TorontoGiFellow

 https://www.youtube.com/watch?v=3cP2kvPq7iQ m.c form of acquiring Hep B in Asia - Vertically m.c form of acquiring Hep B in western coutnries: Parenterally (sexual / needles etc) Neonates have immature immune system, so they cant 'fight-off' vertically acquired virus. Over 90% of babies infected with Hep B, go on to have chronic Hep B infection 95% of adults if they acquire Hep B - fight it off! HBV is a DNA virus - replicates efficiently. But is error-prone. Plagued with mutants.  e-antigen negative mutant - tend to be in older patients, tend to be more aggressive. 30-50% of HCC in HBV occurs in absence of cirrhosis Reveal study - 15 year follow-up study of untreated patients with HEp B. The only factor that was relevant in predicting risk of HCC was viral load at base-line! Viral load more than 10*4 (2000 IU/ml) was predictive of risk of HCC or Cirrhosis (similar graph for Cirrhosis as for HCC) Immune Tolerant Phase: typically after vertical infection. DNA remains very high,

  If starting antiviral prophylaxis: - Continue for atleast 18-24 months in total - Conitnue for atleast 6-12 months after cessation of immunosuppressive therapy During antiviral prophylaxis :Check LFT, HbsAg, HBV DNA q3 monthly After completing antiviral prophylaxis :Check LFT, HbsAg, HBV DNA q3 monthly for 1 year