Advertisement

Liver Diseases pp 173-180 | Cite as

Viral Hepatitis B

  • Dar-In Tai
Chapter

Abstract

Hepatitis B virus (HBV) was first discovered on aboriginal Australians in 1963. Epidemiological studies soon recognized that HBV is a global chronic liver disease, with the highest prevalence rates in Asia and Africa. HBV is highly infectious, and in most cases transmitted from family members. Infections acquired during the perinatal period have a 90% chance of progressing to persistent HBV infection. This rate decreases to 2.3% when infection occurs at college student age. The persistent HBV infection starts with the immune tolerance phase when our immune system may recognize HBV antigens, but does not produce significant inflammation. An immune clearance reaction may develop to terminate HBV replication two to four decades later. When this immune clearance reaction successfully suppresses HBV replication, HBsAg carriers may progress to the residual phase. About 50% of HBsAg carriers ultimately clear HBsAg at age 80. Those patients unable to clear HBV replication smoothly have increased risk of chronic hepatitis, liver cirrhosis, and hepatocarcinogenesis. Current therapies decrease hepatic decompensation and increase survival rate. However, the sustained virologic response rate is lower than 40%. About 50% of patients experience a clinical flare within one year after therapy ends. Further studies will be needed to improve sustained virologic response rate.

Keywords

Hepatitis B virus Immune tolerance Perinatal infection HBV replication Interferon Nucleos(t)ide analogues Chronic hepatitis Hepatic decompensation Liver cirrhosis Hepatocellular carcinoma 

