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TUTORIAL

KLINIK
HEPATITIS B

SYLMI ROSA AMALIA

Seorang pasien datang dengan HBsAg positif dan membawa hasil Lab SGOT 125 dan SGPT 87 .

Persistent Hepatitis B • Two clinical patterns • Chronic liver disease • Elevated LFTS • Abnormal hepatic histology • 20% develop cirrhosis • Asymptomatic carrier • Normal LFTs • Asymptomatic • Near normal liver histology • Both risk development of Hepatocellular Carcinoma .

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Overview HBV HBV has a complex structure DNA polymerase HBV DNA Outer lipid envelope containing surface antigen (HBsAg) Inner protein core (HBcAg) HBsAg HBeAg HBcAg = hepatitis B core antigen Howard C. J Gen Virol 1986. WHO 2002: HBeAg = hepatitis B ‘e’ antigen http://www.who.int/csr/disease/hepatitis/whocdscsrlyo20022/en/index2.html HBsAg = hepatitis B surface antigen (accessed February 2013) .

Hepatitis B Characteristics • A Hepadnaviridae – partially double- stranded DNA virus • HBsAg – stimulates protective antibodies. anti-HBcAg persists for life and is a marker of past infection • HBeAG – a marker of active replication and infectivity . identifies acute infection. a marker for current infection • HBcAg – localized within liver cells.

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Immune control – inactive disease Immune Immune Immune Immune Escape/ Tolerant Clearance Control Reactivation HBeAg+ HBeAg– HBV DNA ALT HBeAg + Inactive Carrier HBeAg – Chronic Hepatitis B Status Chronic HBV Immune control – treatment not required .

■ Secara serologi pemeriksaan yang dianjurkan HBsAg. anti HBe dan HBV DNA. HBeAg. biokimiawi dan histologi. petanda virologi.Diagnosis ■ Diagnosis infeksi hepatitis B kronis didasarkan pada pemeriksaan serologi. .

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Algoritme Terapi HBeAg positif Konsensus PPHI 2012 Jumlah virus dan ALT sebagai acuan terapi .

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Treatment options for CHB Immuno-modulators Antivirals IFN (Lamivudine) PEG-IFN Adefovir Cytokines CD8+ HBV Entecavir Vaccine therapy Telbivudine Tenofovir Emtricitabine [Clevudine] Treatment Combinations Treatment Sequential .

interferon alfa- 2b. pegylated interferon alfa-2a. and telbivudine) are available.Hepatitis B Treatment – For acute infection. treatment is supportive. lamivudine. entecavir. – For chronic infection. no medication is available. several antiviral drugs (adefovir dipivoxil. – Persons with chronic HBV infection require medical evaluation and regular monitoring to determine whether disease is progressing and to identify liver damage or .