Abstract
Hepatitis B virus (HBV) chronically infects approximately 250,000 Canadians and 350 million people worldwide. Without intervention, approximately 15% to 40% of chronically infected individuals will eventually develop cirrhosis, end-stage liver disease or hepatocellular carcinoma, or require liver transplantation. The availability and extensive use of the HBV vaccine has dramatically reduced the number of incident infections in Canada and worldwide. Effective therapeutic agents have been and continue to be developed to treat chronic infection. The present review provides a comprehensive overview of diagnostic tests for HBV infection and immunity, and elaborates on HBV risk factors, vaccine prevention and therapeutic monitoring. HBV diagnosis is accomplished by testing for a series of serological markers of HBV and by additional testing to exclude alternative etiological agents such as hepatitis A and C viruses. Serological tests are used to distinguish acute, self-limited infections from chronic HBV infections and to monitor vaccine-induced immunity. Nucleic acid testing for HBV-DNA is increasingly being used to quantify HBV viral load and measure the effectiveness of therapeutic agents. Given the multitude of available tests and the complexity of clinical management, there is a critical need for greater coordination among clinicians, diagnostic laboratory personnel and researchers to define optimal laboratory diagnostic and monitoring assays so that the appropriate tests are used to maximize prevention and optimize treatment outcomes.
Highlights
Le virus de l’hépatite B (HBV) infecte de façon chronique environ 250 000 Canadiens et 350 millions de personnes dans le monde
Vaccination programs have focused on eliminating perinatal transmission to neonates, where the risk of developing chronic infection is 70% to 95%, and to young infants, where the risk of developing chronic infection is estimated at 30%
Given the perinatal and childhood vaccination programs already in place in North America, most hepatitis B virus (HBV)-infected individuals will likely present with chronic infection
Summary
The present review provides a comprehensive overview of diagnostic tests for HBV infection and immunity, and elaborates on HBV risk factors, vaccine prevention and therapeutic monitoring. Nucleic acid testing for HBV-DNA is increasingly being used to quantify HBV viral load and measure the effectiveness of therapeutic agents. Of the approximately 350 million individuals who are chronically infected with hepatitis B virus (HBV) worldwide, it is estimated that between 206,000 and 280,000 live in Canada [1,2]. Many promising new antiviral agents, such as entecavir, emtricitabine, clevudine, tenofovir, telbivudine and pegylated interferons, are in clinical trials or under development These drugs, perhaps used in combination, hold the promise of resolving chronic infection and its sequelae. Polymerase chain reaction-based tests can use either serum or plasma, while hybridization-based assays (eg, Digene Corporation, USA) recommend the use of serum
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More From: Canadian Journal of Infectious Diseases and Medical Microbiology
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