patient information - hbv 1 patient information - viral hepatitis b (hbv) liver consequences and...
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Patient information - HBV 1
Patient Information Patient Information - Viral Hepatitis B (HBV)- Viral Hepatitis B (HBV)
Liver consequences and management
Patient information - HBV 2
Epidemiology
Impact on the liver?
What is Hepatitis B (HBV)?
Liver Diagnosis: non invasive options
In this Presentation
Patient information - HBV 3
What is Hepatitis B?What is Hepatitis B?
Patient information - HBV 4
How is the virus transmitted?
Hepatitis B is the most common serious liver infection. It is caused by the Hepatitis B virus that attacks the liver
Hepatitis B virus is spread through contact with the blood or other body fluids of an infected person.
A person can become infected by: contact with a mother’s blood and body fluids at the time of birth; contact with blood and body fluids through breaks in the skin such as bites, cuts, or sores; contact with objects that could have blood or body
fluids on them such as toothbrushes or razors; having unprotected sex with an infected person; sharing needles when injecting drugs; being stuck with a used needle on the job.
Patient information - HBV 5
Symptoms
Hepatitis B: “the silent infection”Most people do not have symptomsMost common manifestation are flu like symptomsOnly 1% have severe symptoms while their body attacks the virus
Flu like symptoms Severe symptoms(Life threatening condition, requires medical
attention)
FeverVomiting and mild nauseaMuscle or joint painLoss of appetite
Nausea and vomitingYellow eyes and skin (jaundice)Bloated or swollen stomach
Patient information - HBV 6
Acute or Chronic?
Acute (short-term) illness(90% of hep B cases)
VSVS
Chronic (long-term) infection.(10% of hep B cases)
Clearance within 6 month Virus remaining in blood for more than 6 month
This can lead to:loss of appetite diarrhea and vomitingtiredness jaundice (yellow skin or eyes)pain in muscles, joints, and stomach
Can be very serious, and often leads to:liver damage (cirrhosis) liver cancer death
More common in adults. More common among infants and children.
Children usually do not have acute illness. Infected people can spread HBV to others, even if they don’t appear sick.
Patient information - HBV 7
EpidemiologyEpidemiologyWho is infected?Who is infected?
Patient information - HBV 8
Hepatitis B - EpidemiologyHepatitis B - Epidemiology
To RememberTo Remember
Over 300 millions infection cases worldwide
Hepatitis B remains to often undiagnosed : about 80%
About 1 out of 5 patients is treated after diagnosis
About 50% of treated patient don’t respond to treatment and continue to develop liver injury
Patient information - HBV 9
Hepatitis B - EpidemiologyHepatitis B - Epidemiology
To RememberTo Remember In 2005, about 51,000 people
became infected with hepatitis B.
About 1.25 million people in the United States have chronic HBV infection.
Each year about 3,000 to 5,000 people die from cirrhosis or liver cancer caused by HBV.
Asia ( China) : 10% HBV , most of them not diagnosed
Patient information - HBV 10
Hep B vaccine?
About vaccinesAbout vaccines Prevents hepatitis B disease and its
serious consequences like hepatocellular carcinoma (liver cancer). Therefore, this is the first anti-cancer vaccine.
Medical, scientific and public health communities strongly endorse using hepatitis B vaccine as a safe and effective way to prevent disease and death.
Scientific data show that hepatitis B vaccines are very safe for infants, children, and adults.
Persons allergic to yeast should not be vaccinated with vaccines containing yeast.
Patient information - HBV 11
Impact on the liver?Impact on the liver?
Patient information - HBV 12
Virus Hep BLiver
The Liver disease progression
Inflammation
-presence of inflammatory cells in the liver-change in liver structure-slowed blood circulation
Fibrosis
-scarring of the liver due to excessive liver damage -most apparent clinical
feature: hypertension
Cirrhosis
-liver becomes permanently scarred -alteration of liver
structure-liver function is impaired
Hepatic insufficiency/Liver failure
Hepatocellular carcinoma(Liver cancer) Hemorrhage
Patient information - HBV 13
Virus Hep BLiver
The Liver disease progression
Inflammation
-presence of inflammatory cells in the liver-change in liver structure-slowed blood circulation
Fibrosis
-scarring of the liver due to excessive liver damage -most apparent clinical
feature: hypertension
Cirrhosis
-liver becomes permanently scarred -alteration of liver
structure-liver function is impaired
Hepatic insufficiency/Liver failure
Hepatocellular carcinoma(Liver cancer) Hemorrhage
How to measure liver disease progression?
Patient information - HBV 14
Non-Invasive Non-Invasive liver diagnosis and staging liver diagnosis and staging
Patient information - HBV 15
Traditional method: the liver biopsy
ProProSpecificSensitiveGood diagnostic and prognostic information
ConCon
Invasive and painful (30% of cases)ExpensiveAssociated morbidity (ex: haemorrhage: 3/1.000)Associated mortality (3/10.000)Not 100% reliable
variability due to sample quality as analyses only 1/50.000 of total liver tissue
Siegel 2005; Ratziu 2005; Bateller 2005; Bravo 2001
Patient information - HBV 16
F1
Minimal fibrosis
F2
Moderate fibrosis F4
Cirrhosis
The liver biopsy analyses only 1/50.000° of total liver tissue…. The liver biopsy analyses only 1/50.000° of total liver tissue….
Patient information - HBV 17
… … clearly not enough!clearly not enough!
The very same liver!!The very same liver!!
Bedossa et al, Hepatology 2003
Patient information - HBV 18
The non invasive option: liver Biomarkers
A new Solution to unmet clinical needs: FibroTest Simple, least expensive Accurate Good diagnostic value
for every stage of fibrosis Dynamic assessment: after successful/ failed therapy
Good prognostic value (as good as biopsy) Universal fibrosis marker: validated in all common
liver diseases (83 publications, 33 validations) A Validated screening tool of at risk patients Accepted use in clinical trials
New concept in liver diseases Use of biomarkers validated for the most frequent
chronic liver diseases Public health interest :
SCREENING advanced fibrosis Treatment efficacious , at least for HCV and HBV
USA: “FibroSure”
Patient information - HBV 19
FibroTest in Hepatitis B
Virus Hep BLiver
Inflammation
-presence of inflammatory cells in the liver-change in liver structure-slowed blood circulation
Fibrosis
-scarring of the liver due to excessive liver damage -most apparent clinical
feature: hypertension
Cirrhosis
-liver becomes permanently scarred -alteration of liver
structure-liver function is impaired
ActiTest/ ActiSure (usa)(Part of FibroTest/FirboSure)
Viral inflammation quantification
FibroTest/ FibroSure (usa)Liver fibrosis measurement
Patient information - HBV 20
How to? In 4 easy steps!
Notes Step 1: Patient goes to a prescribing doctor. Step 2: With the prescription, goes to a validated lab (list on www.biopredictive.com ) Step 3: Calculation algorithms and security controls are automatically performed Step 4: Test results delivered within 24 hours
Simple. Reliable. Cost-effective.Simple. Reliable. Cost-effective.