Detection of the surface antigen of the hepatitis B virus: why it is done and what it gives

With hepatitis C, pain occurs due to a long-term inflammatory process in the body. There are often discomforts in the right hypochondrium, joints may become inflamed, and muscles may ache. In addition to pain, other symptoms often appear - changes in the color of stool and urine, loss of appetite, vomiting or nausea, chronic fatigue. If suspicious symptoms are detected, you should undergo a medical examination.

What are antibodies

What are antibodies, what does it mean if they are present in the blood?

To fight viral agents and prevent further development of hepatitis infection, the human immune system, in response to the penetration of pathogenic agents into the blood, begins to actively produce antibodies to hepatitis B or other types of disease.

An antibody test for hepatitis shows how successfully the body’s natural protective function copes with foreign cells.

At their core, antibodies are special protein structures, their action is to protect the body from the causative agent of the disease. What does it mean if, as a result of a laboratory test, antibodies are detected in the blood serum:

• That the liver is affected by a disease that is in the early stages of development. Moreover, the first symptoms of the presence of pathology are still absent.
• That the disease is in the fading stage.
• That hepatitis B is in a chronic form.
• That the liver is affected by viral agents.
• That immunity is formed after recovery.
• The fact that the patient is a carrier of pathogen cells can become a source of infection for surrounding people.

If virus shells and antibodies to its cells are found in the blood fluid, this is not always evidence that the person has hepatitis B or has already had the disease. In some cases, positive results may be a consequence of previous vaccination.

Detection of virus markers may be due to the following factors:

• Dysfunctions in the functioning of the immune system, this may include the progression of various autoimmune pathologies.
• The presence of a tumor-like process in the body.
• Infectious processes in other organs and systems.

In such cases, the results are considered false positive, and the blood will need to be donated again.

Surface antigen

Hepatitis B virus surface antigen is produced by the body in response to the activity of pathological cells. Against this background, experts identify the following anti hbs antibodies:

• Hepatitis surface antigen – characterized by the formation of a viral envelope.
• Nuclear antigen - located in the nuclear protein of the cell.

Surface antigen is a component of the hepatitis B virus and is very persistent. Able to retain its properties, regardless of the environment in which it lives, resistant to very low and high temperature conditions. With its help, the agent is introduced into hepatocytes and further multiplies and progresses the disease.

The antigen penetrates the systemic circulation even before the first clinical manifestations of the disease appear; it can be detected in the blood using a special analysis several weeks after infection.

It is the surface antigen that is a very important link in the formation of an immune response to virus cells.

Nuclear

This agent is part of the protein core of the virus. It can be detected during a liver tissue biopsy procedure. Not found in blood fluid . Such an analysis is carried out infrequently, since the procedure for collecting the studied material is quite labor-intensive.

During the study, the following antigens may be detected:

Normally, the first of them is not present in the blood and is detected during an exacerbation of the disease. It is replaced by a second one, which remains in the blood for a long time.

General information

Hepatitis C is infectious. The causative agent is a specific virus that penetrates the liver tissue through the blood. Pathogenic microorganisms attack healthy cells, preventing them from functioning properly. Subsequently, infected hepatocytes die due to the attack of immune agents produced in response to infection.

The main mechanism of transmission is parenteral. The virus is contained in the patient’s blood, but is capable of penetrating into other biological fluids. Therefore, infection is possible through contact, or less commonly through household routes.

Sources of infection are often unsterile medical instruments, reusable cosmetic devices, and needles. The disease is transmitted vertically from mother to child. The process occurs transplacentally or by passing through the birth canal.

Hepatitis C is one of the most dangerous diseases, since it can occur in a latent form for a long time without pronounced symptoms. The risk of complications due to liver pathology is extremely high. Possible consequences include cirrhosis, oncology, and encephalopathy.