References

  1. 1.
    Liaw Y-F, Zoulim F, editors. Hepatitis B virus in human diseases. New York: Humana Press; 2016.Google Scholar
  2. 2.
    Wen J, Song C, Jiang D, Jin T, Dai J, Zhu L, et al. Hepatitis B virus genotype, mutations, human leukocyte antigen polymorphisms and their interactions in hepatocellular carcinoma: a multi-centre case-control study. Sci Rep. 2015;5:16489.CrossRefGoogle Scholar
  3. 3.
    Lazarevic I. Clinical implications of hepatitis B virus mutations: recent advances. World J Gastroenterol. 2014;20:7653–64.CrossRefGoogle Scholar
  4. 4.
    Beasley RP. Rocks along the road to the control of HBV and HCC. Ann Epidemiol. 2009;19(4):231–4.CrossRefGoogle Scholar
  5. 5.
    Yan H, Zhong G, Xu G, He W, Jing Z, Gao Z, et al. Sodium taurocholate cotransporting polypeptide is a functional receptor for human hepatitis B and D virus. Elife. 2012;1:e00049.CrossRefGoogle Scholar
  6. 6.
    Wieland S, Thimme R, Purcell RH, Chisari FV. Genomic analysis of the host response to hepatitis B virus infection. Proc Natl Acad Sci U S A. 2004;101:6669–74.CrossRefGoogle Scholar
  7. 7.
    Liaw YF. Impact of therapy on the outcome of chronic hepatitis B. Liver Int. 2013;33(Suppl 1):111–5.CrossRefGoogle Scholar
  8. 8.
    Bunchorntavakul C, Reddy KR. Acute liver failure. Clin Liver Dis. 2017;21:769–92.CrossRefGoogle Scholar
  9. 9.
    Tai DI, Tsay PK, Chen WT, Chu CM, Liaw YF. Relative roles of HBsAg seroclearance and mortality in the decline of HBsAg prevalence with increasing age. Am J Gastroenterol. 2010;105:1102–9.CrossRefGoogle Scholar
  10. 10.
    Tai DI, Lin SM, Sheen IS, Chu CM, Lin DY, Liaw YF. Long-term outcome of HBeAg-negative HBsAg carriers in relation to changes of alanine aminotransferase levels over time. Hepatology. 2009;49:1859–67.CrossRefGoogle Scholar
  11. 11.
    Kamatani Y, Wattanapokayakit S, Ochi H, Kawaguchi T, Takahashi A, Hosono N, et al. A genome-wide association study identifies variants in the HLA-DP locus associated with chronic hepatitis B in Asians. Nat Genet. 2009;41:591–5.CrossRefGoogle Scholar
  12. 12.
    Mbarek H, Ochi H, Urabe Y, Kumar V, Kubo M, Hosono N, et al. A genome-wide association study of chronic hepatitis B identified novel risk locus in a Japanese population. Hum Mol Genet. 2011;20:3884–92.CrossRefGoogle Scholar
  13. 13.
    Tai DI, Jeng WJ, Lin CY. A global perspective on HBV-related SNPs and evolution during human migration. Hepatol Commun. 2017;1:1005–13.CrossRefGoogle Scholar
  14. 14.
    Liaw YF. Clinical utility of HBV surface antigen quantification in HBV e antigen-negative chronic HBV infection. Nat Rev Gastroenterol Hepatol. 2019. https://doi.org/10.1038/s41575-019-0197-8.15.
  15. 15.
    World Health Organization. Guidelines on hepatitis B and C testing, Geneva. 2017. http://www.who.int/hepatitis/publications/guidelines-hepatitis-c-b-testing/en/. Accessed Feb 2017.
  16. 16.
    Li X, Zhao J, Yuan Q, Xia N. Detection of HBV covalently closed circular DNA. Viruses. 2017;9(6). pii: E139.CrossRefGoogle Scholar
  17. 17.
    Kennedy PTF, Sandalova E, Jo J, Gill U, Ushiro-Lumb I, Tan AT, et al. Preserved T-cell function in children and young adults with immune-tolerant chronic hepatitis B. Gastroenterology. 2012;143(3):637–45.CrossRefGoogle Scholar
  18. 18.
    Mason WS, Gill US, Litwin S, Zhou Y, Peri S, Pop O, et al. HBV DNA integration and clonal hepatocyte expansion in chronic hepatitis B patients considered immune tolerant. Gastroenterology. 2016;151:986–98.CrossRefGoogle Scholar
  19. 19.
    Kollmann TR, Levy O, Montgomery RR, Goriely S. Innate immune function by Toll-like receptors: distinct responses in newborns and the elderly. Immunity. 2012;37:771–83.CrossRefGoogle Scholar
  20. 20.
    Chang ML, Jeng WJ, Liaw YF. Clinical events after cessation of lamivudine therapy in patients recovered from hepatitis B flare with hepatic decompensation. Clin Gastroenterol Hepatol. 2015;13:979–86.CrossRefGoogle Scholar
  21. 21.
    Mandala M, Fagiuoli S, Francisci D, Bruno R, Merelli B, Pasulo L, et al. Hepatitis B in immunosuppressed cancer patients: pathogenesis, incidence and prophylaxis. Crit Rev Oncol Hematol. 2013;87:12e27.Google Scholar
  22. 22.
    Liaw YF, Tai DI, Chu CM, Chen TJ. The development of cirrhosis in patients with chronic type B hepatitis: a prospective study. Hepatology. 1988;8:493–6.CrossRefGoogle Scholar
  23. 23.
    Chen CJ, Tsay PK, Huang SF, Tsui PH, Yu WT, Hsu TH, et al. Effects of hepatic steatosis on non-invasive liver fibrosis measurements between hepatitis B and other etiologies. Appl. Sci. 2019;9:1961.CrossRefGoogle Scholar
  24. 24.
    Lim JK, Flamm SL, Singh S, Falck-Ytter YT. Clinical Guidelines Committee of the American Gastroenterological Association. American Gastroenterological Association Institute guideline on the role of elastography in the evaluation of liver fibrosis. Gastroenterology. 2017;152:1536–43.CrossRefGoogle Scholar
  25. 25.
    Shiha G, Ibrahim A, Helmy A, Sarin SK, Omata M, Kumar A, et al. Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update. Hepatol Int. 2017;11:1–30.CrossRefGoogle Scholar
  26. 26.
    Ng AWT, Poon SL, Huang MN, Lim JQ, Boot A, Yu W, et al. Aristolochic acids and their derivatives are widely implicated in liver cancers in Taiwan and throughout Asia. Sci Transl Med. 2017;9(412)  https://doi.org/10.1126/scitranslmed.aan6446.CrossRefGoogle Scholar
  27. 27.
    Ahn SM, Jang SJ, Shim JH, Kim D, Hong SM, Sung CO, et al. Genomic portrait of resectable hepatocellular carcinomas: implications of RB1 and FGF19 aberrations for patient stratification. Hepatology. 2014;60:1972–82.CrossRefGoogle Scholar
  28. 28.
    Chen HL, Lee CN, Chang CH, Ni YH, Shyu MK, Chen SM, et al. Taiwan Study Group for the Prevention of Mother-to-Infant Transmission of HBV (PreMIT Study); Taiwan Study Group for the Prevention of Mother-to-Infant Transmission of HBV PreMIT Study. Efficacy of maternal tenofovir disoproxil fumarate in interrupting mother-to-infant transmission of hepatitis B virus. Hepatology. 2015;62:375–86.CrossRefGoogle Scholar
  29. 29.
    Woo ASJ, Kwok R, Ahmed T. Alpha-interferon treatment in hepatitis B. Ann Transl Med. 2017;5:159.CrossRefGoogle Scholar
  30. 30.
    Marcellin P, Lau GK, Bonino F, Farci P, Hadziyannis S, Jin R, et al. Peginterferon alfa-2a alone, lamivudine alone, and the two in combination in patients with HBeAg-negative chronic hepatitis B. N Engl J Med. 2004;351:1206–17.CrossRefGoogle Scholar
  31. 31.
    Agarwal K, Brunetto M, Seto WK, Lim YS, Fung S, Marcellin P, et al. 96 weeks treatment of tenofovir alafenamide vs. tenofovir disoproxil fumarate for hepatitis B virus infection. J Hepatol. 2018;68:672–81.CrossRefGoogle Scholar
  32. 32.
    Jeng WJ, Chen YC, Sheen IS, Lin CL, Hu TH, Chien RN, et al. Clinical relapse after cessation of tenofovir therapy in hepatitis B e antigen-negative patients. Clin Gastroenterol Hepatol. 2016;14:1813–20.CrossRefGoogle Scholar
  33. 33.
    Jeng WJ, Sheen IS, Chen YC, Hsu CW, Chien RN, Chu CM, et al. Off-therapy durability of response to entecavir therapy in hepatitis B e antigen-negative chronic hepatitis B patients. Hepatology. 2013;58:1888–96.CrossRefGoogle Scholar
  34. 34.
    Chang ML, Liaw YF, Hadziyannis SJ. Systematic review: cessation of long-term nucleos(t)ide analogue therapy in patients with hepatitis B e antigen-negative chronic hepatitis B. Aliment Pharmacol Ther. 2015;42:243–57.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Dar-In Tai
    • 1
  1. 1.Liver Research Center, Chang Gung Memorial HospitalLinkou Medical CenterTaoyuan CityTaiwan

Personalised recommendations