Запись вебинара «Гепатит В: диагностика, наблюдение, лечение» 15 ноября 2022 г.

Updated: November 19, 2024

Вместе против гепатита


Summary

This YouTube video provides a comprehensive explanation of acute and chronic hepatitis B, detailing the virus's entry into the body, immune responses, symptoms, risks, monitoring strategies, and treatment options. It covers crucial aspects such as immune response analysis, diagnosis methods, treatment goals, vaccination significance, pregnancy planning considerations, and advancements in antiviral therapy research. The discussion delves into interpreting lab results, liver health indicators, treatment criteria, liver imaging techniques, and the importance of tailored treatment for effective management of hepatitis B, highlighting the need for lifelong monitoring and personalized care.


Introduction to Hepatitis B

Explanation of acute and chronic hepatitis B, how the virus enters the body, and its implications.

Acute Hepatitis B

Details on the acute phase of hepatitis B, including the immune system response, symptoms, and recovery timeline.

Chronic Hepatitis B

Discussion on chronic hepatitis B, its development, ongoing infection, and potential risks like cirrhosis and cancer.

Symptoms and Immune Response

Insights into the immune response to the hepatitis B virus, acute symptoms, and differences in outcomes between adults and children.

Chronic Infection and Risks

Explanation of chronic hepatitis B, its persistence, risks of liver damage, and the importance of monitoring and treatment.

Diagnosis and Monitoring

Information on diagnosis, testing for HBs antigen, surveillance strategies, and the frequency of medical check-ups for individuals with hepatitis B.

Treatment and Follow-Up

Overview of treatment options for severe cases, monitoring schedules, and the significance of regular check-ups and follow-up appointments.

Importance of Regular Check-ups

Discussing the importance of regular check-ups even if initial tests show no need for treatment as virus behavior can change over time, and monitoring is crucial for timely intervention if needed.

Understanding Virus Analysis

Explaining the analysis of viruses, specifically focusing on the HB antigens and antibodies, and how they help in determining different stages of viral infections and immune responses.

PCR Analysis for Hepatitis B

Detailing the PCR analysis for Hepatitis B, which detects the virus's DNA in the patient's body, providing essential information on the presence and activity of the virus.

Monitoring for Hepatitis D and HIV/Hepatitis C

Emphasizing the importance of monitoring for Hepatitis D in Hepatitis B patients and highlighting the similar transmission routes and monitoring requirements for HIV and Hepatitis C infections.

Clinical Blood Analysis

Discussing key indicators in clinical blood analysis for liver health, including ALT, AST, GGT, and alkaline phosphatase, and their significance in evaluating liver function and inflammation levels.

Understanding Lab Results

Discusses the interpretation of lab results and the significance of international units in measuring virus quantities.

Mathematical Representation of Virus Quantity

Explains the mathematical representation of virus quantity in lab results using exponents and the practice of simplifying large numbers.

Importance of Alpha Protein Testing

Emphasizes the regular testing of alpha protein for patients with chronic hepatitis and cirrhosis to monitor the risk of liver cancer.

Use of Ultrasound (УЗИ) for Abdominal Organs Examination

Describes the role of ultrasound in examining abdominal organs, especially the liver, for monitoring cancer risk.

Stages of Liver Changes

Discusses the stages of liver changes from healthy to cirrhosis and the importance of timely diagnosis and monitoring.

Liver Imaging Methods

Explains liver imaging methods like elastography and the importance of accurate results for further diagnosis and treatment decisions.

Criteria for Treatment Decisions

Outlines the criteria for determining the need for treatment based on ALT levels, virus quantity, fibrosis stage, and other factors.

Purpose and Process of Treatment

The speaker discusses the purpose of treatment and its process, emphasizing the goal of achieving complete eradication of the virus, which is challenging due to the virus's integration into the genetic materials of liver cells. Currently, treatment focuses on suppressing the virus's reproduction to reduce its quantity over time, leading to improvements in liver condition.

Modern Treatment Goals and Methods

Modern treatment involves the use of tablets and interferon injections. Tablets are preferred for their minimal side effects, requiring once-daily intake. In contrast, interferon injections, while effective, often come with significant side effects. The speaker highlights the importance of tailored treatment and considers the unique characteristics of the hepatitis B virus in the context of treatment options.