Interpretation of test results

Antibodies to hbsag reflect how hbsag activity develops, progresses, or, conversely, subsides. Anti hbs antibodies are detected in the following situations:

• When a person has suffered from a disease, he or she has developed immunity.
• If titers are detected, the person is a carrier of the virus and has previously suffered from hbs hepatitis.
• Total hbcoreag antibodies can sometimes be detected if a person has undergone a transfusion procedure where the donor was a person who is hbs positive.

If hepatitis is detected and hbsag is positive in the blood sample, this means:

• acute course of the pathological process, in which hbeag constantly increases in the blood under the influence of immunity,
• chronic infection in the body,
• healthy carrier.

With the parallel disappearance of HBsAg and the appearance of anti-HBs, we can say that the body has successfully overcome the disease. If positive nuclear IgM markers are detected, this is a signal of severe liver damage.

At this time, a sick person poses a great risk of infection to the people around him . If IgM subsides, this is a signal of cure.

Characteristics of surface antigen

Hepatitis B has been considered one of the main problems of humanity for many years. The pathology is characterized by massive death of liver cells (hepatocytes). Negative processes arise due to the activity of the inflammatory process, leading to the development of liver failure. The disease can occur without characteristic symptoms, gradually turning into a chronic stage.

Antibodies to hepatitis

Infection occurs through contact with biological material of an infected person. This may be blood, bile, urine or saliva. When diagnosing the disease, laboratory tests for antibodies are performed. After the virus enters the body, the synthesis of protein compounds is observed. They are called antibodies to the virus. The study allows us to determine the nature of the complication of the inflammatory process or determine the quality of the prescribed treatment.

The surface shell of the virus is the HBsAg protein. This is one of the main markers that allows us to determine the nature of infection of the human body. Detection is carried out within 4-6 weeks after exposure to the virus. The method detects infection with maximum accuracy. Cases of rapid disappearance of HBsAg immediately after the onset of symptomatic signs may indicate the initial stage of development of fulminant type hepatitis. If the protein is eliminated for 3 months, a conclusion is made that the patient has recovered. The patient's symptomatic manifestations disappear and metabolic processes are restored. If, after six months, a surface antigen is detected in the biological material, this indicates the transition of the disease to the chronic phase.

A distinctive feature of HBsAg is its persistence. It has the ability to survive in various environments (acidic, alkaline), and can be exposed to high and low temperatures. The characteristics enable the virus to penetrate liver cells and subsequently destroy the internal organ. Protein plays a role in the formation of the body’s own protective functions against hepatitis B. After vaccination, a laboratory blood test can be carried out, but it is not detected in the biological material.

Liver destruction by virus

How is hepatitis B transmitted?

A person becomes a virus carrier long after the symptoms of the disease appear, a week before the end of the incubation period. Outwardly, a person is healthy, but his body fluids contain a pathogen. Hepatitis B is transmitted mainly through blood and sexual contact. Due to the survivability of the virus, it remains on household items and surfaces for a long time. They can actually become infected during dental procedures, instrumental examinations, and when visiting salons that provide cosmetic services that involve special or accidental trauma to the skin. During unprotected sexual intercourse, the pathogen is transmitted through the male seminal fluid; it is found in high concentrations in vaginal secretions. Other body fluids that are potentially dangerous include:

• saliva;
• breast milk;
• tears;
• urine.

You can become infected:

• when kissing, if the mucous membranes of the mouth or lips are damaged;
• during childbirth, the virus enters the baby’s blood through the umbilical cord;
• when caring for a patient, if there are cuts on the hands;
• during instrumental studies of internal organs using untreated equipment.

Types of analyzes

If you suspect the presence of viral hepatitis B in your body, it is important to have an idea not only of what tests are recommended to be taken, but also what preparation is required from the patient. Such activities are carried out in order to obtain the most reliable results in the future. Basic requirements include:

• carrying out a procedure for collecting blood on an empty stomach;
• It is recommended to take the last meal no later than 8–12 hours before the test;
• It is advisable to exclude coffee and tea from the diet a few days before the study, as these drinks can affect the results obtained;
• It is recommended to adhere to fasting days, during which the consumption of fatty, spicy and fried foods is prohibited. Such dishes can provoke the production of enzymes that affect the analysis results.

