eMedicine Specialties > Gastroenterology > Liver

Hepatitis B: Multimedia

Author: Nikolaos T Pyrsopoulos, MD, PhD, FACP, Chief of Hepatology, Medical Director of Liver Transplantation, Florida Hospital; Associate Professor of Medicine, University of Central Florida College of Medicine
Coauthor(s): K Rajender Reddy, MD, FACP, FACG, Professor, Department of Medicine, Division of Hepatology, University of Miami School of Medicine
Contributor Information and Disclosures

Updated: Jun 19, 2009

Multimedia

Liver biopsy specimen showing ground-glass appear...Media file 1: Liver biopsy specimen showing ground-glass appearance of hepatocytes in a patient with hepatitis B.
Liver biopsy specimen showing ground-glass appear...

Liver biopsy specimen showing ground-glass appearance of hepatocytes in a patient with hepatitis B.

Liver biopsy with trichrome stain showing stage 3...Media file 2: Liver biopsy with trichrome stain showing stage 3 fibrosis in a patient with hepatitis B.
Liver biopsy with trichrome stain showing stage 3...

Liver biopsy with trichrome stain showing stage 3 fibrosis in a patient with hepatitis B.

Liver biopsy with hematoxylin stain showing stage...Media file 3: Liver biopsy with hematoxylin stain showing stage 4 fibrosis (ie, cirrhosis) in a patient with hepatitis B.
Liver biopsy with hematoxylin stain showing stage...

Liver biopsy with hematoxylin stain showing stage 4 fibrosis (ie, cirrhosis) in a patient with hepatitis B.

More on Hepatitis B

Overview: Hepatitis B
Differential Diagnoses & Workup: Hepatitis B
Treatment & Medication: Hepatitis B
Follow-up: Hepatitis B
Multimedia: Hepatitis B
References
Further Reading

References

  1. Purcell RH. The discovery of the hepatitis viruses. Gastroenterology. Apr 1993;104(4):955-63. [Medline].

  2. Fattovich G, Giustina G, Schalm SW, et al. Occurrence of hepatocellular carcinoma and decompensation in western European patients with cirrhosis type B. The EUROHEP Study Group on Hepatitis B Virus and Cirrhosis. Hepatology. Jan 1995;21(1):77-82. [Medline].

  3. Chang MH, Chen CJ, Lai MS, et al. Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. Taiwan Childhood Hepatoma Study Group. N Engl J Med. Jun 26 1997;336(26):1855-9. [Medline][Full Text].

  4. Yu MC, Yuan JM, Ross RK, Govindarajan S. Presence of antibodies to the hepatitis B surface antigen is associated with an excess risk for hepatocellular carcinoma among non-Asians in Los Angeles County, California. Hepatology. Jan 1997;25(1):226-8. [Medline][Full Text].

  5. Yang HI, Yeh SH, Chen PJ, et al. Associations between hepatitis B virus genotype and mutants and the risk of hepatocellular carcinoma. J Natl Cancer Inst. Aug 20 2008;100(16):1134-43. [Medline][Full Text].

  6. Blumberg BS. Australia antigen and the biology of hepatitis B. Science. Jul 1 1977;197(4298):17-25. [Medline].

  7. Norder H, Courouce AM, Magnius LO. Complete genomes, phylogenetic relatedness, and structural proteins of six strains of the hepatitis B virus, four of which represent two new genotypes. Virology. Feb 1994;198(2):489-503. [Medline].

  8. Lau JY, Wright TL. Molecular virology and pathogenesis of hepatitis B. Lancet. Nov 27 1993;342(8883):1335-40. [Medline].

  9. Chisari FV, Ferrari C. Hepatitis B virus immunopathology. Springer Semin Immunopathol. 1995;17(2-3):261-81. [Medline][Full Text].

  10. Davies SE, Portmann BC, O'Grady JG, et al. Hepatic histological findings after transplantation for chronic hepatitis B virus infection, including a unique pattern of fibrosing cholestatic hepatitis. Hepatology. Jan 1991;13(1):150-7. [Medline].

  11. Jung MC, Diepolder HM, Pape GR. T cell recognition of hepatitis B and C viral antigens. Eur J Clin Invest. Oct 1994;24(10):641-50. [Medline].

  12. Chisari FV. Cytotoxic T cells and viral hepatitis. J Clin Invest. Apr 1 1997;99(7):1472-7. [Medline][Full Text].

  13. Dong Q, Liu Z, Chen Y, et al. High level virion production and surface antigen expression with 1.5 copies of hepatitis B viral genome. J Virol Methods. Aug 2009;159(2):135-40. [Medline].

  14. Keeffe EB, Dieterich DT, Han SH, et al. A treatment algorithm for the management of chronic hepatitis B virus infection in the United States: an update. Clin Gastroenterol Hepatol. Aug 2006;4(8):936-62. [Medline].

