Extrahepatic Manifestations of Hepatitis B Infection

Trépo, C.; Amiri, Maryam; Guillevin, Loı̈c

doi:10.1002/9781118637272.ch11

Cited by 5 publications

(5 citation statements)

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“…40 Though very rare nowadays, HBV infection associated poly arteritis nodosa (PAN) is another HBV-related extra-hepatic manifestation which can involve the kidneys. 41 PAN is focal, transmural, necrotizing inflammation involving the mediumsized arteries. Involvement of renal arteries, mainly interlobar and arcuate arteries, may lead to development of arterial aneurysms, thrombosis, renal infarction or hemorrhage.…”

Section: Mechanisms and Pathology Of Renal Involvement In Hbv Infectionmentioning

confidence: 99%

Renal disease in patients infected with hepatitis B virus

Jaryal¹

2015

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Infection with hepatitis B virus (HBV) can result in hepatic diseases which may include an asymptomatic non-replicative carrier state, immunotolerant phase characterized by high DNA levels without significant hepatic injury, immune-reactive phase characterized by occurrence of chronic hepatitis and fibrosis in the liver, or complications like cirrhosis or hepatocellular carcinoma. Extrahepatic manifestations may also accompany HBV infection. These may include serum sickness syndrome, polyarthralgia, polyarthritis, dermatologic manifestations like pitted keratolysis, urticaria, purpura, oral lichen planus or Gianotti-Crosti syndrome-a childhood papular eruption. Renal involvement may occur with HBV infection and usually involves glomerular or vascular injury. Various morphologic forms of renal injury have been reported with HBV infection, the commonest being membranous glomerulonephritis. The manifestations may include swelling over face and body, pedal edema, and urinary abnormalities. Evaluation may detect proteinuria, hematuria and reduction in estimated glomerular filtration rate (GFR). The management options include use of antiviral drugs targeting HBV infection with or without concomitant immunosuppressive medication. With availability of newer drugs like entecavir and tenofovir, these have become the first line agents as they have a high barrier to resistance. Sole use of immunosuppression is not recommended for lack of clear benefit and the possible risk of HBV reactivation or flare.

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Section: Mechanisms and Pathology Of Renal Involvement In Hbv Infectionmentioning

confidence: 99%

Renal disease in patients infected with hepatitis B virus

Jaryal¹

2015

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“…One situation has illustrated the potential for a cure for chronic HBV infection with frequent HBsAg clearance and seroconversion associated with cure. This is polyarteritis nodosa in which the use of a pathophysiological approach using the triple sequential combination of short term steroid priming, followed by plasma exchange and antiviral therapy (vidarabine then interferon then lamivudine) resulted in a cure and HBe and HBs Ag seroconversion and clearance of HBV in more than 60% of cases .…”

Section: Vaccine and Treatmentsmentioning

confidence: 99%

A brief history of hepatitis milestones

Trépo

2013

Liver International

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Hepatitis has been a major plague of mankind. The history of the discovery of causative viruses is one of the most fascinating scientific adventures of this half century. Individualization of several types of hepatitis only emerged after world war two. Their identification has been associated with milestones which revolutionized medicine and public health. The discovery of HBV brought the first ever vaccine not prepared by tissue culture but initially directly from plasma and soon the first vaccine produced by genetic engineering. HBV vaccine proved to be the first "anti-cancer" vaccine by preventing hepatocellular carcinoma and practically eradicating it from childhood in Taiwan. Successful vaccines became also available for HAV and more recently HEV. The discovery of HCV in 1989 opened a new era since it was the first virus was identified by a direct molecular approach. Two billion people are infected with HBV and 350 million are chronic carriers of the virus. The extraordinary effectiveness of HBV vaccination was best illustrated in Taiwan and Singapore where in less than 2 decades HBs Ag carriers dropped from 9,1% to 2,7% and HCC from 27% to 17%. Successful development of nucleos(t)ides analogs make it now possible to fully control disease progression with a daily pill long term therapy. The progress in HCV therapy has been even more spectacular and successful treatment jumped from 6 % with interferon alone in 1986 to more than 80% in 2013 with triple combination therapies. Remarkably chronic hepatitis C is the only chronic disease which is curable. It will be soon possible to eradicate HCV infection with, an all oral, daily single pill (containing several molecules) for 3 to 6 months which will cure over 90% of patients. This unprecedented therapeutic victory benefiting hundred millions of people matches the triumphs over small pox, polio and tuberculosis. The next 10 years should undoubtedly witness cure or full control over all forms of acute and chronic hepatitis.The history of the discovery of hepatitis viruses is one of the most fascinating scientific adventures of the last 50 years. Their identification has been associated with unique cognitive milestones and breakthroughs which revolutionized medicine and public health. The discovery of HBV started the process by bringing the hepatitis B vaccine, the first ever vaccine not prepared by tissue culture but directly from plasma. This unique achievement was soon followed by a new leap to become the first vaccine produced by genetic engineering. The implementation of HBV vaccine proved to be the first 'anti-cancer' vaccine by preventing hepatocellular carcinoma and practically eradicating it from childhood in Taiwan.Since then universal HBV vaccination has been adopted by most of the countries.The discovery of HCV in 1989 opened a new era since it was the first virus which was identified by a direct molecular approach, without tissue culture, electron microscopy or serology. Innumerable new viruses have been discovered this way since.Remarkably, HC...

