surface antigen may be detected in serum for several days; this is known as vaccine antigenaemia .
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose. Resources: