1. • Prashiddha Dhakal
• Anju Shah
• Aseem Poudel
• Ashok Sapkota
• Lalit Karki
• Mamta Yadav
• Navin Yadav
• Pratik Kumar
• Sujata Pandey
• Swostika Sedhai

2.  Inflammation of liver parenchyma
INFECTIOUS CAUSE NON-INFECTIOUS
CAUSE
• Hepatotrophic viruses- • Alcohol
HAV,HBV,HCV,HDV,HEV,HGV • Drugs
• Other viruses- • Toxins
Yellow fever virus, CMV • Metabolic
• Bacteria-
Leptospira icterohaemorrhagiae
• Fungus-
Amanita phalloides
• Protozoa
Entamoeba histolytica

3. Hepatitis B Virus
– Hepadnaviridae family
– DNA virus
– Double-shelled particles
– Outer lipoprotein envelope
(surface Ag)
– Inner viral nucleocapsid (core)
– seven genotypes
– four major subtypes.
– All HBV subtypes share one
common antigenic determinant -
"a.“

4. • 42 nm virion, 27nm nucleocapsid core
• Small circular
• 3 particulate forms-spherical, tubular, double
spherical
• HBV DNA codes for 4 sets of viral products

5. Genomic Structure of HBV
Genes Regions Gene products
S S Major protein (S)
S+Pre S2 Middle protein (M)
S+Pre S1 Large protein (L) HBsAg
& S2
C C HBcAg
C+Pre C HbeAg
P DNA polymerase
X HBxAg which contribute in
carcinogenesis by binding
to p53.

8.  Antigen Detection- HBsAg,HBcAg,HBeAg
 Antibody Detection-Anti HBc, Anti-HBe, Anti-HBs
 DNA Detection- HBV DNA

9. Acute Hepatitis B Virus Infection with Recovery
Typical Serologic Course
Titer
HBsAg
0 4 8 12 16 20 24 28 32 36 52 100
Weeks after Exposure

10. Acute Hepatitis B Virus Infection with Recovery
Typical Serologic Course
Titer
HBV DNA
HBsAg
0 4 8 12 16 20 24 28 32 36 52 100
Weeks after Exposure

11. Acute Hepatitis B Virus Infection with Recovery
Typical Serologic Course
HBeAg
Titer
HBV DNA
HBsAg
0 4 8 12 16 20 24 28 32 36 52 100
Weeks after Exposure

12. Acute Hepatitis B Virus Infection with Recovery
Typical Serologic Course
Symptoms
HBeAg
Total anti-HBc
Titer
IgM anti-HBc
HBV DNA
HBsAg
Window
Period
0 4 8 12 16 20 24 28 32 36 52 100
Weeks after Exposure

13. Acute Hepatitis B Virus Infection with Recovery
Typical Serologic Course
Symptoms
HBeAg anti-HBe
Total anti-HBc
Titer
IgM anti-HBc
HBV DNA
HBsAg
0 4 8 12 16 20 24 28 32 36 52 100
Weeks after Exposure

14. Acute Hepatitis B Virus Infection with Recovery
Typical Serologic Course
Symptoms
HBeAg anti-HBe
Total anti-HBc
Titer
IgM anti-HBc
HBV DNA
HBsAg anti-HBs
Window
Period
0 4 8 12 16 20 24 28 32 36 52 100
Weeks after Exposure

15. Treatment and Prevention
 Interferon therapy - For HBeAg +ve carriers with
chronic active hepatitis. Response rate is 30 to
40%.
 Drugs-
 Lamivudine, Adefovir, Entecavir
Vaccination-
 Recombinant vaccines
 genetically engineered by cloning the S gene of
HBV in Baker’s yeast

16. Hepatitis B Immunoglobulin –
 Efficacious within 48 hours of the incident.
 It may also be given to neonates whose mothers are
HBsAg and HBeAg positive.
Other measures –
 Screening of blood donors, blood and body fluid
precautions.

17.  Persons born in hyperendemic areas
 Homosexuals
 Injection drug users
 Patients on dialysis
 HIV infected patients
 Pregnant women
 Family and household contacts and sexual contacts
of HBV-infected persons.

18. • Anju Shah
• Aseem Poudel
• Ashok Sapkota
• Lalit Karki
• Mamta Yadav
• Navin Yadav
• Prashiddha Dhakal
• Pratik Kumar
• Sujata Pandey
• Swostika Sedhai