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“…Daneben können im Rahmen einer CHB oder CHC aber auch extrahepatische Manifestationen auftreten. Die Prävalenz klinisch signifikanter extrahepatischer Manifestationen ist zwar gering, kann aber mit einer signifikanten Morbidität und Mortalität vergesellschaftet sein [4][5][6]. Diese können rheumatoide Symptome verursachen und stellen eine relevante Differenzialdiagnose dar.…”

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“…Extrahepatische Manifestation einer HBV-Infektion:[4,15,[18][19][20]23].Unspezifische grippeähnliche Symptome teilweise mit Fieber Selten auch als Caroli-Trias: Polyarthralgie, Urtikaria, Kopfschmerzen 1-7 Wochen vor einer ikterischen Phase; mit Auftreten eines Ikterus selbstlimitierend Immunkomplexes als Auslöser zu[20]. Daneben sind jedoch auch PAN-Fälle mit HBeAg-negativer, hoch replikativer CHB bekannt[21].…”

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“…Eine Behandlung analog einer nichtviralen PAN (Kortikosteroide und Plasmaseparation) zeigt zwar kurzfristig ein gutes Ansprechen, aber es zeigt sich ein schlechteres Outcome bei HBV-assoziierter PAN, vor allem aufgrund leberspezifischer Komplikationen durch die Immunsuppression[22]. Spezifischere Therapiekombinationen mit zusätzlicher antiviraler Therapie zeigten hingegen ein deutlich besseres, teilweise komplettes klinisches Ansprechen (bis zu 66-75 %)[4]. Als Algorithmus erfolgen häufig eine Kortikosteroid-Stoßtherapie, sowie eine Plasmaseparation zur Entfernung von Immunkomplexen, sowie eine antivirale Therapie.…”

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Die infektiöse Hepatitis: extrahepatische Manifestationen und der Einfluss auf die antirheumatische Therapie

2017

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ZusammenfassungRheumatologische Beschwerden bei gleichzeitig vorliegender Infektion mit dem hepatotropen Hepatitis B (HBV) und Hepatitis C Virus (HCV) stellen häufig ein diagnostisches Dilemma dar, da beide Virusinfektionen neben einer Hepatitis, extrahepatische rheumatoide Manifestationen verursachen können. Beispielsweise ist das Auftreten von Arthralgien, einer Arthritis, einer Vaskulitis, als auch einer Sicca-Symptomatik möglich. Diese sprechen zumeist gut auf eine antivirale Therapie an. Als auslösende Pathomechanismen sind sowohl virusspezifische Faktoren, wie Immunkomplexe oder eine Stimulation von B-Zellen, als auch patientenspezifische Faktoren bekannt. Zugleich schließt eine HBV oder HCV Infektion eine zeitgleiche, nicht virusassoziierte rheumatische Erkrankung nicht aus, deren Diagnostik bei unspezifischer Erhöhung von Autoantikörpern im Rahmen einer HBV oder HCV Infektion häufig erschwert ist. Darüber hinaus stellen vor allem auch moderne antirheumatische Therapien im Falle einer chronischen Virushepatitis ein signifikantes Risiko für eine Reaktivierung bis hin zum fulminanten Leberversagen dar. Im Folgenden gehen wir daher auf häufige extrahepatische Manifestationen der Hepatitis B und C ein, welche eine relevante Differenzialdiagnose für die rheumatologische Praxis darstellen. Zudem werden aktuelle Empfehlungen und Risiken der Anwendung antirheumatischer Therapien bei Patienten mit rheumatologischen Erkrankungen und chronischer HBV oder HCV Infektion diskutiert.

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Extrahepatic Manifestations of Hepatitis B Infection

Cited by 5 publications

References 50 publications

Renal disease in patients infected with hepatitis B virus

Renal disease in patients infected with hepatitis B virus

A brief history of hepatitis milestones

Die infektiöse Hepatitis: extrahepatische Manifestationen und der Einfluss auf die antirheumatische Therapie

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