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Hepatitis B virus. Hepatitis viruses: A B formerly serum hepatitis C D non A nonB E G. One of the most prevalent infections. Worldwide: 2 out of 6 billion encountered with HBV 350–400 million CHB cases - 4 million new cases/year - >1 million deaths/year. HBV.

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hepatitis b virus

Hepatitis B virus

Hepatitis viruses:

A

B formerly serum hepatitis

C

D non A nonB E G

one of the most prevalent infections
One of the most prevalent infections

Worldwide:

2 out of 6 billion encountered with HBV

350–400 million CHB cases

- 4 million new cases/year

- >1 million deaths/year

slide3
HBV
  • Hepadnavirus
  • semi (relaxed) circular 3.2 kb ds DNA
  • Encodes 7 polypeptides
  • Large amounts of of HBs is released from infected cells
  • HBV genome integrates to host cell chromosome
slide5
Proteins: 4 ORF
  • Two structural proteins: HBs and HBc/HBe
  • Polymerase
  • X protein
  • 3 initiation codons for S: L, M, S
  • 2 inititions codons for C: HBc+e
slide6
S protein contains common antigenic determinan “a”
  • Phenotypes of HBs: adw, ayw*, adr and ayr – 8 serotypes
slide7
In serum with EM:
  • Spherical particles 22 nm
  • Tubuler of filamentous 200 nm long
  • Spherical virions 42 nm (Dane particle)
replication
Replication
  • Attachment and uncoating
  • cccDNA formation in nucleus
  • cccDNA  3.5 kb pregenomic RNA
  • Pregenomic RNA is encapsidated with new HBc and + sense DNA is produced by reverse transcription in Golgi
slide14
Transmission: Through blood and body fluids (semen, saliva, milk, vagina, menstruel secretions and amniotic fluids
  • Vertical transmission
  • Incubation period min 6 weeks
slide15
1/3 of world pop. Has serologic evidence350 M chronically infectedHBV related HCC >1 M deaths and 5-10 % liver transplantations
high risk groups for hepatitis b virus
High-Risk Groups for Hepatitis B Virus
  • People from endemic regions (i.e., China, parts of Africa, Alaska, Pacific Islands)
  • Babies of mothers with chronic hepatitis B virus
  • Intravenous drug abusers
  • People with multiple sex partners, homosexual and heterosexual
  • Hemophiliacs and other patients requiring blood and blood product treatments
  • Health care personnel who have contact with blood
  • Residents and staff members of institutions for the mentally retarded
  • Hemodialysis patients and blood and organ recipients
chronic hepatitis b
Chronic hepatitis B

1. HBsAg-positive 6 months

2. Serum HBV DNA 20,000 IU/mL (10 5copies/mL), lower values 2,000-

20,000 IU/mL (10 4-10 5 copies/mL) are often seen in HBeAg-negative

chronic hepatitis B

3. Persistent or intermittent elevation in ALT/AST levels

4. Liver biopsy showing chronic hepatitis with moderate or severe

necroinflammation

slide31

Resolved hepatitis B

1. Previous known history of acute or chronic hepatitis B or the presence

of anti-HBc anti-HBs

2. HBsAg

3. Undetectable serum HBV DNA*

4. Normal ALT levels

*Very low levels may be detectable using sensitive PCR assays

slide36
IFN-alpha
  • LAmivudin
  • Entacavir
  • Adefovir
  • Tenofovir
  • Telbivudin
hdv prevalence in turkey
HDV prevalence in Turkey

CHB n = 5961 20 %

 1980-1990 31 %

 1991-2000 19.4 %

 2001-2005 11 %

Cirrhosis n= 264 32.5 %

 1980-1990 43.5 %

 1991-2000 26.1 %

 2001-2005 24 %

(

slide39
Viroid
  • HBV dependent
  • 1700 bp ss RNA
  • HBsAg envelope
  • Cellular RNA pol II copies genomik RNA

 Ribozyme  cleaves circular RNA into mRNA for small delta ag

slide40
Delta ag gene is mutated by celular ds RNA activated adenosine deaminase enzyme which allows large delta ag production.
slide41
Percutaneous
  • Blood and blood product transfusion kan ve faktör
  • Person-person
  • Open lesions of the skin
slide52
HCV

Flaviviridae

+ sense ssRNA

About 9000 bp, enveloped

milestones in hcv
Milestones in HCV
  • 1989 cloning of hepatitis C (HCV) genome
  • 1989 developement ofHCV antibody test (ELISA)
  • 1990 HCV viral load test (HCV RNA
  • test)
  • 1998 approval ofInterferon + ribavirin combination therapy

2001 FDA approval of pegylated IFN

slide54
Worldwide 210 million HCV infection
  •  Annual 35.000 new cases
  •  10000-12000 deaths per year
  •  Anti-HCV seropositivity rate in Turkey 0.5 % - 1.8 %
diagnosis
Diagnosis
  • Anti-HCV antibodies

ELISA

RIBA (recombinant immunoblot assay)

HCV RNA

slide65

Fecal-oral transmission

    • HAV (+++)
    • HEV (+++)
  • Parenteral transmission
    • HBV (+++)
    • HCV (+++)
    • HDV (++)
    • HGV (++)
    • HAV (+)
  • Sexual transmission
    • HBV (+++)
    • HDV (++)
    • HCV (+)
  • Perinatal transmission
    • HBV (+++)
    • HCV (+)
    • HDV (+)
  • Sporadic (unknown) transmission
    • HBV (+)
    • HCV (+)