Approximately 2 weeks before the scheduled procedure, the patient must stop taking medications. If this is not possible, you should inform your doctor.

https://youtu.be/EqIiiiyT6b3Y

If the presence of viral hepatitis in a person’s body is suspected, the patient is sent to donate blood. It's called quantitative analysis. The method allows you to determine the activity of the pathology and the chances of a complete recovery of the patient. During the deciphering process, the doctor receives information regarding the effectiveness of the selected therapy, how susceptible the patient’s body is to the use of antiviral drugs, and whether the patient is ready for therapeutic measures aimed at eliminating the inflammatory process in the liver area. Tests are taken not only if the presence of hepatitis is suspected, but also in preparation for immunization of the body.

Viral hepatitis B. Determination of the form and stage of the disease

Comprehensive study for confirmed hepatitis B virus (HBV). Analysis of infection markers allows us to establish the clinical stage of the disease, the immunological status of the patient, and also evaluate the effectiveness of treatment. Includes the determination of viral proteins (antigens), the main classes of specific antibodies, as well as the detection of viral DNA in the blood.

What biomaterial can be used for research?

How to properly prepare for research?

• Eliminate fatty foods from your diet for 24 hours before the test.
• Do not smoke 30 minutes before the test.

Decoding the results

The HBsAg antigen makes it possible to determine the nature of the development or subsidence of the pathological process. A positive test result may indicate various factors:

• exacerbation of an existing disease in the body;
• transition of pathology to the chronic stage;
• previous blood transfusion procedures, while the donor's biological material contained the HBsAg antigen.

Interpretation of a blood test
Detection of the titer of the main indicators should be carried out in order to determine the need for immunization of the body. It is carried out through the use of a vaccine against hepatitis B. In addition, after vaccination, a person develops long-term immunity. The normal value when interpreting the results corresponds to a quantitative value of 0–10 mIU/ml. The total amount corresponds to the limit value of 500 mcg/ml. A similar indicator corresponds to the number of the body’s own serum proteins. The final result is determined in the format of a positive, negative or doubtful conclusion.

The data must be decrypted by a qualified specialist, and it is important to maintain accuracy and consistency of actions. The establishment of a specific conclusion largely depends on this, since often as a result the patient receives a dubious or false negative result.

What to do if the result is positive

Finding a positive result is a reason to contact a medical specialist. An infectious disease doctor deals with a similar problem. To confirm the diagnosis, a number of additional diagnostic studies are required. After establishing the conclusion, the patient is hospitalized, after which therapy is prescribed.

Repeated blood test

As a rule, after receiving a confirmatory result, the patient is sent for a repeat procedure. This is due to the fact that reagents with inappropriate antibodies may have been used in the study. Detection of an antigen to the hepatitis B virus is not a reason to panic. Modern methods of therapy make it possible to eliminate pathology even in the most advanced stages. Patients in childhood suffer more severely from the disease. Often it can go into a chronic phase.

The surface antigen HBsAg is one of the markers of hepatitis B. Its detection in human blood indicates the need for laboratory tests, since the data obtained from one marker are not able to provide complete information regarding the existing pathology. The subsequent course of the disease and the effectiveness of the selected treatment depend on the activity of the patient’s actions. The therapy requires patience from the patient, as it is long-term. You should not neglect medical recommendations, this reduces the chances of getting rid of the disease.

Hepatitis B

- an anthroponotic viral disease caused by a pathogen with pronounced hepatotropic properties - the hepatitis B virus (in the specialized literature it can be referred to as “HB virus”, HBV or HBV) from the hepadnavirus family.

Hepatitis B surface antigen was discovered in 1964 by the American physician and virologist Baruch Samuel Blumberg while studying blood samples from an Australian aboriginal, who subsequently received the Nobel Prize in Physiology or Medicine in 1976 for his research on hepatitis B.

