Comprehensive Guide to Pathophysiology and Treatment of Hepatitis B

Abstract

Table of Contents Title page1 Introduction3 Pathophysiology of Hepatitis B4 Pharmacological treatments for Hepatitis B6 Patient education considerations 7 Conclusion 8 Reference List……………………………………………………………………………………..9 Hepatitis B Introduction Hepatitis B is a liver inflammation attributed to alcohol use, drugs/toxins, autoimmune or viral infections. World Health Organization (WHO) defines Hepatitis B as a life-threatening viral infection caused by the hepatitis B virus (HBV). It is an infection that affects the liver leading to acute and chronic disease like liver cancer and cirrhosis that claims many lives (WHO, 2021). Hepatitis B virus is spread through direct contact with the victim, like a mother to child during birth and delivery, blood or other body fluids contact, especially during sex with an infected partner. The virus is also transmitted through exposure to sharp instruments like razor blades, needles, and unsafe injections that have been in contact with an infected person. According to W.H.O. (2019), 230,154 people were living with chronic hepatitis B (C.H.B.), representing 0.9% of Australia's population, a rate that has increased from 0.74% in 2004. W.H.O. estimates 1.5 million infections of hepatitis B and over eight hundred thousand deaths attributed to cirrhosis and liver cancer globally each year. However, WHO (2019) confirms that C.H.B. claimed 427 Australian lives, with 316 and 111 deaths attributed to hepatocellular carcinoma (H.C.C.) and cirrhosis consecutively. Unfortunately, hepatitis B infects all people regardless of age or gender. Children are more prone to chronic hepatitis B. Aboriginals and Torres Strait Islanders contact HBV more than non-indigenous Australians. The essay will offer a thorough discussion of pathophysiology, pharmacological treatments, and patient education consideration of hepatitis B to understand better the origin, impact, and prevention of hepatitis B. Pathophysiology of Hepatitis B HBV introduces physical and biological abnormalities in the affected body, thus the need to analyze how the virus is contacted or transmitted and its effects on the body. HBV is a D.N.A. virus of the Hepadnaviridae family (Mehta, 2021). It is a very hardy virus that can survive on any surface for up to a month but only affects human beings (Peters, 2019). HBV is detected in semen, vaginal mucus, saliva, serum, and tears. It is a virus transmitted sexually and parenterally when victims contact the body fluids or mucous membranes of the infected persons through blood transfusions/blood products, shared needles while injecting drugs, needle sticks, and hemodialysis (Mehta, 2021). The virus is also transmitted perinatally, where 90% of infants of HBeAg-positive women are at a higher risk of contracting infection and chronic Hepatitis B virus in the long run. HBV causes innate and adaptive immune response dysfunction, which involves monocytes, dendritic cells, natural killer cells, and T cells (Li et al., 2019). Monocytes found in peripheral blood and organ tissues are natural immune cells that play a significant role in the innate and acquired immune responses (Li et al., 2019). According to Li et al. (2019), HBV induces suppressive function of the natural and adaptive immune cells, potentially contributing to the persistent HBV mechanism. It is imperative to note that HBV stimulates monocytes' secretion of transforming growth factors while inhibiting the secretion of tumor necrosis factor, thus playing a significant role in the immune parthenogenesis of chronic persistent infection (Li et al., 2019). The higher the level of monocytes in HBV victims, enhance the production of inflammatory cytokines and chemokines, causing liver damage. HBV also induces myeloid-derived suppressive cells differentiation, directly inhibiting T cell response through mechanisms like arginase and indirectly influencing immunomodulatory function by inducing regulatory T cells (Li et al., 2019). N.K. Cells limits liver fibrosis through cytotoxicity of activated H.S.C. thus, the presence of HBV induces suppressive N.K. Cells in liver fibrosis, hence the need for vaccination to limit the occurrence of such physical and biological abnormalities. According to (Mehta, 2021), the incubation period of an acute HBV infection is roughly 12 weeks. Infected persons experience mild illness during this period, with less than 1% experiencing fulminant hepatic failure. For instance, during the prodromal period that occurs immediately after the incubation period, the patient expresses some symptoms like fatigue, malaise, and anorexia' Further experiences may range from right upper quadrant pain due to hepatic inflammation while others experience fever, rash, or arthralgias (Mehat 2021). Mehta further confirms that during the icetric phase, HBV victims develop jaundice and painful hepatomegaly with dark-colored urine and pale-colored stool. Unfortunately, after this phase, the patients experience rapid improvements in symptoms leading to fulminant hepatic failure after some days or weeks, with developments of prolonged illnesses in the long run (Mehta, 2021). It is imperative to note that after the acute infection resolves, most HBV adult and infant victims develop antibodies that fight against H.B. surface antigen. It is after this fight that such a victim ends up recovering fully. However, the percentage of HBV cases develop chronic infection, with about 20% of cases developing cirrhosis and hepatic decomposition and a smaller percentage developing hepatocellular carcinoma (Mehta, 2021). Chronic hepatitis B infection patients