Hepatitis B Virus

• Aka, “Serum hepatitis.”
• DNA Hepadnavirus, with an enveloped, icosahedral capsid.
• Antigens

– Surface antigen = HBsAg (outnumbers HBV virions in serum) – Envelope antigen = HBeAg – Core antigens = HBcAg, HBeAg

• Carried in the blood, tissue, and semen

– Transmitted via intravenous drug use, during birth, and is a sexually-transmitted infection. – Chronic carriers facilitates viral spread.

• Clinical course varies depending on the host’s ability to clear the virus.

– Acute infection with resolution. Adults are more often symptomatic, and have “serum sickness-like” problems due to the development of Hypersensitivity Type III reactions. For example, patients can experience rash, vasculitis, joint pain, and renal damage due to immune complex formation. – Chronic infection with liver destruction. Complications include cirrhosis, liver failure, and hepatocellular cancer. Hepatocellular cancer (HHC) is a significant cause of cancer-related mortality.

• Establishment of chronic infection and long-term complications are more likely in neonates.
• Extrahepatic problems (uncommon)

– Glomerulonephritis – Polyarthritis – Polyarteritis nodosa – Guillain-Barre

• Histopathology:

– Chronic infection = "Ground glass" hepatocytes.

• Serological values

– HBV infection = HBsAg Acute = IgM & HBeAg Chronic = IgG. Higher infectivity HbeAg; Lower infectivity Anti-HBeAg – Replication/Infectious = HBeAg – Recovery = Anti-HBs; IgG – Immunized = Anti-HBs

• Vaccine available
• Post-exposure prophylaxis = Hepatitis B immune globulin.
• Chronic infection treatment = antivirals, including entecavir, tenofovir, and others.

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