Hepatitis B and D

Hepatitis B virus (HBV) is a global health problem and major cause of cirrhosis, fulminant hepatitis and hepatocellular carcinoma. Hepatitis D is dependent on HBV for its reproduction. Approximately 5% of the global population is infected with HBV. This translates to over 400 million HBV carriers worldwide. It is estimated that 1.4 million people in the USA have chronic hepatitis B with 46 000 documented new HBV infections in 2006. HBV is transmitted by vertical transmission (perinatal) or horizontal transmission. The key to prevention is elimination of further spread of infection. Persons with chronic HBV infection can be asymptomatic and have no evidence of liver disease, or they can have a spectrum of disease, ranging from chronic hepatitis to cirrhosis or liver cancer. US mortality data for 2000–2003 indicated that HBV infection was the underlying cause of an estimated 2000–4000 deaths annually. The majority of these deaths resulted from cirrhosis and liver cancer. Treatment of chronic hepatitis B is aimed at viral suppression to reduce damage to the liver and its consequences, cirrhosis and HCC, and improve overall survival rate. There are seven drugs currently approved by the Food and Drug Administration (FDA) for treatment of hepatitis B. The general treatment guidelines (EASL and AASLD HBV Guideline recommendations) are reviewed and will provide further information in difficult to treat populations such as compensated/decompensated cirrhotics and treatment during pregnancy.