Vaccination Against Hepatitis B

The speaker explains the significance of vaccination against hepatitis B, highlighting that the vaccine does not contain the virus and is safe for administration. Vaccination is crucial for preventing the spread of the virus, especially among close contacts of infected individuals. The discussion covers the immunity development process and the importance of vaccination for both infants and adults as a preventive measure.

Diagnostic Criteria and Treatment Protocol

The criteria for diagnosing hepatitis B involve specific blood tests and liver assessments. The speaker stresses the importance of monitoring and distinguishing between acute and chronic cases to determine the appropriate treatment, typically antiviral therapy. Continual observation and proper diagnosis are essential for effective treatment, with specific considerations for each patient's unique situation.

Vaccination Protocol and Risks

The chapter delves into the vaccination protocol for hepatitis B and the risk factors associated with infection, particularly for individuals in high-risk groups like HIV-infected individuals. The speaker clarifies the four-dose vaccination regimen and the flexibility in administration based on individual risk factors and exposure situations, ensuring comprehensive protection against the virus.

Discussion on Hepatitis B and C

A conversation about the presence of antibodies for Hepatitis B and C, including the absence of DNA detection in a particular case, indicating a potential functional recovery from the disease.

Interpretation Challenges

The difficulty in interpreting antibody tests, the distinction between antigens and antibodies in disease progression, and rare cases of chronic Hepatitis B functional recovery.

Functional Recovery in Chronic Hepatitis B

Explaining functional recovery in chronic Hepatitis B, where HBs antigen disappears, and anti-HBs antibodies are produced, resembling acute Hepatitis B recovery.

Rare Functional Recovery Cases

Rare cases of functional recovery indicating the disappearance of antigens and the formation of antibodies, suggesting a positive prognosis and a significant decrease in disease activity.

Misinterpretation Risks

Addressing the risks of misinterpretation in chronic Hepatitis B cases, emphasizing the importance of clear lab results and avoiding confusion between antigens and antibodies.

Considerations for Pregnancy in Hepatitis B

Discussion on pregnancy planning with a history of chronic Hepatitis B, highlighting the need for continuous treatment to prevent disease reactivation and potential transmission risks to the baby.

Vaccine History and Immunity

Clarifying the possibility of vaccine failure leading to Hepatitis B infection, the importance of proper vaccine storage, and the rare instances of vaccination of already infected individuals.

Diagnosis of Hepatitis B

In some cases, individuals may be vaccinated without prior examination and later discover they have Hepatitis B. Diagnosis of acute Hepatitis B involves a combination of antigen and antibody indicators along with the patient's medical history.

Vaccination Considerations

There is a possibility that individuals may receive vaccinations while already infected with Hepatitis B. It is recommended to conduct surface antigen analysis before and after vaccination to determine immunity development.

New Antiviral Drugs Development

Focus in pulmonology has shifted towards Hepatitis B research, with new antiviral drugs being developed to target different stages of the Hepatitis B virus life cycle, potentially leading to combination treatments in the future.

Viral Replication Inhibition

Antiviral drugs aim to block specific stages of viral replication, causing a critical decrease in viral activity. Ongoing research may lead to combination therapies targeting various virus life cycle stages and immune responses.

Interpreting Hepatitis B Virus Levels

The concentration of Hepatitis B virus in an individual can be extremely high, exceeding the detection limits of standard laboratory tests. Lab measurements typically register virus quantities in the range of 10^7 to 10^8.

Terminology and Hepatitis B Severity

Medical terminology for Hepatitis B often lacks subjective descriptors like 'low' or 'high' to maintain clinical objectivity. Specific thresholds, such as viral load cutoffs, are used to assess disease activity and progression.

Cirrhosis Complications and Treatment

Ascites, or fluid accumulation in the abdomen due to severe cirrhosis, necessitates a tailored treatment approach involving diuretics and albumin therapy to manage the complex issues associated with advanced liver disease.

Alcohol Albumin and Diuretics

Discussing the reasons for fluid accumulation in the abdomen, including low albumin levels, and the use of diuretics to help eliminate the excess fluid by administering intravenous solutions such as saline or glucose.