  15. Lok AS, McMahon BJ. AASLD Practice Guidelines: Chronic hepatitis B. Hepatology. Feb 2007;45(2):507-39. [Medline][Full Text].

  16. Mutimer D, Naoumov N, Honkoop P, et al. Combination alpha-interferon and lamivudine therapy for alpha-interferon-resistant chronic hepatitis B infection: results of a pilot study. J Hepatol. Jun 1998;28(6):923-9. [Medline].

  17. Wong DK, Cheung AM, O'Rourke K, et al. Effect of alpha-interferon treatment in patients with hepatitis B e antigen-positive chronic hepatitis B. A meta-analysis. Ann Intern Med. Aug 15 1993;119(4):312-23. [Medline][Full Text].

  18. [Best Evidence] Lau GK, Piratvisuth T, Luo KX, et al. Peginterferon alfa-2a, lamivudine, and the combination for HBeAg-positive chronic hepatitis B. N Engl J Med. Jun 30 2005;352(26):2682-95. [Medline][Full Text].

  19. Schnittman SM, Pierce PF. Potential role of lamivudine (3TC) in the clearance of chronic hepatitis B virus infection in a patient coinfected with human immunodeficiency virus type. Clin Infect Dis. Sep 1996;23(3):638-9. [Medline].

  20. Dienstag JL, Schiff ER, Wright TL, et al. Lamivudine as initial treatment for chronic hepatitis B in the United States. N Engl J Med. Oct 21 1999;341(17):1256-63. [Medline][Full Text].

  21. Grellier L, Mutimer D, Ahmed M, et al. Lamivudine prophylaxis against reinfection in liver transplantation for hepatitis B cirrhosis. Lancet. Nov 2 1996;348(9036):1212-5. [Medline].

  22. Tipples GA, Ma MM, Fischer KP, et al. Mutation in HBV RNA-dependent DNA polymerase confers resistance to lamivudine in vivo. Hepatology. Sep 1996;24(3):714-7. [Medline][Full Text].

  23. Honkoop P, Niesters HG, de Man RA, Osterhaus AD, Schalm SW. Lamivudine resistance in immunocompetent chronic hepatitis B. Incidence and patterns. J Hepatol. Jun 1997;26(6):1393-5. [Medline].

  24. Yang H, Westland CE, Delaney WE 4th, et al. Resistance surveillance in chronic hepatitis B patients treated with adefovir dipivoxil for up to 60 weeks. Hepatology. Aug 2002;36(2):464-73. [Medline][Full Text].

  25. Villeneuve JP, Durantel D, Durantel S, et al. Selection of a hepatitis B virus strain resistant to adefovir in a liver transplantation patient. J Hepatol. Dec 2003;39(6):1085-9. [Medline].

  26. Angus P, Vaughan R, Xiong S, et al. Resistance to adefovir dipivoxil therapy associated with the selection of a novel mutation in the HBV polymerase. Gastroenterology. Aug 2003;125(2):292-7. [Medline].

  27. Chang TT, Lai CL. Hepatitis B virus with primary resistance to adefovir. N Engl J Med. Jul 20 2006;355(3):322-3; author reply 323. [Medline].

  28. Marcellin P, Chang TT, Lim SG, et al. Adefovir dipivoxil for the treatment of hepatitis B e antigen-positive chronic hepatitis B. N Engl J Med. Feb 27 2003;348(9):808-16. [Medline].

  29. [Best Evidence] Hadziyannis SJ, Tassopoulos NC, Heathcote EJ, et al, for the Adefovir Dipivoxil 438 Study Group. Long-term therapy with adefovir dipivoxil for HBeAg-negative chronic hepatitis B. N Engl J Med. Jun 30 2005;352(26):2673-81. [Medline][Full Text].

  30. [Best Evidence] Lai CL, Shouval D, Lok AS, et al. Entecavir versus lamivudine for patients with HBeAg-negative chronic hepatitis B. N Engl J Med. Mar 9 2006;354(10):1011-20. [Medline].

  31. Lai C-L, Gane E, Liaw Y-F, et al. Telbivudine (LdT) vs. lamivudine for chronic hepatitis B: first-year results from the international phase III GLOBE Trial [abstract]. Hepatology. 2005;42:748A.

  32. Liaw YF, Gane E, Leung N, et a. 2-Year GLOBE Trial results: telbivudine is superior to lamivudine in patients with chronic hepatitis B. Gastroenterology. Nov 1 2008;epub ahead of print. [Medline].

  33. Heathcote J, George J, Gordon S, et al. Tenofovir disoproxil fumarate (TDF) for the treatment of HBeAg-positive chronic hepatitis B: week 72 TDF data and week 24 adefovir dipivoxil switch data (study 103) [abstract]. J Hepatol. 2008;(suppl):S26.

