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Hepatitis B is a serious death-defying infection of the liver, which is caused by the hepatitis B virus. It is an example of a major worldwide health issue. The virus may be the reason for chronic infection and poses threat to human life, increasing the risk to die from cirrhosis and hepatic cancer. Hepatitis B virus is a DNA-containing virus belonging to the family of Hepadnaviruses. Different sources estimate that 3 to 6% of people living with hepatitis B worldwide (World Health Organization). The presence of the virus in the human organism is not necessarily accompanied by disease manifestations, but still, such carriers can pass the disease to other people.
Hepatitis B virus is present as Dane particles, which are represented by icosahedral nucleocapsid inside the lipid envelope. The diameter of the virion is about 42 nm (Mayo Clinic). There are 10 different genotypes of the virus: A, B, C, D, E, F, G, H, I, and J. The differences between them may comprise more than 8 % of the DNA sequence. Genotypes A and D are ubiquitous, while genotypes C and B are typical of South-East Asia and Japan. Genotype E is widespread in Africa. Genotype F was found among the indigenous population of South America and Alaska. Genotype G is found sporadically in different parts of the world, particularly in the United States of America and France. Genotypes E and G are characterized by low genetic variability compared to the others. Taking into account the fact that the hepatitis B virus is a DNA virus, it should be noted that its life cycle includes an RNA stage. After penetration into the cell, viral DNA moves into the nucleus, where it is transcribed with the formation of a full-sized pregenomic RNA and three mRNAs. The produced RNA molecules move into the cytoplasm, where t mRNAs are translated, while pregenomic RNA with the polymerase is packaged into the protein capsid. Thus, the virion includes both DNA and polymerase within the protein capsid. The polymerase of the hepatitis B virus is capable of reverse transcription, and viral minus-chain is synthesized on the template of the pregenomic RNA. Also, the virus genome completely or partially can be integrated into the genome of hepatocytes (World Health Organization). It can damage the genes of hepatocytes that lead to liver cancer. It was identified that the virus can be alternatively located in the episomal condition when oncogenic protein X is produced.
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Detection of the Virus
The clinical picture of hepatitis does not allow to distinguish between the causative factors of the disease, and thus, identify, if the disorder was caused by the virus. Therefore, it is extremely important to perform laboratory tests for the correct diagnosis. There are several types of blood tests for diagnosis of hepatitis B and further monitoring of the patients. Also, they can be used to differentiate between acute and chronic infections. Laboratory diagnosis is based on the identification of external antigen of hepatitis B virus HbsAg (World Health Organization). The WHO recommends testing for hepatitis B among all blood donors to prevent the accidental transmission of the virus to recipients.
Description of the Illness
Hepatitis B virus can exist outside the human body for at least 6-7 days. During this time, the virus still preserves the ability to cause the disease, if it reaches the human body. The incubation stage of hepatitis B is about 70-75 days but can vary from 25 to 185 days. The infection can be discovered within one or two months after the entrance of the virus into the body even in the case of chronic hepatitis B. In highly endemic areas, hepatitis B is transmitted from mother to child, which can occur through the placenta, during delivery, or after birth. Horizontal transmission is common during blood transfusion mainly (Mayo Clinic). The risks for chronic infection are high for infants, who have infected mothers.
Chronic hepatitis B can be treated with medication, including oral antiviral drugs. Treatment can decelerate the progression of the disease, decrease the incidence of liver cancer, and improve the outcome in the long-term perspective. The WHO recommends the usage of oral tenofovir or entecavir, as they are the representatives of the most efficient medication suppressing the hepatitis B virus (World Health Organization). Their use rarely leads to resistance compared to other drugs, and their intake regimen is easy to follow by the patients. Moreover, they have few adverse effects and require only minor monitoring. However, this treatment does not cure hepatitis B, as it inhibits replication of the virus only. Therefore, treatment of hepatitis B has to continue for a lifetime. It is possible to treat the disease with injections of interferon, but this approach is rather expensive and is less affordable in developing countries, where the disease is mainly spread.
For the prevention of infection, which is caused by the hepatitis B virus, there is a possibility for vaccination. The vaccine consists of a solution of the major immunogenic protein of hepatitis B virus, HbsAg. Antibodies to this protein appear within two weeks after the vaccine injection (World Health Organization). After the three planned injections, 99% of people develop stable immunity. In many regions with scanty resources, there is still restricted access to diagnosis and medication against hepatitis B, and several people get examined only when their liver disease is already in progress. Liver cancer, which is a common complication of untreated hepatitis B, progresses promptly, and therefore treatment capabilities become limited, which leads to the fatal outcome. In areas with low income, most patients with liver cancer die within several months after diagnosis. In developed states, timely intervention can prolong life even for several years.
Hepatitis B is an infectious liver disease caused by the virus. Infection is spread worldwide, and everyone can be at risk of transmission. Hepatitis B virus is passed mainly through blood. Chronic viral hepatitis B is a serious disease that can lead to serious consequences and death of the affected person. Therefore, it is crucial to recognize and begin treatment of this illness in time. There are vaccines against the virus, which protect from the disease effectively.
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