Hepatitis B virus do not need presentation - its statistics tell about it more as there are more than two hundred million infected people in the world (Sundaram and Kowdley, 2015). In many patients hepatitis B infection leads to the development of the liver cirrhosis and other complications, can cause decompensation of the liver function and lead to death. Prevalence and malignant course of this infection make it a major challenge for modern medicine. Reviewed article lists and shows clinically proved and effective methods of the hepatitis B management. The discovery of a vaccine became the turning point in the fight against the virus by significantly reducing the number of new cases of infection with hepatitis B. There are seven serologic markers of hepatitis B virus nowadays. HBsAg - a viral superficial protein that indicates the presence of hepatitis B virus in the blood. Anti-HBs - human antibodies to the HBsAg. Anti-HBc - antibodies against hepatitis B core antigen. IgM point on acute infection and IgG show chronic infection. HBeAg - antigen which is produced during translation of the hepatitis B virus DNA in the infected cells. Anti-HBe - an antibody against that antigen.
The development of the hepatitis B infection can be divided into four main stages. First stage is characterised by immune tolerance against the virus. Since our immune system first meets this HBV antigens it needs time to react to it and start the immune response. Patient has a high level of hepatitis B virus DNA, however, the virus causes minimal inflammatory changes in the hepatocytes and the immune response towards it is also low. In the next stage inflammation of the liver starts and the levels of antibodies rise rapidly. The level of liver enzymes rises depending on the activity of the inflammatory process. After this phase level of liver enzymes fall and so decreases the level of viral DNA and antigens. However, in the blood can be found HBeAg and HBsAg. Finally, there is one more possible stage, during which happens reactivation of the virus even after an absence of the viral antigens.
Unfortunately, nowadays there are few medicines proved effective in treating hepatitis B. One of them is pegylated interferon. Interferon produced in our body by cells when they are infected by the virus. The interaction between interferon and surrounding cells make them more resistant to the virus. This makes it difficult to the virus to rapidly infect big amount of cells. Therefore, interferon is not effective when the virus is not actively replicating and releasing into the exracellular space. However, it is obvious that interferons area of influence is not studied completely. This, in particular, shows a high incidence of side effects of pegylated interferon therapy. Often it is depressions, anemia, fatigue, and pancytopenia (Trépo, Chan and Lok, 2014). Because of that, it is very crucial to correctly estimate the indications which tell us that patient will respond to the treatment properly and it will give us good clinical results. Due to the limitations stated above, treatment with pegilated interferon must be maximally limited in time because of its complications and above written limitations.
Another way of hepatitis B therapy includes the use of nucleotide analogs. The development of this group started with the invention of acyclovir - first medicament with direct antiviral activity. These medicines include lamivudine, entecavir, and tenofovir. In contradistinction to pegylated interferon, these drugs have fewer side effects and are generally safer. Because of that, their use can be more continuous than the use of interferon. Also, this extended duration of the therapy can lead to the delay the onset of cirrhosis and reduce the degree of liver damage. It follows from this conclusion that today all treatments are focused on prevention of hepatitis b virus replication process, but none of them is able to completely free the body from infection. Beside this, in hepatitis B virus lifecycle are many possibly weak links around which is developing new drugs to combat the disease. an important aspect in the treatment of hepatitis B is the presence of the factors which can significantly worsen the disease progression. These factors, for example, include simultaneous human immunodeficiency virus coinfection, pregnancy, and hepatitis delta virus. HIV infection predictably impairs immune system of the patient and, therefore, reduces its resistance to the hepatitis B virus and accelerates the disease progression. For simultaneous treatment of these infections is used a combination of the antiretroviral therapy and nucleotide analogs against hepatitis B virus. Hepatitis D virus does not cause disease itself but worsens the prognosis of the disease outcome when the person is already infected with hepatitis B virus. People, who infected with these two viruses, are more likely to suffer from liver failure during the disease because the damage to the liver, in that case, is much higher. In the case of hepatitis D infection, main strategy of therapy is the use of pegylated interferon. Pregnancy is a subject of much concern in the hepatitis B management. It is so because hepatitis B virus is able to transmit through the placenta and infect the infant. Another complexity of hepatitis B infection in pregnant women is the limitations of the therapy with nucleotide analogs as they can negatively affect the child development.
I think the WHO and national health care systems should pay more attention to hepatitis B virus. It causes a huge concern because of the big amounts of people infected with HBV and because this virus significantly reduces the efficiency and life expectancy of many people. While more and more atention is paid to viruses like Ebola and Zika, people all around the world suffer and die from the complications of hepatitis B. Next aspect of hepatitis B infection is related to the fact that the frequency of hepatitis B infection is very high in poor countries compared to the developed western countries. This suggests that HBV problem can be solved with rising living standards in these countries which include quality medicine, reduction of the illegal drug market and promotion of the protected sex. In addition, it is important to cover with vaccinations certain contingents of the population. People who are in the risk groups such as medical workers, drug adicts, children born from infected women should be vaccinated first of all. Susceptibility to chronic hepatitis and severe damage to such an important internal organ like the liver make the virus a serious problem individually for patients and their families. As infected people are forced to spend large sums of money for medicines and medical care. What is the most interesting about the virus to me is how our immunity, while fighting the virus deals the most severe damage to the hepatocytes. Finally, despite the difficulties in the treatment of this infection, I think that in the future it will be defeated like smallpox.
Sundaram, V. and Kowdley, K. (2015). Management of chronic hepatitis B infection. BMJ, 351(oct21 3), pp.h4263-h4263.
Trépo, C., Chan, H. and Lok, A. (2014). Hepatitis B virus infection. The Lancet, 384(9959), pp.2053-2063.