can develop positive HBsAg for life, while all H.B. virus infection has the presence of anti-HBc. However, the HBV vaccine helps individuals develop protective anti-HBs as a potential response to HBsAg, thus requiring vaccination during childhood. Pharmacological Treatment of Hepatitis B Blood tests, liver ultrasounds, and liver biopsies are the most potent ways doctors employ to diagnose Hepatitis B and offer appropriate prevention and treatment measures. When a person is exposed to an HBV victim, an immunoglobulin injection serves as the most potent remedy that protects such a person from contracting the virus. However, such an injection provides short-term protection, thus the need for vaccination if a person never received the H.B. vaccine during childhood. In chronic H.B. infection, long-term medication must be administered to the victim throughout their lives. Antiviral medications like entecavir, tenofovir, lamivudine, adefovir, and telbivudine are the most common remedies that help fight the Hepatitis virus (Mo et al., 2021). These types of antiviral medication are taken through the mouth and can fight the virus and slow its ability to damage the liver. Interferon injections alfa-2b (Intro A) is a substance produced by the body to fight the infection that proves a potential remedy for Hepatitis B. Interferon injection is a man-made version of a substance mainly employed on young people with H.B. and women willing to get pregnant for a short period after a finite therapy course (Tang, Yau, and Yu, 2014). A liver transplant is also a potential remedy for fighting hepatitis B. In cases of severe liver damage, a liver transplant is the only viable option where the damaged liver is replaced with a healthy liver. All the medications mentioned above slow the progression of cirrhosis, improve long-term survival, and reduce the incidence of liver cancer among victims. All infants should receive the H.B. vaccine immediately after birth, followed by 2-3 doses of the H.P. vaccine at least four weeks apart to complete a whole vaccination series (WHO). It is also essential to use antiviral prophylaxis to prevent H.B. transmission during birth and vaccination in case of contact with an infected person if a person was not vaccinated during childhood. Patient Education Considerations Make sex safer: It is imperative to know the HBV status of any sexual partner, and in case of any doubts, they need to avoid unprotected sex is essential. If an individual is sexually active, there is the need to tell the sexual partner when infected with HBV and outline the risks of transmitting the infection. In such a case, both the infected and the healthy sexual partner will understand the need to use a latex condom every time they engage in sex and thus engage in safe sex. In unprotected sex, advise the sexual partner to get an HBV test: it is imperative to be considerate after contact with healthy persons infected with HBV. After unprotected sex, advise the sexual partners to get tested for the virus so that in case infected, they reduce transmitting it to other persons. Do not share personal care items: One of the significant ways of transmitting the H.B. virus is through direct contact with sharp objects like razor blades, needles, and toothbrushes, among others; thus, the need to avoid sharing such personal items to limit the chances of transmission from infected to healthy persons. General personal care/hygiene: Eating nutritious meals is one of the primary ways of maintaining a healthy body; thus, the need to eat healthy to fight the effects of HBV in the body. Fruits and, vegetables, and exercises prove essential in maintaining health fitness, thus the need for HBV victims. Avoid alcohol and illegal drugs: Excessive alcohol consumption enhances liver damage. If infected with HBV, avoid alcohol and any other illegal drug or any drug without a doctor's consultation. Conclusion Hepatitis B is a viral disease that leads to liver inflammation. Hepatitis B is preventable through vaccination of infants within 24 hours after birth, followed by 2-3 doses of the H.P. vaccine at least four weeks apart to complete a full dose of vaccination series. The infection is caused by the hepatitis B virus, among other causes like alcohol consumption. HBV infection can be treated using various medications like antiviral medication and liver transplants. However, it is imperative to protect against transmission of this viral infection through vaccination, safe sex, nutritious meals, and avoiding alcohol to ensure healthy liver. References Li, T. Y., Yang, Y., Zhou, G., & Tu, Z. K. (2019). Immune suppression in chronic hepatitis B infection associated liver disease: A review. World journal of gastroenterology, 25(27), 3527. Mehta, P., & Reddivari, A. K. R. (2021). Hepatitis. StatPearls [Internet]. Mo, H., Min, S., Han, A., Jung, I. M., & Ha, J. (2021). Outcome after kidney transplantation in hepatitis B surface antigen-positive patients. Scientific Reports, 11(1), 1-8. Peters, M. G. (2019). Hepatitis B virus infection: What is current and new. Topics in Antiviral Medicine, 26(4), 112. Tang, C. M., Yau, T. O., & Yu, J. (2014). Management of chronic hepatitis B infection: current treatment guidelines, challenges, and new developments. World journal of gastroenterology: W.J.G., 20(20), 6262. World Health Organization, W.H.O. (2019). Doherty.edu.au. Retrieved 17 April 2022, from https://www.doherty.edu.au/uploads/content_doc/National_Surveillance_for_Hepatitis_B_Indicators_2019_final.pdf. World Health Organization. (2021). Hepatitis B. Who. int. Retrieved 17 April 2022, from https://www.who.int/news-room/fact-sheets/detail/hepatitis-b.