The virus is extremely resistant to various physical and chemical factors: low and high temperatures (including boiling), repeated freezing and thawing, and prolonged exposure to an acidic environment. In the external environment at room temperature, the hepatitis B virus can persist for up to several weeks: in blood stains, on a razor blade, or the end of a needle. In blood serum at a temperature of +30°C, the infectivity of the virus persists for 6 months, at a temperature of −20°C for about 15 years; in dry plasma - 25 years. Inactivated by autoclaving for 30 minutes, dry heat sterilization at 160°C for 60 minutes, heating at 60°C for 10 hours.

Epidemiology [edit | edit code]

Hepatitis B virus (HBV) infection remains a global health problem, and it is estimated that approximately 2 billion people worldwide have been infected with the virus, with more than 350 million people affected.

The mechanism of infection transmission is parenteral. Infection occurs through natural (sexual, vertical, household) and artificial (parenteral) routes. The virus is present in the blood and various biological fluids - saliva, urine, semen, vaginal secretions, menstrual blood, etc. The contagiousness (infectiousness) of the hepatitis B virus is 50-100 times higher than that of HIV [2] [3]: the infectious dose is 0.0000001 ml of serum containing HBV [4].

Sexual tract [edit | edit code]

In recent years, sexual transmission of the virus has become increasingly important in developed countries, which is due, firstly, to a decrease in the importance of the parenteral route (the emergence of disposable instruments, the use of effective disinfectants, early detection of sick donors), and secondly, the so-called “sexual revolution": frequent changes of sexual partners, the practice of anal intercourse, accompanied by greater trauma to the mucous membranes and, accordingly, an increased risk of the virus entering the bloodstream. At the same time, infection through kissing, transmission of infection through mother's milk, and spread by airborne droplets are considered impossible [5]. The spread of drug addiction also plays a big role, since intravenous drug addicts are a high-risk group and, importantly, they are not an isolated group and easily engage in promiscuous unprotected sexual relations with other people. Approximately 16-40% of sexual partners become infected with the virus during unprotected sex. [ source not specified 3720 days

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Vertical path [edit | edit code]

Of great importance in countries with intensive circulation of the virus (high incidence) is both the transplacental route of transmission, when the child is infected by the mother, and contact, when infection occurs during childbirth while passing through the birth canal. The activity of the infectious process in the mother’s body is of great importance. Thus, with a positive HBe antigen, which indirectly indicates a high activity of the process, the risk of infection increases to 90%, while with a single positive HBs antigen, this risk is no more than 20%. [ source not specified 3720 days

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Everyday way [edit | edit code]

With the domestic route of infection, infection occurs in the family, immediate environment and in organized groups. Danger comes from the use of shared razors, blades, manicure and bath accessories, toothbrushes, towels, etc. Dangerous are any microtraumas to the skin or mucous membranes with objects, as well as contact with them with a damaged surface (abrasions, cuts, cracks, inflammation of the skin, punctures , burns, etc.), on which there is even a small amount of infected biological fluids (blood, sperm, saliva).

Parenteral route [edit | edit code]

The parenteral route is carried out through medical, laboratory instruments and medical products contaminated with HBV. Infection with viral hepatitis B can also occur through transfusions of blood and/or its components in the presence of HBV.

In the transmission of viral hepatitis B, a significant place is occupied by non-medical invasive procedures in consumer service organizations (hair salons, manicure, pedicure, cosmetology), in tattoo, piercing and other invasive procedures [4].