  34. Marcellin P, Jacobson I, Habersetzer F, et al. Tenofovir disoproxil fumarate (TDF) for the treatment of HBeAg-negative chronic hepatitis B: week 72 TDF data and week 24 adefovir dipivoxil switch data (study 102) [abstract]. J Hepatol. 2008;48:S26.

  35. [Best Evidence] Marcellin P, Heathcote EJ, Buti M, et al. Tenofovir disoproxil fumarate versus adefovir dipivoxil for chronic hepatitis B. N Engl J Med. Dec 4 2008;359(23):2442-55. [Medline][Full Text].

  36. Caputo R, Gelmetti C, Ermacora E, Gianni E, Silvestri A. Gianotti-Crosti syndrome: a retrospective analysis of 308 cases. J Am Acad Dermatol. Feb 1992;26(2 pt 1):207-10. [Medline].

  37. Alexopoulou A, Karayiannis P, Hadziyannis SJ, Aiba N, Thomas HC. Emergence and selection of HBV variants in an anti-HBe positive patient persistently infected with quasi-species. J Hepatol. Apr 1997;26(4):748-53. [Medline].

  38. Brzosko WJ, Krawczynski K, Nazarewicz T, Morzycka M, Nowoslawski A. Glomerulonephritis associated with hepatitis-B surface antigen immune complexes in children. Lancet. Aug 31 1974;2(7879):477-82. [Medline].

  39. Centers for Disease Control and Prevention. Hepatitis B vaccination of adolescents--California, Louisiana, and Oregon, 1992-1994. MMWR Morb Mortal Wkly Rep. Aug 26 1994;43(33):605-9. [Medline].

  40. de Jongh FE, Janssen HL, de Man RA, et al. Survival and prognostic indicators in hepatitis B surface antigen-positive cirrhosis of the liver. Gastroenterology. Nov 1992;103(5):1630-5. [Medline].

  41. Ershova ON, Golovenko NIa, Galkin BN, Zhilina ZI. [Reduction of cytochrome p-450 content and activity by porphyrins after damage to the microsomal membrane by tetrachloromethane] [Russian]. Ukr Biokhim Zh. May-Jun 1993;65(3):111-3. [Medline].

  42. Fattovich G, Brollo L, Giustina G, et al. Natural history and prognostic factors for chronic hepatitis type B. Gut. Mar 1991;32(3):294-8. [Medline][Full Text].

  43. Greenberg HB, Pollard RB, Lutwick LI, et al. Effect of human leukocyte interferon on hepatitis B virus infection in patients with chronic active hepatitis. N Engl J Med. Sep 2 1976;295(10):517-22. [Medline].

  44. Guidotti LG, Chisari FV. To kill or to cure: options in host defense against viral infection. Curr Opin Immunol. Aug 1996;8(4):478-83. [Medline].

  45. Guillevin L, Lhote F, Cohen P, et al. Polyarteritis nodosa related to hepatitis B virus. A prospective study with long-term observation of 41 patients. Medicine (Baltimore). Sep 1995;74(5):238-53. [Medline].

  46. Hadziyannis SJ, Tassopoulos NC, Heathcote EJ, et al, for the Adefovir Dipivoxil 438 Study Group. Adefovir dipivoxil for the treatment of hepatitis B e antigen-negative chronic hepatitis B. N Engl J Med. Feb 27 2003;348(9):800-7. [Medline][Full Text].

  47. Hadziyannis SJ, Tassopoulos NC, Heathcote EJ, et al, for the Adefovir Dipivoxil 438 Study Group. Long-term therapy with adefovir dipivoxil for HBeAg-negative chronic hepatitis B for up to 5 years. Gastroenterology. Dec 2006;131(6):1743-51. [Medline].

  48. Honkoop P, de Man RA, Heijtink RA, Schalm SW. Hepatitis B reactivation after lamivudine. Lancet. Oct 28 1995;346(8983):1156-7. [Medline].

  49. Korenman J, Baker B, Waggoner J, et a. Long-term remission of chronic hepatitis B after alpha-interferon therapy. Ann Intern Med. Apr 15 1991;114(8):629-34. [Medline].

  50. Lohr H, Goergen B, Weber W, et al. Mixed cryoglobulinemia type II in chronic hepatitis B associated with HBe-minus HBV mutant: cellular immune reactions and response to interferon treatment. J Med Virol. Dec 1994;44(4):330-5. [Medline].

  51. Marcellin P, Lau GK, Bonino F, et al. Peginterferon alfa-2a alone, lamivudine alone, and the two in combination in patients with HBeAg-negative chronic hepatitis B. N Engl J Med. Sep 16 2004;351(12):1206-17. [Medline][Full Text].

