Chronic HBV infection raises the relative risk of death in women to 1.16 (1.04–1.34) when compared to noncarriers, which is consistent with prior study findings. As a result, life expectancy falls from 82.0 years in noncarriers to 80.1 years in carriers (Figure 3). In men, life expectancy falls from 79.3 years in noncarriers to 77.4 years in carriers.
HBV infection also increases the risk of developing many types of cancer, including hepatocellular carcinoma and cholangiocarcinoma. Cancer is the second most common cause of death in people with chronic hepatitis B.
An effective vaccine against HBV has been available for over 20 years. Despite this fact, there are still about 350 million people worldwide who have evidence of current or past infection with HBV. Unfortunately, despite its effectiveness as a vaccine, few people actually get vaccinated against HBV. The main reason cited by participants in a national survey conducted in 2004 was "fear of needles".
People who do not know they are infected may suffer long-term consequences of HBV infection such as liver damage, cirrhosis, or cancer. It is also possible that they may pass on their infection to others through blood products or sexual contact. Although these outcomes require confirmation by scientific studies, they are considered major complications associated with HBV.
Life expectancy for carriers is projected to be 71.8 years, compared to 76.2 years for noncarriers (Figure 5). These findings are consistent with prior estimates that 15 to 40% of HBV carriers die as a result of liver problems. However, many carriers do not develop serious complications and may even exhibit protective effects against other people's infections. It is possible that antibodies protect some carriers from becoming infected.
HCC is the leading cause of death in those aged 80 to 84, and it affects both men and women equally. Because the e antigen has a 6.27 RR for HCC mortality, e-positive persons are always at risk.
| Input Variablesa | Life expectancy (years) | |
|---|---|---|
| HBV-associated CLD | ||
| Low | 72.5 | 80.5 |
| High | 71.0 | 79.6 |
HBV does not require cell death in order to produce infectious offspring. As a result, whether HBV sensitizes hepatocytes to apoptosis for viral propagation in the liver remains debatable (18,19). It is known that HBx can inhibit apoptosis by interacting with various proteins involved in the induction of apoptosis (20-22). It has also been shown that HBV can induce apoptosis of hepatocytes in vitro and in vivo.
Apoptosis is usually defined as an active process used by organisms to delete damaged or unwanted cells. Apoptosis occurs during normal development processes such as fetal loss or immune system regulation. It also occurs in response to stress signals from within or without the body. Healthy mature cells cannot divide and replace themselves; instead they undergo programmed cell death or apoptosis. Cells that are no longer needed or function abnormally will eventually be cleared by macrophages or other immune cells. Impairment of this process leads to the accumulation of unneeded cells that may cause cancer.
There are two main types of apoptosis: programmed and non-programmed. Programmed cell death involves orders from within the cell itself to commit suicide. This type of apoptosis is important for removing unhealthy or unnecessary cells that could otherwise cause cancer.
Although there is no treatment for HBV at the moment, having the vaccination can help avoid infection. Chronic infections can be treated with antiviral medicine. If persistent HBV begins to cause irreversible liver damage, a liver transplant may enhance long-term survival. The term "D-dimer" refers to a fragment of cross-linked fibrin.
Hepatitis B virus (HBV) causes more than 780,000 deaths every year, mostly from cirrhosis and hepatocellular carcinoma. Effective vaccines are available that protect people against infection with HBV. However, despite this availability, many people worldwide remain unvaccinated or lose immunity after vaccination. This means they are vulnerable to becoming infected with the virus.
In these patients, non-pharmacological approaches should be considered first, such as reducing alcohol consumption if the patient is an alcoholic or using drugs such as methadone which can suppress immune function.
If these measures fail, pharmacotherapy can be used to reduce serum levels of HBV proteins and therefore inhibit viral replication. Interferon alpha is the only drug approved by the US FDA for treatment of chronic HBV. It must be administered under medical supervision daily for several months until antibodies produced by the body fight off the infection.
According to the European Association for the Study of the Liver (EASL), an inactive hepatitis B virus (HBV) carrier state is defined as chronic HBV infection that has been present for at least 6 months, is associated with normal ALT (Alanine aminotransferase), undetectable or very low serum HBV DNA levels below 2000 IU/ml, and is HBeAg negative. An inactive carrier state indicates that the patient's body is able to fight off the infection but cannot do so completely. A small number of patients may develop progressive liver disease over time.
Inactive carriers are not infectious. They can spread the virus to others through contact with infected blood or other bodily fluids though they will not know they are carrying the virus. Inactive carriers are treated the same as people who have healed from acute infection. They must be tested regularly for evidence of re-activation of the virus and any time there is exposure to blood or other bodily fluids they should be given preventive medication.
People who have active hepatitis B may appear healthy but their livers could be suffering damage due to the presence of the virus. Their ALT levels may be high compared to an uninfected person. Active carriers can spread the virus through contact with infected blood or other bodily fluids. They should be treated just like people with acute infection or chronic hepatitis.
New hepatitis B infections are most common among adults aged 30–49 years old, owing to the fact that many people in this age range have not been vaccinated as advised. Children under five are also at risk because they can't tell the difference between a healthy liver and one with chronic hepatitis B.
The virus that causes hepatitis B can also cause serious long-term problems for those who are infected. Infection during adulthood may lead to cirrhosis of the liver, cancer, or death. People who are infected while still babies usually will grow up to be sickly if they are not given the proper treatment immediately after diagnosis. The only cure for hepatitis B is a replacement liver transplant or therapy which restores the patient's immune system to fight off the infection.
Hepatitis C is more likely to cause severe disease in infants born to mothers with hepatitis B or C than it is in adults. This is because their immune systems are not developed enough to fight off the virus that causes it. Most children born with hepatitis C do not know it until they are diagnosed with some other condition, such as diabetes or hemophilia. At that point, they need treatment before their organs begin to fail.
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