Introduction< /p>
Viral hepatitis is a liver infectious disease caused by a virus, which is characterized by acute hepatocyte necrosis, degeneration and inflammatory response pathologically. This article mainly reviews hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), Symptoms, diagnosis, treatment and prevention of hepatitis due to hepatitis virus (HEV) and hepatitis G virus (HGV) infection.
One table summary: symptoms, diagnosis, treatment, and prevention of viral hepatitis
Table 1 summarizes the epidemiological data, mode of transmission, signs and symptoms, diagnosis and management of the six types of viral hepatitis.
Table 1 Symptoms, diagnosis, treatment and prevention of viral hepatitis
Note: HBIg, hepatitis B immunoglobulin; HCC, hepatocellular carcinoma; HBeAg, hepatitis B e-antigen; CHB, chronic hepatitis B; HBsAg, hepatitis B surface antigen; NAs, nuclear Glycoside (Acid) Analogs
Methods for the diagnosis and management of CHB
1. Diagnosis
HBV has the highest infection carrier rate in China Hepatitis virus, it is estimated that there are about 70 million cases of chronic HBV infection in China, of which 20 million to 30 million are CHB patients. ChronicHBV infection can be divided into the following categories: chronic HBV carrier status, HBeAg positive CHB, inactive HBsAg carrier status, HBeAg negative CHB , occult HBV infection and hepatitis B cirrhosis.
chronicHBV carrier status: serum HBsAg, HBV DNA, HBeAg, and hepatitis B e antibody (anti-HBe) were positive, but alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were normal, and liver histology was unremarkable.
HBeAg-positive CHB: positive for serum HBsAg, HBeAg, and HBV DNA, persistent or repeated elevation of ALT, or hepatic Histological examination showed hepatic lesions.
InactiveHBsAg carrier status: Serum HBsAg positive, HBeAg negative, anti-HBsAg – HBe positive or negative, HBV DNA undetectable or below the threshold, followed up for more than 3 consecutive times within 1 year, and ALT in the normal range.
HBeAg-negative CHB: serum HBsAg positive, HBeAg negative, HBV DNA positive, persistent or recurrent abnormal ALT, or Liver histology showed hepatitis.
occultHBV infection: Serum HBsAg negative, but serum and/or liver Tissues were positive for HBV DNA.
hepatitis B cirrhosis: current HBV infection (HBsAg positive) or history of chronic HBV infection (previous HBsAg positive >6 months, currently HBsAg negative, anti-HBc positive) and other etiologies + liver cirrhosis excluded.
2. Treatment
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Current antiviral treatment regimens for CHB are mainly drug therapy represented by interferon-α and NAs.
Interferon-alpha: Approved in my country Pegylated interferon-α (Peg-IFN-α) and common interferon (IFN-α) are used for the treatment of CHB. The former only needs to be injected once a week, and its pharmacokinetics and dosing schedule are better than those of the latter. By.
NAs: mainly lamivudine (LAM), Adelphi Divir dipivoxil (ADV), telbivudine (LdT), entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide fumarate (TAF). my country’s “Guidelines for the Prevention and Treatment of Chronic Hepatitis B (2019 Edition)” recommends that the treatment of naïve patients should be the first choice for treatment with potent and low-drug resistant NAs (ETV, TDF, TAF). For patients who are being treated with non-preferred drugs, it is recommended to switch to potent and less resistant drugs to further reduce the risk of drug resistance.
For those who apply ADV, it is recommended to use ETV, TDF or TAF;
Applicants of LAM or LdT,It is recommended to switch to TDF, TAF or ETV;
For those who have LAM or LdT resistance, switch to TDF or TAF;< /p>
For those with ADV resistance, switch to ETV, TDF or TAF;
< span>For combined ADV and LAM/LdT treatment, switch to TDF or TAF.
References:
[1] Odenwald MA, Paul S. Viral hepatitis: Past, present, and future[J]. World J Gastroenterol 2022; 28(14 ): 1405-1429. DOI: 10.3748/wjg.v28.i14.1405
[2] Ge Junbo, Xu Yongjian, Wang Chen, et al. Internal Medicine (Ninth Edition) [M]. People’s Health Publishing House, 2018:388-390.
[3] Chinese Medical Association, Chinese Medical Association Journal, Chinese Medical Association General Practice Branch, et al. Guidelines for Primary Diagnosis and Treatment of Chronic Hepatitis B (Practical Edition·2020)[J]. Chinese Journal of General Practitioners, 2021,20(03):281-289.
[4] Chinese Society of Infectious Diseases, Chinese Society of Hepatology. Guidelines for the prevention and treatment of chronic hepatitis B (2019 edition) [J]. Journal of Clinical Hepatobiliary Diseases, 2019,35(12):2648-2669.