Over time in Russia, the age structure of patients with acute viral hepatitis B is changing significantly. If in the 70-80s, 40-50 year old people were more likely to suffer from serum hepatitis, then in recent years, from 70 to 80% of people with acute hepatitis B are young people aged 15-29 years. [ source not specified 3720 days

]

Current [edit | edit code]

The incubation period (time from infection to the onset of symptoms) of hepatitis B averages 12 weeks, but can range from 2 to 6 months. The infectious process begins from the moment the virus enters the blood. After viruses enter the liver through the blood, there is a latent phase of reproduction and accumulation of viral particles. When a certain concentration of the virus is reached in the liver, acute hepatitis B develops. Sometimes acute hepatitis goes almost unnoticed for a person and is discovered by chance, sometimes it occurs in a mild anicteric form - manifested only by malaise and decreased performance. Researchers believe that the asymptomatic course, the anicteric form and the “icteric” hepatitis form equal groups in terms of the number of affected individuals. That is, identified diagnosed cases of acute hepatitis B account for only one third of all cases of acute hepatitis. According to other researchers, for one “icteric” case of acute hepatitis B, there are from 5 to 10 cases of diseases that usually do not come to the attention of doctors. Meanwhile, representatives of all three groups are potentially infectious to others.

Acute hepatitis either gradually disappears with the elimination of the virus and the leaving of stable immunity (liver function is restored after a few months, although residual effects can accompany a person throughout his life), or becomes chronic.

Chronic hepatitis B occurs in waves, with periodic (sometimes seasonal) exacerbations. In the specialized literature, this process is usually described as the phase of integration and replication of the virus. Gradually (the intensity depends on both the virus and the human immune system) hepatocytes are replaced by stromal cells, fibrosis and cirrhosis of the liver develop. Sometimes a consequence of chronic HBV infection is primary cell carcinoma of the liver (hepatocellular carcinoma). The addition of the hepatitis D virus to the infectious process dramatically changes the course of hepatitis and increases the risk of developing cirrhosis (as a rule, liver cancer does not have time to develop in such patients).

It is worth paying attention to the following pattern: the earlier a person gets sick, the higher the likelihood of chronicity. For example, more than 95% of adults who contract acute hepatitis B recover. And of newborns infected with hepatitis B, only 5% will get rid of the virus. Of the infected children aged 1-6 years, about 35% will become chronic.

Pathogenesis

For the virus to penetrate, it is sufficient for the contaminated environment or object to come into contact with microscopic wounds on the skin and mucous membranes of a person. With the bloodstream, the pathogen spreads throughout the body and enters the liver, where it integrates into its cells, making them factories for the production of new viruses. The immune system begins to perceive its own liver cells as foreign. Thus, the virus itself does not have a destructive effect, but causes an aggressive immune response.

Dead liver cells are replaced by fibrous tissue, eventually leading to cirrhosis. The organ no longer fulfills its functions of detoxification and bile production, which leads to liver failure.

Clinic [edit | edit code]

All symptoms of viral hepatitis B are caused by intoxication due to a decrease in the detoxification function of the liver and cholestasis - a violation of the outflow of bile. Moreover, it is assumed [ by whom?

] that in one group of patients exogenous intoxication prevails - from toxins coming from raw food or formed during digestion in the intestines, and in another group of patients endogenous intoxication prevails - from toxins formed as a result of metabolism in their own cells and during necrosis of hepatocytes.

Since nervous tissue, in particular neurocytes of the brain, is sensitive to any toxins, a cerebrotoxic effect is primarily observed, which leads to increased fatigue, sleep disturbance (in mild forms of acute and chronic hepatitis), and confusion up to hepatic coma (in massive necrosis of hepatocytes or the last stages of liver cirrhosis) Do not confuse cause with effect? Liver function is impaired - removal of toxins - toxins affect nerve cells.

In the late stages of chronic hepatitis, with extensive fibrosis and cirrhosis, the syndrome of portal hypertension, aggravated by vascular fragility due to a decrease in the synthetic function of the liver, comes to the fore. Hemorrhagic syndrome is also characteristic of fulminant hepatitis.

Sometimes polyarthritis develops with hepatitis B.

Symptoms

The early stages proceed without any discomfort. There are no manifestations characteristic of hepatitis indicating liver disorders. The disease progresses sluggishly for a long time - during this period the patient experiences weakness and fatigue. As the affected area increases, a different clinical picture appears. Intense symptoms appear due to intoxication caused by impaired liver function.

