Hepatitis B – still the commonest sexually transmitted hepatitis in Croatia

Abstract

Hepatitis B predstavlja značajan javnozdravstveni problem. Trećina svjetske populacije ima serološke znakove aktualne ili preboljele infekcije, a 350 milijuna ljudi je kronično inficirano. Jetrena bolest uzrokovana hepatitis B virusom uzrokuje godišnje preko milijun smrtnih ishoda kao posljedica dekompenzirane ciroze jetre i hepatocelularnog karcinoma. Predominantni načini prijenosa ovise o geografskom području i higijenskim uvjetima. U zemljama poput Hrvatske, hepatitis B se najčešće prenosi seksualnim putem i korštenjem nečistih igala kod intravenskih ovisnika o drogama. Rizik kroniciteta ovisi o dobi u času infekcije, odnosno o imunološkoj zrelosti zaražene osobe. Liječenje hepatitisa B ima za cilj eradikaciju virusa u ranoj fazi bolesti te trajnu supresiju HBV replikacije kod kronične bolesti, prevenirajući time razvoj ciroze i hepatocelularnog karcinoma. Lijekovi za hepatitis B odobreni u Europi su konvencionalni i pegilirani interferon-α, lamivudin, telbivudin, entekavir, adefovir i tenofovir. Uobičajene indikacije za terapiju su serumski HBV DNA >2000 IU/mL (>10 000 kopija/mL), povišen serumski ALT (2×) te umjerena do teška nekroinflamatorna aktivnost i/ili fibroza. Najvažnije je, međutim, provoditi profilaktičke mjere u osoba s rizikom akviriranja infekcije.Hepatitis B is a global public health problem. Approximately one third of the world population has serological evidence of past or present infection with hepatitis B virus (HBV), with more than 350 million people chronically infected, of whom roughly one million die annually from HBV-related liver disease (liver cirrhosis, hepatocellular cancer). The predominant mode of transmission of HBV varies in different areas of the world. In countries like Croatia, unprotected sexual intercourse and intravenous drug use in adults are major routes of transmission. Risk of chronicity depends on the age at infection and resultant immune maturity. Chronic carriers of HBV are at increased risk of developing liver cirrhosis and hepatocellular carcinoma (HCC). The goals of therapy for hepatitis B are eradication of virus in the early stage of disease and continuous suppression of viral replication in chronic disease, thus preventing the progression of cirrhosis and HCC. Drugs approved for the treatment of HBV infection in Europe are conventional interferon alpha, pegylated interferon alpha, lamivudine, telbivudine, entecavir, adefovir and tenofovir. The usual indications for treatment are serum HBV DNA>2000 IU/mL (>10 000 copies/mL), elevated aminotransferase levels and moderate to severe necroinflammatory activity and/or fibrosis. Preventive measures are most important in persons at risk of aquiring infection