Diagnosis of chronic hepatitis B and the implications of viral variants and mutations.
Chronic infection with the hepatitis B virus (HBV) is a major cause of morbidity and mortality worldwide, necessitating accurate and timely diagnosis of infected patients coupled with optimal treatment strategies. Although the prevalence of HBV infection in the United States is low owing to the implementation of universal vaccination, growing immigration from areas where infection is more endemic means that prevalence is forecast to increase. Healthcare providers must be active in providing low-cost screening (hepatitis B surface antigen identification) and vaccination programs for high-risk communities, such as Asian Americans, with linked specialist referral schemes for patients found to carry the virus. Serologic technologies and improved nucleic acid testing techniques generate important information about the stage of disease, viral load, and disease subtype, including the presence of precore and core promoter variants that provide prognostic indicators and can guide patient management. Serial DNA monitoring is playing the major role in the assessment of therapeutic response and steering treatment approaches. More research is needed to further clarify the significance of HBV variants and their relation to therapeutic agents and strategies.
Gish
Robert G
RG
Liver Transplant Program, California Pacific Medical Center, San Francisco, California 94115, USA. gishr@sutterhealth.org
D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000150:complications; D003362:Cost-Benefit Analysis; D004279:DNA, Viral / Q000235:genetics; D014644:Genetic Variation; D005838:Genotype; D006515:Hepatitis B virus / Q000235:genetics*; D019694:Hepatitis B, Chronic / Q000150:complications / Q000175:diagnosis* / Q000821:virology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications; D009154:Mutation; D012698:Serologic Tests; D013997:Time Factors
D004279:DNA, Viral