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Epidemiology and Natural History of Chronic Hepatitis B Virus Infection

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Hepatitis B Virus and Liver Disease

Abstract

Hepatitis B virus (HBV) infection is a major public health issue worldwide despite the availability of an effective vaccine and the development of effective antiviral treatments. The World Health Organization estimates that 248 million people worldwide are chronically infected with HBV, with the highest prevalence in East Asia, sub-Saharan Africa, and the Pacific Islands. Complications of chronic HBV infection include hepatocellular carcinoma, end-stage liver disease, liver transplant, and death, with the risk of these complications varying by mode of transmission and disease duration. Annually, an estimated 650,000 people die from complications of chronic HBV, with 40% of these deaths occurring in Global Vaccine Alliance countries. Perinatal transmission is the leading cause of HBV transmission worldwide, accounting for more than 60% of all childhood-acquired HBV. Implementation of national vaccination programs has significantly decreased prevalence in multiple countries in both Asia and Africa. The initiation of antiviral therapy in pregnant mothers with detectable virus can also reduce the risk of perinatal HBV transmission when combined with vaccination and, where available, HBIG. Chronic HBV is defined as hepatic necroinflammation due to the persistent presence of infection (hepatitis B surface antigen-positive) beyond 6 months and can be divided into at least five major phases of infection. Each phase is associated with characteristic patterns of ALT, HBV DNA levels, hepatitis B e antigen (HBeAg) status, liver histology, and response to antiviral therapy. The age the infection is acquired largely dictates the immune response against acute HBV infection and the subsequent natural history of chronic infection.

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Correspondence to Robert G. Gish M.D. .

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Bogler, Y., Wong, R.J., Gish, R.G. (2018). Epidemiology and Natural History of Chronic Hepatitis B Virus Infection. In: Kao, JH., Chen, DS. (eds) Hepatitis B Virus and Liver Disease. Springer, Singapore. https://doi.org/10.1007/978-981-10-4843-2_4

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