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Stages of Liver Disease ,[object Object],[object Object],[object Object],[object Object]
Progression of Hepatitis B Infection Short-term Infection Long-term Hepatitis Cirrhosis 30 - 50 Years Liver Cancer Death Long-term Carrier Resolution Cirrhosis Resolution Death Silent Cirrhosis
Hepatic Fibrosis Cirrhosis Liver Cancer Healthy Liver
Hepatic Fibrosis Cirrhosis Liver Cancer Healthy Liver
Types of Hepatitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Hoofnagle 1994; Linnen  et al.  1996
What is Hepatitis B? ,[object Object]
Hepatitis B is a Devastating Global Healthcare Issue   ,[object Object],[object Object],[object Object],RoW Asia Pacific 75% ,[object Object],1  WHO 1998;  2  Mast 1993;  3  Lee 1997;   4 Boag 1991;  5  Gust 1996
Hepatitis – Disease Terminology ,[object Object],[object Object],[object Object],[object Object]
How Hepatitis B is Acquired? ,[object Object],[object Object],1  Margolis  et al.  1991;  2  Thomas 1996
How the Infection  is Acquired  in the West? Transfusion and transplant recipients Individuals with multiple  sexual partners  Healthcare workers Newborns of long-term  carriers Intravenous drug users Prisoners and other  institutionalised people
Where Are the Long-term HBV Carriers?   Percentage long-term HBV carriers (350 million long-term carriers): < 2% - Low 2-7% - Intermediate > 8% - High Margolis  et al.  1991
Hepatitis B – Diagnosis Terminology ,[object Object],[object Object],[object Object],[object Object]
Diagnosis of Chronic Hepatitis B ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Signs and Symptoms of HBV Infection The majority of patients with chronic hepatitis B have no symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prevention of Hepatitis B ,[object Object],[object Object],[object Object],[object Object],Return to Main Index
Universal Hepatitis B Vaccination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hepatitis B Vaccines: Where Further Attention is Needed ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Recommendations for Pre-exposure Vaccination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Recommendations for Post-exposure Vaccination ,[object Object],[object Object],[object Object]
Conclusions ,[object Object],[object Object],[object Object],[object Object]
Global Control of Hepatitis B ,[object Object],–  the integration of hepatitis B vaccine into    national immunisation schedules and –  effective treatment of the many millions of  chronic carriers of hepatitis B
 
 
 
liver biopsy ,[object Object]
 
 
 
Detection of serologic markers of hepatitis B virus (HBV) infection, as a function of time, in acute cases.
The Efficacy and Safety of Lamivudine in HBeAg-positive Chronic Hepatitis B  Return to  Main Index Enter
Lamivudine is a Potent Inhibitor  of HBV Replication ,[object Object],[object Object],[object Object]
Lamivudine has an Excellent Pharmacokinetic Profile ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What Patient Populations Have Been Studied in Controlled Clinical Trials? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Key Lamivudine Clinical Studies (1) ,[object Object],[object Object],[object Object]
Key Lamivudine Clinical Studies (2) ,[object Object],[object Object],[object Object]
Patient Entry Criteria ,[object Object],[object Object],[object Object],[object Object]
Lamivudine Rapidly Suppresses  Serum HBV DNA Study Week Median % Change 0 10 20 30 40 50 Schiff Dienstag Lai Dienstag Schiff Lai Schalm Lamivudine -100 -80 -60 -40 -20 0 10 Placebo
Lamivudine Leads to HBeAg Seroconversion (HBeAg-, Anti-HBe+) Lamivudine + IFN 6 7 21 0 5 10 15 20 25 30 Placebo Lamivudine IFN Lai Dienstag Schalm *p<0.04 compared to placebo Patients (%) 13 14 Schiff 29 * 17 * 20 21 20
One Year of Lamivudine - Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Resistance to Anti-Viral Drugs ,[object Object],[object Object]
 
Concurrent immunologic diseases in type 1 autoimmune hepatitis.
Probabilities of clinical, biochemical, and histologic remission during corticosteroid therapy.
Clinical features of type 2 autoimmune hepatitis. ,[object Object],[object Object],[object Object],[object Object],[object Object]
Liver transplantation for autoimmune hepatitis. ,[object Object],[object Object],[object Object]
Survival expectations and probability of developing cirrhosis during and after corticosteroid treatment .  ,[object Object],[object Object],[object Object],[object Object]

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Hepatitis

  • 1.
  • 2. Progression of Hepatitis B Infection Short-term Infection Long-term Hepatitis Cirrhosis 30 - 50 Years Liver Cancer Death Long-term Carrier Resolution Cirrhosis Resolution Death Silent Cirrhosis
  • 3. Hepatic Fibrosis Cirrhosis Liver Cancer Healthy Liver
  • 4. Hepatic Fibrosis Cirrhosis Liver Cancer Healthy Liver
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10. How the Infection is Acquired in the West? Transfusion and transplant recipients Individuals with multiple sexual partners Healthcare workers Newborns of long-term carriers Intravenous drug users Prisoners and other institutionalised people
  • 11. Where Are the Long-term HBV Carriers? Percentage long-term HBV carriers (350 million long-term carriers): < 2% - Low 2-7% - Intermediate > 8% - High Margolis et al. 1991
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.  
  • 23.  
  • 24.  
  • 25.
  • 26.  
  • 27.  
  • 28.  
  • 29. Detection of serologic markers of hepatitis B virus (HBV) infection, as a function of time, in acute cases.
  • 30. The Efficacy and Safety of Lamivudine in HBeAg-positive Chronic Hepatitis B Return to Main Index Enter
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37. Lamivudine Rapidly Suppresses Serum HBV DNA Study Week Median % Change 0 10 20 30 40 50 Schiff Dienstag Lai Dienstag Schiff Lai Schalm Lamivudine -100 -80 -60 -40 -20 0 10 Placebo
  • 38. Lamivudine Leads to HBeAg Seroconversion (HBeAg-, Anti-HBe+) Lamivudine + IFN 6 7 21 0 5 10 15 20 25 30 Placebo Lamivudine IFN Lai Dienstag Schalm *p<0.04 compared to placebo Patients (%) 13 14 Schiff 29 * 17 * 20 21 20
  • 39.
  • 40.
  • 41.  
  • 42. Concurrent immunologic diseases in type 1 autoimmune hepatitis.
  • 43. Probabilities of clinical, biochemical, and histologic remission during corticosteroid therapy.
  • 44.
  • 45.
  • 46.