Sodium Chloride and Glucose Solutions

Explaining the benefits of using sodium chloride and glucose solutions for intravenous infusion to patients with cirrhosis to manage fluid accumulation in the abdomen.

Portal Hypertension Treatment Options

Exploring treatment options for a patient diagnosed with stage three portal hypertension, including the choice between shunting procedures and liver transplantation for severe cases.

Liver Transplantation Considerations

Discussing the criteria for liver transplantation based on liver function and severity of complications, such as varicose veins in the esophagus, to determine the necessity and timing of the procedure.

Vascular Changes in Cirrhosis

Highlighting the risk of varicose veins in the esophagus due to altered blood flow in cirrhosis patients and the management strategies, including ligating the veins to prevent bleeding complications.

Liver Function and Varicose Veins Relationship

Explaining the relationship between liver function and varicose veins in the esophagus, emphasizing the need for individualized assessment to determine the appropriate treatment approach, such as shunting procedures or transplantation.

Viral Infection Management Post-Transplant

Addressing concerns about viral infections post-liver transplant and the protocols in place to prevent viral reactivation, including antiviral medications and monitoring for optimal organ function.

Duration of Antiviral Treatment

Discussing the prolonged use of antiviral medications, such as nucleotide analogs, emphasizing the importance of continuous therapy based on infection activity and regular monitoring for efficacy.

Immunological Response to Viral Infection

Exploring the long-term immunological response to viral infections and the considerations for discontinuing antiviral therapy based on individual immune system changes and infection stability over time.

Lifestyle and Immune System Adaptation

Highlighting the potential adaptation of the immune system to viral infections over time, allowing for the possibility of reducing or ceasing antiviral therapy under medical supervision.

Long-Term Medication Management

Discussing the necessity of lifelong antiviral therapy for chronic viral infections and the individualized approach to medication adherence and therapy duration based on infection activity and immune response.

Webinar Announcement

Not planning a webinar on hepatitis D in the near future, but mentioning an upcoming webinar on oncology and various hepatitis viruses, including hepatitis D.

Upcoming Recording Session

The speaker mentions that in exactly a week, there will be a recording session for two hours in Moscow.


FAQ

Q: What is hepatitis B and how does the virus enter the body?

A: Hepatitis B is a viral infection that primarily affects the liver. The virus enters the body through contact with infected blood or other body fluids.

Q: What are the differences between acute and chronic hepatitis B?

A: Acute hepatitis B is a short-term infection that the body can usually clear on its own, while chronic hepatitis B is a long-lasting infection that can lead to serious complications.

Q: What are the potential risks associated with chronic hepatitis B?

A: Chronic hepatitis B can lead to complications like cirrhosis (scarring of the liver) and liver cancer if left untreated.

Q: How is hepatitis B diagnosed?

A: Hepatitis B is diagnosed through blood tests that check for the presence of specific antigens and antibodies related to the virus.

Q: What are the treatment options for severe cases of hepatitis B?

A: Treatment for severe cases of hepatitis B often involves antiviral therapy, which aims to suppress the virus's replication and reduce its quantity over time to improve liver condition.

Q: Why is monitoring and regular check-ups important for individuals with hepatitis B?

A: Monitoring and regular check-ups are crucial for timely intervention if needed, as the virus's behavior can change over time, and monitoring helps in determining the need for treatment.

Q: What is the significance of vaccination against hepatitis B?

A: Vaccination against hepatitis B is essential for preventing the spread of the virus, especially among close contacts of infected individuals, and is safe for administration.

Q: How is Hepatitis B virus quantity measured in lab results?

A: The concentration of Hepatitis B virus in an individual is typically measured using laboratory tests that register virus quantities in the range of 10^7 to 10^8, without subjective descriptors like 'low' or 'high'.

Q: What are the potential complications associated with advanced liver disease such as cirrhosis?

A: Complications of advanced liver disease like cirrhosis can include ascites, which is fluid accumulation in the abdomen, requiring tailored treatment approaches.

Q: What treatment options are available for individuals with cirrhosis and fluid accumulation in the abdomen?

A: Treatment for individuals with cirrhosis and ascites may involve diuretics and albumin therapy to manage fluid accumulation, with intravenous solutions like saline or glucose being administered.

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