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Hepatitis-b virus (hbv) and Small Fiber Neuropathy (SFN)

Hepatitis-B Virus (HBV)

Description:

Hepatitis-B virus (HBV) is a serious liver infection caused by the hepatitis B virus. It’s considered a major global health problem and the most serious type of viral hepatitis. It can cause chronic liver disease and puts people at high risk of death from cirrhosis of the liver and liver cancer.

Prevalence:

According to the World Health Organization (WHO), an estimated 296 million people were living with chronic hepatitis B infection in 2019. It’s most common in sub-Saharan Africa and East Asia, where between 5% to 10% of the adult population is chronically infected.

Risk Factors:

  • Unprotected Sex: Having unprotected sex with an infected person can spread HBV.
  • Sharing Needles: Sharing needles, syringes, or other drug-injection equipment can expose you to HBV.
  • Mother to Child: Pregnant women infected with HBV can pass the virus to their babies during childbirth.
  • Blood Transfusion: In some cases, receiving a blood transfusion can be a risk factor.
  • Unsterilized Medical Equipment: Using unsterilized medical or dental equipment can expose you to HBV.

Prognosis:

The prognosis for HBV varies greatly depending on the stage of the disease and whether it’s acute or chronic. Acute HBV infection does not usually require treatment because most adults clear the infection spontaneously. Chronic HBV infection can be treated with antiviral medications to slow the progression of cirrhosis, reduce incidence of liver cancer and improve long term survival.

Complications:

  • Cirrhosis: Chronic HBV infection can lead to cirrhosis, a condition that replaces healthy liver cells with scar tissue.
  • Liver Cancer: People with chronic HBV infection are at risk of developing liver cancer.
  • Liver Failure: Over time, HBV can lead to liver failure, a life-threatening condition that requires a liver transplant.

Prevention:

  • Vaccination: The primary prevention measure against HBV is the hepatitis B vaccine.
  • Safe Sex: Using protection during sex can prevent transmission of HBV.
  • Avoid Sharing Needles: Never share needles or other drug-injection equipment.
  • Screen Blood Donors: All blood donors should be screened for HBV to prevent transmission through blood transfusion.

Epidemiology:

HBV infection is highest in the Western Pacific and African regions where between 6.2% and 6.1% of the adult population is infected. In the Eastern Mediterranean and South-East Asia regions, an estimated 3.3% and 2.0% of the general population is infected, respectively. In the Americas and European regions, 0.7% and 1.6% of the population is infected, respectively. The prevalence of HBV varies greatly by age and gender, with men generally more likely to be infected than women.

Hepatitis-B virus (HBV) connection to Small Fiber Neuropathy (SFN)

Association:

Hepatitis B virus (HBV) has been linked to Small Fiber Neuropathy (SFN) through several mechanisms. HBV can cause a systemic inflammatory response, which in turn can lead to the development of SFN. This is due to the fact that the virus can directly infect the peripheral nerves, leading to inflammation and damage. Additionally, the immune response triggered by the body to fight off the virus can also result in damage to the small fibers of the peripheral nerves.

Research Updates:

Recent research into the connection between HBV and SFN is ongoing. A 2020 study published in the Journal of Neurology, Neurosurgery, and Psychiatry found that patients with chronic HBV infection had a higher risk of developing SFN compared to those without the infection. The study also found that the risk of SFN increased with the duration of the HBV infection. However, the exact mechanisms through which HBV leads to SFN are still not fully understood, and further research is needed in this area.## Symptoms of Hepatitis-B virus (HBV)

List of Symptoms:

Hepatitis-B virus (HBV) can cause both acute and chronic infections. The symptoms can vary widely, and some people may not have symptoms at all. However, common symptoms can include:

  • Fatigue: This is a common symptom and can range from mild to severe.
  • Jaundice: This is a yellowing of the skin and eyes due to a high level of bilirubin, a yellow-orange substance, in the blood.
  • Abdominal pain: This can be located on the right side where the liver is located.
  • Loss of appetite: People with HBV may not feel like eating, leading to weight loss.
  • Nausea and vomiting: These symptoms can be due to the body’s response to the virus.
  • Joint pain: This can occur in some people with HBV.
  • Dark urine and pale stools: Changes in the color of urine and stools can be due to problems with liver function.

It’s important to note that small fiber neuropathy (SFN) is not typically associated with HBV. However, peripheral neuropathy, which can include SFN, has been reported in some cases of chronic HBV, particularly in people with advanced liver disease.

Severity:

The severity of HBV symptoms can vary widely. Some people may have no symptoms at all, especially in the early stages of the disease. In others, the symptoms can be severe and can include serious complications such as liver failure, cirrhosis (scarring of the liver), and liver cancer.

Onset:

The onset of symptoms can vary. In acute HBV infection, symptoms usually appear about one to four months after exposure to the virus, but they can appear as early as two weeks post-exposure. In chronic HBV infection, symptoms may not appear until decades after the initial infection, often when liver damage has occurred. It’s important to be aware that many people with HBV, particularly those with chronic infection, may not have symptoms until the disease has progressed.