Characteristic features:

• Lack of appetite.
• Nausea, vomiting.
• Dizziness.
• Fever.
• Chills.
• Cold sweat.
• Headache.
• General malaise.

Subsequently, jaundice, characteristic of hepatitis, occurs. The phenomenon is accompanied by a violation of skin pigmentation. It takes on a brown tint, which is explained by excess bilirubin in the blood, which should normally be excreted from the body as part of bile. Also, severe itching, swelling, and rashes are observed on the skin.

It is important to know! During exacerbations, joint pain is often diagnosed with hepatitis C. The syndrome can also be localized in the muscles.

An unpleasant stabbing sensation in the side is a sign of stagnation of bile in the liver. Exacerbations occur with pronounced clinical manifestations. However, during remission the patient does not experience severe symptoms.

Diagnostics [ edit | edit code ]

In Russia, doctors of all specialties, paramedical workers of treatment and preventive institutions, regardless of the form of ownership and departmental affiliation, as well as children's, adolescent and health institutions, identify patients with acute and chronic forms of hepatitis B, carriers of HBV on the basis of clinical, epidemiological and laboratory data when providing all types of medical care. Serological screening of groups of people at high risk of infection is carried out [4].

In the initial diagnosis based on clinical data, it is impossible to distinguish hepatitis B from hepatitis caused by other viral agents, therefore laboratory confirmation of the diagnosis is extremely important. There are several types of blood tests to diagnose and monitor people with hepatitis B. These tests can be used to distinguish between acute and chronic infections [6] . The final diagnosis is made after laboratory tests (liver function indicators, signs of cytolysis, serological markers, isolation of viral DNA).

Diagnostic markers of HBV infection [edit | edit code]

To make a diagnosis, serological markers of hepatitis B virus infection (HBsAg, anti-HBcIgM, anti-HBc, anti-HBs, HBeAg, anti-HBe) and viral DNA (HBV-DNA) should be identified. In the body of people infected with the hepatitis B virus, surface HBsAg, E-antigen (HBeAg) and antibodies to these antigens, as well as virus-specific DNA (HBV-DNA) can be detected at different frequencies and at different stages. [4]

Differential diagnosis [edit | edit code]

Typically, viral hepatitis B is not difficult to diagnose correctly. Difficulties arise only with super- and coinfections (when it is difficult to isolate the currently active agent), as well as in the presence of non-infectious diseases of the liver and bile ducts.

Markers anti-HBe, anti-HBc IgM and anti-HBc IgG

Using anti-HBc IgM and anti-HBc IgG, the nature of the infection is determined. They have one undoubted advantage. The markers are found in the blood during the serological window - at the moment when HBsAg has disappeared, anti-HBs have not yet appeared. The window creates conditions for obtaining false negative results when analyzing samples.

The serological period lasts 4-7 months. The immediate appearance of antibodies after the disappearance of foreign protein molecules is considered a poor prognostic factor.

IgM anti-HBc marker

With the acute development of infection, IgM anti-HBc antibodies appear. Sometimes they act as one single criterion. They are also found in cases of aggravated chronic forms of the disease.

It is not easy to detect such antibodies to an antigen. In a person suffering from rheumatic diseases, when examining samples, false positive values ​​are obtained, which leads to erroneous diagnoses. If the IgG titer is high, anti-HBcor IgM is in short supply.

IgG anti-HBc marker

After IgM disappears from the blood, anti-HBc IgG is detected in it. After a certain period of time, IgG markers will become the dominant species. They remain in the body forever. But they do not show any protective properties.

This type of antibody, under certain conditions, remains the only sign of infection. This is due to the formation of mixed hepatitis, when HBsAg is produced in negligible concentrations.

HBe antigen and markers for it

HBe is an antigen that indicates the reproductive activity of viruses. It indicates that the virus actively reproduces due to the construction and doubling of the DNA molecule. Confirms the severe course of hepatitis B. When anti-HBe proteins are detected in pregnant women, a high probability of abnormal fetal development is assumed.

