Modern aspects of the natural course of chronic viral hepatitis B

Abstract

Currently there are about 400 million people infected with the hepatitis B virus, including five million people - in Russia. A serious problem is the development of complications of chronic viral hepatitis’ - liver cirrhosis and hepatocellular carcinoma, from which eventually 20-35% of patients die. Undoubtedly, the outstanding science achievement of the XX century was the creation of a genetically engineered vaccine against hepatitis B. The pursued immunizations on a global scale has led to significant results - reduction of the number of cases of acute forms of viral hepatitis B, the frequency of formation of the chronic variant of the disease. Despite these successes, there remains the problem of prevention of the perinatal transmission path. Identified were the risk factors for neonatal infection, amongst which the most significant are the presence of the antigen of the hepatitis B virus, which is not a part of the Dane particles (HBEAg), and the level of viremia prior to delivery. The basis of prevention is an active-passive immunization, which helps prevent infection in infants in 90-95% of cases. Encouraging results (reduction in the risk of infant infection) were obtained in studies of antiviral therapy in the III trimester of pregnancy. The introduction of new molecular biological diagnostic methods (polymerase chain reaction) made it possible to determine the genetic material of the virus in serum and tissues, the presence of mutations and genetic variability of the virus. At present, identified are the factors that determine the progression of the disease, the efficacy of antiviral therapy. Identified are the new variants of the clinical course of viral hepatitis B, depending on the profile of the serological (antigen-antibody) markers. The latent course of viral hepatitis B deserves special attention. The serological feature of this variant is the presence of «isolated» antibodies and/or deoxyribonucleic acid of the virus, or the absence of all markers of hepatitis B. It is obvious that patients with a latent course of infection pose a real threat in spreading viral hepatitis B.