Dr. Abonyi Margit PhD SE 1st Medical Clinic Associate Professor. Hepatology-2014

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1 Dr. Abonyi Margit PhD SE 1st Medical Clinic Associate Professor Hepatology-2014

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3 Other virus hepatitis Epstein-Barr vírus Cytomegalo vírus Herpes simplex vírus Coxsackie vírus

4 Hepatitis B vírus Hepadnavírus, diameter: 42nm,DNS

5 Hepatitis B Incubation: mean:30 days (14-45) Transmission: by blood,blood product,vertikal,sexual road Antigens: HBsAg and HBeAg Antibodies:anti-HBs,anti-HBe,anti- HBc,anti-HBc IgM Fulminant:0.5-1% Spontan recovery: 90%

6 Hepatitis B Chronic active hepatitis:10% Cirrhosis: 1%- Vaccination: activ and és passiv

7 Hepatitis B therapy Peginterferon-alfa2a: 180 ug / week/sc 48 weeks Lamivudine:100mg/ day (resistency-ymdd-75% in few years) Adefovir:10 mg/ day (resistency:29%-during 5 years ) Entecavir:1 mg /day (at naive pts:0.5 mg /day) (R:1.2 %) Telbivudine:600 mg/day (R:2-5%-after 1 year) Tenofovir: 300 mg /day( R: not known until yet)

8 Hepatitis B HBeAg + pts:after the HBeAg seroconversion more 12 months HBeAg pts: long time, lifelong,it depends of the HBV DNS PCR results In decompensated cirrhosis:entecavir,tenofovir,adefovir or Telbivudine lifelong treatment!!! Lactate acidosis danger!

9 Hepatitis B In pregnancy: in the last trimester could be treated by hyperimmunserum or Tenofovir or Lamivudine ortelbivudine at the time of the delivery of the babythe mother and baby will be negative, but at the newborn you should give active and passive immunisation

10 Hepatitis B profilaxis Passive: HBIG-high titer anti-hbs treatment 0.1 ml/kg or 5 ml 12 (36) hours after the child birth or exposition Active: 3x- 0., 1., and 6. month ( 10 or 20 ug HBsAg)- effective,if the anti-hbs titer is higher, than 100 IU Before the immunisation we must know about current HBV infection(hbsag, anti-hbc and anti-hbs)

11 Hepatitis D Viroid Diameter:36 nm,rns Together with HBV infection or super - infection after HBV infection Antigen: HDAg Antibody: anti-hdv, anti HDV IgM

12 Hepatitis D Fulminant: % Spontan recovery:50-80% Chronic type:: % Develop cirrhosis: 10 % -25 % No vaccination possibility 300 million HBV +, 5 % HDV+,too!!!

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16 Hepatitis C treatment 2011 Peginterferon alfa 2a or 2b sc./ week and Ribavirin mg / kg per os, /day SVR: Genotype 1,4 ( 48 week th) % Genotype 2,3( 24 week th) % %-of the HCV+ pts is not treated USA: only 15% of HCV+pts is treated!

17 Hepatitis C 2011 or 2012 new treatment possibilities: Boceprevir th. ( 28 and 36 weeks treatment ) SVR: 78-91% Telaprevir th. ( 24 weeks treatment) SVR: %

18 Hepatitis C result -definition RVR: Rapid Virological Response- the HCV RNA PCR is negative in the 4.week of treatment EVR: Early Virological Response-the HCV RNA PCR is negative in the 12. week of the treatment EOT:End of Teatment Response- the HCV RNA PCR is negative of the end of treatment in the 48.week

19 Hepatitis C SVR: Sustained Virological Response- the HCV RNA PCR is negative after 24 weeks of the end of treatment ( in the 72.week)) RGT:Response Guided Therapy-during the treatment we decide to change the treatment knowing the HCV RNA PCR result DAA: Direct Acting Agents: Boceprevir, Telaprevir ( NS 3 protease inhibitors)

20 Hepatitis C IL 28B genetic test C/C good allel,good treatment result C/T worser result T/T - worst result In C/C allel is a spontan recovery possibility-after Ltx (liver transplantation) is also helpful

21 Hepatitis C modern algorytm of treatment 2,3 genotypes, if it is RVR, the th weeks long, 1 genotype:if it is RVR, the therapy 24 or 28 or 36 weeks long, 1 genotype: if it is late response,the PCR is negatíve only at the 24.weeks,the therapy 72 weeks long

22 2011-hepatology centers must done: HCV RNA and HBV DNA PCR- Quantiplex measuring Virus genotypes monitoring IL 28B polymorphism checking Fibroscan and US,FNAB, core biopsy

23 2011 NEW GOALS At the time of diagnosis, later at week 0.,4.,12.,24.,48. and 72. PCR!( 7x)-in HCV+ pts HBV DNA PCR must we measure at the time of the diagnosis and every 6.month of the treatment

24 NASH %, over40 years BMI > 30 kg/m 2 II.DM, glucose intolerancy,niddm HOMA index > 2 Hypertony ALAT-elevated CK-18 fragment is elevated ( U/l)

25 NASH therapy Daily 800 mg E vitamin ACE inhibitors Statins US and Fibroscan is important ACI Doppler UH and Aspirin protect!