Diagnosis of Hepatitis-B virus (HBV)

Methods:

Diagnosis of Hepatitis-B virus (HBV) is typically done through blood tests. These tests can detect markers of the virus, such as antigens and antibodies, as well as the actual DNA of the virus. Here are the primary tests used:

  • HBsAg Test: This test looks for the surface antigen of the Hepatitis B virus, which is the earliest indicator of acute infection. It also signifies chronic infection if it’s still present after 6 months.
  • Anti-HBs Test: This test detects antibodies produced in response to the virus’s surface antigen. A positive result indicates recovery and immunity from future infection.
  • HBcAg Test: This test detects the core antigen of the virus, which isn’t typically found in the blood, so doctors test for the presence of antibodies to the core antigen (anti-HBc).
  • HBeAg Test: This test detects the hepatitis B envelope antigen. A positive result indicates the person is highly infectious.
  • Anti-HBe Test: This test detects antibodies against the hepatitis B envelope antigen. A positive result usually indicates a lower level of infectiousness.
  • HBV DNA Test: This test detects the presence of HBV DNA in your blood. It indicates that the virus is currently in your body and can be multiplying.

Differential Diagnosis:

Several other conditions may present symptoms similar to Hepatitis-B virus (HBV), especially in the context of small fiber neuropathy (SFN). These include:

  • Hepatitis C virus (HCV): Like HBV, HCV is a viral infection that affects the liver. It can also cause similar symptoms and complications.
  • Autoimmune hepatitis: This is a disease where the body’s immune system attacks liver cells. It can cause symptoms similar to HBV.
  • Alcoholic hepatitis: This is inflammation of the liver caused by drinking alcohol. It can cause symptoms similar to HBV, especially jaundice and abdominal pain.
  • Non-alcoholic fatty liver disease (NAFLD): This condition, often linked to obesity and diabetes, can cause liver inflammation and damage similar to that caused by HBV.

Limitations:

There are several limitations and challenges in diagnosing Hepatitis-B virus (HBV):

  • Asymptomatic patients: Many people with HBV do not have symptoms, especially in the early stages. This makes it difficult to diagnose the disease without routine screening.
  • Similar symptoms: As mentioned above, several other conditions can cause similar symptoms to HBV, complicating the diagnosis.
  • Test limitations: While blood tests for HBV are generally accurate, they can sometimes give false-positive or false-negative results. For example, the HBsAg test can be negative in the window period (the time between the onset of infection and the appearance of detectable antibodies).
  • Co-infections: Co-infections with other hepatitis viruses, such as HCV or hepatitis D virus (HDV), can complicate the diagnosis and management of HBV.

Treatments for Hepatitis-B virus (HBV)

Options:

Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic diseases. The virus is most commonly transmitted from mother to child during birth and delivery, as well as through contact with blood or other body fluids. Here are some of the treatment options:

  • Antiviral Medications: These are the most common treatment for chronic Hepatitis B. They can help to slow the progression of cirrhosis, reduce incidence of liver cancer, and increase long term survival. Examples include Entecavir (Baraclude), Tenofovir (Viread), Lamivudine (Epivir), Adefovir (Hepsera), and Telbivudine (Tyzeka).
  • Interferon Injections: Interferon alfa-2b (Intron A) is a man-made version of a substance produced by the body to fight infection. It’s used mainly for young people with hepatitis B who wish to avoid long-term treatment or women who might want to get pregnant within a few years, after completing a finite course of therapy.
  • Liver Transplant: If the liver has been severely damaged, a liver transplant may be an option. During a liver transplant, the surgeon removes your damaged liver and replaces it with a healthy liver.

Effectiveness:

The effectiveness of these treatments can vary greatly from person to person. Antiviral medications can help to control the replication of the virus and slow the progression of disease in the liver. Interferon injections can help to boost the immune system’s response to the virus. Liver transplants are typically reserved for severe cases where the liver has been significantly damaged.

In the context of SFN, it is important to manage the underlying condition, in this case, Hepatitis B. Effective management of Hepatitis B can help to control symptoms and slow the progression of SFN.

Side Effects:

Like all medications, those for Hepatitis B can have side effects. These can include:

  • Antiviral Medications: Side effects can include headache, fatigue, dizziness, nausea, and elevated liver enzymes.
  • Interferon Injections: Side effects can include flu-like symptoms, depression, irritability, hair loss, and low white blood cell counts.
  • Liver Transplant: Risks associated with a liver transplant include infection, bleeding, blood clots, liver failure, rejection of the new liver, and side effects from the immunosuppressive drugs needed to prevent rejection.

Recent Advancements:

In recent years, there have been advancements in the treatment of Hepatitis B. Newer drugs such as tenofovir alafenamide (Vemlidy) have been approved for the treatment of Hepatitis B. This medication has a lower risk of certain side effects related to kidney function and bone density compared to other antiviral medications.

Additionally, research is ongoing into new treatment options for Hepatitis B, including immune modulator therapies and gene therapies. However, these are still in the experimental stages and are not yet available for general use.