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## IntechOpen Book Series Infectious Diseases Volume 5

Dr Luis Rodrigo MD is an Emeritus Professor of Medicine at the University of Oviedo (Spain). He has been the Chief of Gastroenterology Service at the HUCA Hospital in Oviedo for more than 40 years. He obtained his PhD in 1975 and has a long teaching and research career. He has published a total of 590 scientific papers, 310 written in English and the rest in Spanish. He has participated as the main investigator in a total of 45 clinical trials

and has directed 40 doctoral theses. He has contributed actively to the formation of around one hundred specialists in gastroenterology working in his hospital and other hospitals in Spain and abroad. He has written around 35 chapters in books of several subjects and has been the editor of 24 books in his specialty and related diseases. His areas of interest are mainly related to celiac disease and autoimmune associated diseases.

**Editor of Volume 5: Prof. Luis Rodrigo MD** Emeritus Professor of Medicine University of Oviedo, Oviedo. Spain

**Book Series Editor: Shailendra K. Saxena** King George's Medical University

### Scope of the Series

The series will give a most comprehensive overview of recent trends in various infectious diseases (as per the most recent Baltimore classification), as well as general concepts of infections, immunopathology, diagnosis, treatment, epidemiology and etiology to current clinical recommendations in management of infectious diseases, highlighting the ongoing issues, recent advances, with future directions in diagnostic approaches and therapeutic strategies. This book series will focus on various aspects and properties of infectious diseases whose deep understanding is very important for safeguarding human race from more loss of resources and economies due to pathogens.

Contents

**Section 1**

*by Johra Khan*

**Section 2**

of the Art

Latin America

Cirrhosis

Hepatitis B and C Viruses *by Isaac Thom Shawa*

**Preface III**

Hepatitis B **1**

**Chapter 1 3**

**Chapter 2 15**

Hepatitis C **27**

**Chapter 3 29**

**Chapter 4 53**

**Chapter 5 73**

**Chapter 6 83**

Coinfection of Hepatitis B and C in HIV Patients: A Review of the State

Challenges and Strategies for Access to Treatment of Hepatitis C in

Direct-Acting Antivirals in Chronic Hepatitis C Infection with Liver

*by Vijay Gayam, Arshpal Gill, Pavani Garlapati and Smruti Mohanty*

*by Alexandra Porras-Ramírez and Alejandro Rico-Mendoza*

Molecular Variants for HBsAg: Surface and Subtype

Hepatitis B Genotyping and Clinical Implication

*by Damodar Paudel and Sushma Suvedi*

*by David Kershenobich and Nayelli Flores*

## Contents


Preface

Viral hepatitides are important public health problems in humans. The etiologic agents were not identified until 1965, when Baruch S. Blumberg found the relationship of an Australia antigen to serum hepatitis. The antigen was found to be the surface antigen of the hepatitis B virus (HBV). This observation launched a new era in the diagnosis, prevention, and treatment of hepatitis B. Over 15 to 20 years, the natural history of HBV infection was elucidated, and more importantly, an effective vaccine became available. The routes of transmission were also made clear, rendering effective interruption in the transmission. The vaccine, together with effective interruption of the transmission, contributed greatly to the control of HBV infection. However, these measures do very little for those who have already been chronically infected. Fortunately, specific therapies against chronic hepatitis B started to appear about 10–15 years before, and the treatments have improved

Nevertheless, hepatitis B virus infection remains a major problem for public health worldwide and represents a challenging disease for practicing physicians. Of the 2 billion people who have been infected with the hepatitis B virus, more than 350 million have chronic infections. Roughly, around 30% of the world's population show serological evidence of current or past infection. These chronically infected individuals are at high risk of death from cirrhosis and liver cancer. The use of new antiviral drugs, such us nucleotide analogues, offers hope in the prognosis of

The hepatitis B virus is a partly double-stranded DNA virus, with several serological markers: HBsAg and anti-HBs, HBeAg and anti-HBe, and anti-HBc IgM and IgG. It is transmitted through contact with infected blood and semen. A safe and effective vaccine has been available since 1981, and although variable, the implementation of universal vaccination in infants has resulted in a sharp decline in prevalence.

Hepatitis B virus is not cytopathic; both liver damage and viral control, and therefore clinical outcomes depend on the complex interplay between virus replication and host immune response. Overall, as much as 40% of men and 15% of women, with perinatally acquired hepatitis B virus infection, will die of liver cirrhosis or hepatocellular carcinoma. In addition to decreasing hepatic inflammation, longterm antiviral treatment can reverse cirrhosis and reduce hepatocellular carcinoma. Development of new therapies that can improve HBsAg clearance and virological

The diffusion of HBV infection is still wide in several low-income countries, where the prevention, management, and treatment of HBV infection are a heavy burden for the governments and healthcare authorities. Of note, the information on the HBV epidemiology is minimal in numerous eastern European and Latin-American countries. The studies on molecular epidemiology performed in some countries provide an important contribution for a more comprehensive knowledge of HBV

**Hepatitis B:**

substantially in the last few years.

patients suffering from chronic hepatitis B.

cure is warranted.