Determination of markers for HBeAg serves as evidence that the patient has begun the process of recovery and removal of viruses from the body. In the chronic stage of the disease, detection of antibodies indicates positive dynamics. The virus stops reproducing.

An interesting phenomenon occurs during the development of hepatitis B. The titer of anti-HBe antibodies and viruses rises in the patient's blood, but the amount of HBe antigen does not increase. This situation indicates a mutation of the virus. In case of such an abnormal phenomenon, the treatment regimen is changed.

In people who have had a viral infection, anti-HBe remains in the blood for some time. The disappearance period lasts from 5 months to 5 years.

Treatment [edit | edit code ]

Acute hepatitis B usually does not require treatment, as most adults clear the infection spontaneously [7] [8] . Early antiviral treatment may be required in less than 1% of cases: patients with aggressive infection (fulminant hepatitis) and immunocompromised individuals. On the other hand, treating chronic infection may be beneficial in reducing the risk of cirrhosis and liver cancer. Chronically infected individuals with persistently elevated levels of alanine aminotransferase, a marker of liver damage, and large amounts of HBV DNA are preferable candidates for therapy [9] . Treatment lasts from six months to a year, depending on the drug and the genotype of the virus [10].

Although none of the available drugs can completely clear the hepatitis B virus from a patient's body, they can stop the virus from multiplying, thereby minimizing liver damage. As of 2020, there are eight drugs licensed to treat infectious hepatitis B in the United States. These include:

Direct acting antivirals (DAAs):

The nucleosides lamivudine, telbivudine and the nucleotide adefovir are obsolete and are not recommended due to the low resistance threshold and the possibility of cross-resistance of the virus to entecavir and tenofovir drugs, respectively. [11] The World Health Organization recommended entecavir or tenofovir as first-line therapy. [12] Entecavir is contraindicated during pregnancy; It is advisable, if possible, to replace TDF, which is nephrotoxic and toxic to bones, with TAF. Patients with cirrhosis are most in need of treatment. Treatment with direct-acting drugs has a moderate level of side effects, but is symptomatic, resulting in suppression of the viral load - it almost never leads to viral seroconversion.

Unlike therapy with direct-acting drugs, interferon therapy has a high level of side effects, but differs favorably from DAA therapy in that it more often leads to HB e

Ag (virus replication marker). The response to interferon treatment depends on several factors. Some patients are much more likely to respond to therapy than others. The reason may be the genotype of the virus with which a person is infected, as well as the genetic characteristics of the patient himself. Treatment reduces viral replication in the liver, thereby reducing viral load (the number of viral particles in the blood) [13]. HBeAg seroconversion during interferon therapy occurs in 37% of patients infected with HBV genotype A, but in only 6% of patients infected with HBV genotype D. HBV genotype B has HBeAg seroconversion rates similar to type A. For HBV genotype C, seroconversion occurs in only 15% of cases. The sustained reduction in HBeAg levels after treatment is

45% of patients for types A and B, 25-30% of patients for types C and D [14] . The use of interferon, which requires injections daily or three times a week, has been replaced by pegylated interferon, a long-acting drug that is injected only once a week [15] .

Nutrition for liver diseases

Nutrition for liver diseases should be chemically gentle, fractional, up to 6 times a day. It is forbidden to consume foods that stimulate increased functioning of the liver and gallbladder. These are alcohol, fried foods, fatty, spicy, salty foods, smoked foods, marinades. Legumes, mushrooms, sorrel, cold and carbonated drinks have a bad effect on digestion.

The diet is based on cereal porridges, lean meat, low-fat fermented milk products, vegetables, and fruits.

How long the liver will hurt depends on the cause of the disease and compliance with the doctor’s recommendations. Chronic diseases with frequent diet violations are accompanied by regular exacerbation of pain.

• Calculous cholecystitis can be reminiscent of hepatic colic after a bumpy ride or intense physical exercise.
• Pain due to bile duct dyskinesia can return if there is an error in diet.
• Cirrhosis of the liver hurts with a constant dull ache.

