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▪ Appears early and ▪ Appears within 3-4 ▪ HBcAg will can not be
usually declines within days of HBsAg detected in blood
6 months ▪ The anti-Hbe will ▪ But anti-HBcAg will
▪ Produces appear within 2nd appear in second
Anti-HBsA-continues month. It indicate viral month, first as IgM
lifelong replication and then as IgG
▪ HBsAg will continue in ▪ Anti-HBc will continue
chronic case till infection is active,
then decline
The antigen-antibody history
of HBV
Viral Load
• HBV-DNA indicates
actives replication
virus, more accurate
than HBeAg
especially in cases of
escape mutant. Used
mainly for monitoring
response therapy.
No Cure! But control of
chronic viral infection
Drugs Goal of treatment
• Pegylated interferon (may cure in • Control of viral load is most
35% cases) important
• With successful treatment,
• Has side effects
the viral load (DNA PCR) is
• May lead to mutants undetectable
• Oral Drugs • Small possibility of mutants
Lamivudine-may lead to mutants with tenofovir/entecavir
• The liver cirrhosis may take
Tenofovir-95% success rate years to develop death may
Entecavir-95% success rate be due to other causes
Hepatitis C Virus Infection
• Clinical entity (non-A, non-B hepatitis) in transfused
patients reported late 1960s
• RNA Flavivirus (Hepacivirus)
• Discovered using recombinant DNA technology 1989
• Bloodborne (primarily) and sexually-transmitted
• Vaccine difficult to develop
• Mutations occur during viral replication
• Substantial heterogeneity (quasispecies) selects for
neutralization escape variants
Global Burden of Hepatitis C