  52. McGory R, Ishitani M, Oliveira W, et al. Hepatitis B immune globulin dose requirements following orthotopic liver transplantation for chronic hepatitis B cirrhosis. Transplant Proc. Jun 1996;28(3):1687-8. [Medline].

  53. Milich DR, Sallberg M, Maruyama T. The humoral immune response in acute and chronic hepatitis B virus infection. Springer Semin Immunopathol. 1995;17(2-3):149-66. [Medline].

  54. Omata M, Ehata T, Yokosuka O, Hosoda K, Ohto M. Mutations in the precore region of hepatitis B virus DNA in patients with fulminant and severe hepatitis. N Engl J Med. Jun 13 1991;324(24):1699-704. [Medline].

  55. Pyrsopoulos NT, Reddy KR. Extrahepatic manifestations of chronic viral hepatitis. Curr Gastroenterol Rep. Feb 2001;3(1):71-8. [Medline].

  56. Stuyver L, De Gendt S, Van Geyt C, et al. A new genotype of hepatitis B virus: complete genome and phylogenetic relatedness. J Gen Virol. Jan 2000;81(pt 1):67-74. [Medline][Full Text].

  57. Takekoshi Y, Tanaka M, Shida N, et al. Strong association between membranous nephropathy and hepatitis-B surface antigenaemia in Japanese children. Lancet. Nov 18 1978;2(8099):1065-8. [Medline].

  58. Tang KH, Yusoff K, Tan WS. Display of hepatitis B virus PreS1 peptide on bacteriophage T7 and its potential in gene delivery into HepG2 cells. J Virol Methods. Aug 2009;159(2):194-9. [Medline].

  59. Thibault V, Laperche S, Akhavan S, et al. Impact of hepatitis B virus genotypes and surface antigen variants on the performance of HBV real time PCR quantification. J Virol Methods. Aug 2009;159(2):265-70. [Medline].

  60. Todo S, Demetris AJ, Van Thiel D, et al. Orthotopic liver transplantation for patients with hepatitis B virus-related liver disease. Hepatology. Apr 1991;13(4):619-26. [Medline].

  61. Trepo C, Thivolet J. [Australia antigen, virus hepatitis and periarteritis nodosa] [French]. Presse Med. Aug 29 1970;78(36):1575. [Medline].

Further Reading

Additional resources on hepatitis B are available at Medscape’s Hepatitis B Resource Center.

Related eMedicine Topics

Clinical Trials

National Guideline Clearinghouse

Keywords

hepatitis B, hepatitis, HBV, hepatitis B infection, viral hepatitis, hepatitis B virus, chronic hepatitis, acute hepatitis, cirrhosis, fulminant hepatitis, hepatocellular carcinoma, HCC, extrahepatic manifestations, hepatitis D virus, HDV, delta virus, hepatitis C virus, HCV, hepatitis B surface antigen, HBsAg, Australia antigen, hepatitis B surface antibody, HBsAb, orthohepadnavirus, hepadnaviridae infection,

liver transplantation, liver transplant, OLT, interferon-alpha, IFN-a, peginterferon-alfa 2a, pegylated IFN-a 2a, lamivudine, adefovir dipivoxil, entecavir, telbivudine, tenofovir

Contributor Information and Disclosures

Author

Nikolaos T Pyrsopoulos, MD, PhD, FACP, Chief of Hepatology, Medical Director of Liver Transplantation, Florida Hospital; Associate Professor of Medicine, University of Central Florida College of Medicine
Nikolaos T Pyrsopoulos, MD, PhD, FACP is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Liver Foundation, American Medical Association, American Society of Gastrointestinal Endoscopy, American Society of Transplantation, International Liver Transplantation Society, and Transplantation Society
Disclosure: Gilead Sciences Honoraria Speaking and teaching; Schering-Plough Honoraria Speaking and teaching; Roche Honoraria Speaking and teaching

Coauthor(s)

K Rajender Reddy, MD, FACP, FACG, Professor, Department of Medicine, Division of Hepatology, University of Miami School of Medicine
K Rajender Reddy, MD, FACP, FACG is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and Florida Medical Association
Disclosure: Nothing to disclose.

Medical Editor

George Y Wu, MD, PhD, Professor, Department of Medicine, Director, Hepatology Section, Herman Lopata Chair in Hepatitis Research, University of Connecticut School of Medicine
George Y Wu, MD, PhD is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, American Medical Association, American Society for Clinical Investigation, and Association of American Physicians
Disclosure: Humana Press Consulting fee Consulting; Novartis Consulting fee Review panel membership

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Oscar S Brann, MD, FACP, Associate Clinical Professor, Department of Medicine, University of California at San Diego; Consulting Staff, Mecklenburg Medical Group
Oscar S Brann, MD, FACP is a member of the following medical societies: American Gastroenterological Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.