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The natural history of chronic hepatitis B infection
1Division of Gastroenterology and Hepatology, Queen Mary Hospital, Pokfulam, Hong Kong.
Insights
Chronic hepatitis B infection impacts 300 million globally, particularly Chinese populations. Perinatal immunisation is crucial for preventing chronic hepatitis B virus infection and its severe liver disease complications.
Area of Science:
- Hepatology
- Virology
- Public Health
Background:
- Chronic hepatitis B infection is a significant global health issue, affecting approximately 300 million individuals worldwide.
- The majority of chronic hepatitis B carriers, especially in China, contract the virus during the perinatal period.
- Understanding the natural history of chronic hepatitis B is vital for developing effective control strategies.
Purpose of the Study:
- To elucidate the natural history of chronic hepatitis B infection.
- To highlight the impact of different disease phases on patient outcomes.
- To emphasize the importance of perinatal immunisation in preventing chronic infection.
Main Methods:
- Review of the natural history of chronic hepatitis B infection.
- Analysis of recent revisions in hepatocellular carcinoma classification.
- Consideration of immunohistochemical findings related to biliary markers in hepatocellular carcinoma.
Main Results:
- The natural history includes immune tolerance, immune clearance, and inactive non-replicative phases, potentially leading to cirrhosis and hepatocellular carcinoma.
- Hepatocellular carcinoma with biliary markers is associated with poorer survival compared to those without.
- A fourth phase, characterized by hepatitis B envelope-negative hepatitis B virus replication due to pre-core mutant strains, can occur.
Conclusions:
- Improved understanding of chronic hepatitis B natural history enhances control strategies.
- Perinatal immunisation against hepatitis B virus is a highly effective preventive measure.
- Further research into hepatocellular carcinoma markers may improve patient prognostication.
Abstract:
Chronic hepatitis B infection is a global health problem that affects about 300 million people. Of these, 75% are Chinese. Most Chinese who become chronic carriers, contract the virus during the perinatal period. The natural history of these chronic hepatitis B carriers includes an initial immune tolerance phase, followed by immune clearance and an inactive hepatitis B non-replicative phase with the development of cirrhosis that may be complicated by hepatocellular carcinoma. The classification of hepato-cellular carcinoma has recently been revised. Based on immunohistochemical studies, it has been found that patients with hepatocellular carcinoma and biliary markers have a poorer survival than patients with hepatocellular carcinoma but who have negative biliary markers. Sometimes, a fourth phase, a hepatitis B envelope-negative hepatitis B virus replicative phase, reflecting the emergence of a pre-core mutant strain, may follow. Our improved understanding of the natural history of chronic hepatitis B infection has led to more effective approaches towards the control of this viral infection and its sequelae. Most importantly, immunisation against hepatitis B virus in the perinatal setting has been shown to prevent chronic infection.