Prevention [ edit | edit code]

Vaccination [edit | edit code]

Vaccination against hepatitis B is a universal method of protection for all routes of infection.

Vaccines to prevent hepatitis B have been widely recommended for infants in the United States since 1991 [16]. The first dose is usually recommended within the first 24 hours after birth [17] .

Most vaccines are given in three doses over several months. A protective response to a vaccine is defined as a serum concentration of anti-HBs antibodies of at least 10 mIU/ml. The vaccine is more effective in children, with 95% of those vaccinated having protective antibody levels. Their levels decline to about 90% at age 40 and to about 75% in people over 60 years of age. The protection provided by vaccination lasts even after antibody levels drop below 10 mIU/mL.

Anyone exposed to body fluids such as blood should be vaccinated [16] . Testing is recommended to verify effective immunization, and additional vaccine doses are provided to those who are insufficiently immunized [16] .

In studies that lasted 10 to 22 years, there were no cases of hepatitis B among vaccinated individuals with normal immune systems. Only rare chronic infections have been reported [18] . Vaccination is especially recommended for high-risk groups, including health care workers, people with chronic kidney failure, and men who have sex with men [19] [20] [21].

UK guidelines state that initial responders (those who are immune through vaccination) need further protection (this applies to people at risk of hepatitis B). To maintain immunity to the hepatitis B virus, they are recommended to undergo repeated vaccination every five years [22].

Sexual tract [edit | edit code]

Safe sex, including minimizing the number of partners and using barrier methods (condoms), protects against transmission [6] .

Vertical path [edit | edit code]

Prevention of vertical transmission of hepatitis B virus from an infected mother to her child during pregnancy is recommended, at least for women with a high viral load and/or high HBsAg levels, from 24–28 weeks of pregnancy until 12 weeks after delivery.

For those newborns whose mothers are infected with HBsAg: hepatitis B vaccine alone, hepatitis B immune globulin alone, or a combination of vaccine plus hepatitis B immune globulin [23] . These measures prevent HBV transmission during childbirth in 86%–99% of cases [24] .

For prevention it is used exclusively [ source not specified 316 days

] tenofovir: If a pregnant woman is already taking direct-acting antivirals (DAAs) other than tenofovir, she should switch to tenofovir.

The presence of active viral hepatitis is not a contraindication to breastfeeding, regardless of whether the breastfeeding woman is on antiviral therapy or not, since this does not affect the risk of transmitting hepatitis B to the child [25] [26].

Tenofovir given in the second or third trimester can reduce the risk of mother-to-child transmission by 77% when combined with hepatitis B immunoglobulin and hepatitis B vaccine, especially for pregnant women with high levels of hepatitis B virus DNA [27] . However, there is insufficient evidence that administration of hepatitis B immunoglobulin alone during pregnancy can reduce the likelihood of transmission of the virus to the newborn [28] .

Everyday way [edit | edit code]

In a family or in an organized group, the usual precautions should be observed [29]: do not allow the use of other people's personal hygiene products and be wary of other people's blood. These rules need to be taught to children too. Nail clippers and files, toothbrushes, earrings, glucometers and others can pose a danger. When cleaning a house or car from blood contamination, it is necessary to use disinfectants and wear latex gloves or, in extreme cases, plastic bags on your hands. Any breaks in the skin should be covered with a plaster or bandage.

Parenteral route [edit | edit code]

For invasive procedures, it is necessary to organize [30]:

• use of gloves;
• safe handling and disposal of sharps and waste;
• safe cleaning of equipment and tools;
• testing of donor blood;
• training of medical personnel;
• preventing the reuse of syringes and other disposable items;
• take measures to reduce the incidence of injuries from piercing and cutting instruments in health care workers.

At the national level, WHO recommends [30] work with people who use intravenous drugs: needle and syringe programs; opioid substitution therapy; condom distribution programs for people who inject drugs and their sexual partners; vaccination, diagnosis and treatment of viral hepatitis.