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Hep B Immunology

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on 1 December 2013

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Transcript of Hep B Immunology

Treatment
(AACC, 2012; Palmer, 2000; Porth, 2011).
Serological Markers
Interpreting Test Results
Transmission
Immune Response
Immunological Aspects of Hepatitis B
Outcomes
Outline
identify 6 HBV serological markers and their significance
be able to determine immunity vs. infection by looking at test results
contrast between HAV, HBV, HCV transmission
describe immune response to a chronic HBV infection
list and describe two treatments for HBV infection
explain procedure in the case of newborn of HBV + mother
6 types of serological markers and their significance
interpretation of patient's serological test results
HBV transmission & its comparison with HCV & HAV
immune response in a chronic HBV infection
Treatment for HBV
Immunoprophylaxis: HBV+ mother & newborn
Immunoprophylaxis
Summary
case study
(Medlibes, 2012)
(adapted from AACC, 2012).
Vaccination: host exposure to HBsAg only; antibody production to HBsAg

Natural Infection: host exposed to HBsAg, HBcAg, HBeAg; production of anti-HBs & anti-HBc
Acute: HBsAg < 6 months, HBeAg=active replication; anti-HBs produced

Chronic: HBsAg > 6 months, IgG anti-HBc indicates chronic infection
HAV - least likely to cause chronic hepatitis --> no carrier state; long term immunity from IgG anti-HAV
(adapted from Palmer, 2000).
Interferon alpha 2-b (Intron A)
infected cells produce cytokines that affect neighboring cells to produce an immune response to prevent hep B viral proliferation
Innate immunity:
dendritic cells
interferons
natural killer cells
Kupffer cells
Adaptive immunity:
B-cells
plasma cells
memory cells
CD-4 T-cells
CD-8 T-cells
chemokines
cytokines
1) Immune Tolerant
-“suboptimal immune response”

2) Immune Active
-high levels of viral load and active liver damage

3) Inactive chronic carrier state
-asymptomatic chronic hep B surface antigen carriers
3 Phases of Chronic HBV Infection
Due to vertical transmission, newborns are given
Hep B Immunoglobulin (HBIG) 12-24 hours after birth and a routine of 3 dose vaccine series.

Exposure to HBsAg intiates baby's immune response to produce
anti-HBs
(Porth, 2011).
(U of W, 2012).
presence of lamivudine-resistant HBV
Lamivudine (Epivir)
stops DNA synthesis by preventing
the action of enzyme reverse transcriptase
(Aschenbrenner & Venable, 2009).
(Nursing Central, 2012).
Your patient presents with the following test results. What is his HBV status?
Out of the two treatments discussed, which would be preferred in this case?
How would you explain the concept of
chronic

HBV infection to this patient?
References
American Association for Clinical Chemistry (AACC). (2012). Hepatitis B: the test. Retrieved from
http://labtestsonline.org/understanding/analytes/hepatitis-b/tab/test
Aschenbrenner, D.S., & Venable, S.J. (2009). Drug Therapy in Nursing (3rd ed.). Philadelphia, PA:
Lippincott Williams & Wilkins
Bertoletti, A., & Carlo, F. (2011). Innate and adaptive immune responses in chronic hepatitis B virus infections: towards restoration of immune control of viral infection. Gut, 1-13. doi:10.1136/gutjnl-2011-301073
Bertoletti, A., & Gehring, A. (2007). Immune response and tolerance during chronic hepatitis B virus
infection. Hepatology Research : The Official Journal of the Japan Society of Hepatology, 3(3), 331-338. doi: 10.1111/j.1872-034X.2007.00221.x
Centers for Disease Control and Prevention (CDC). (2012). Perinatal transmission. Retrieved from
http://www.cdc.gov/hepatitis/HBV/PerinatalXmtn.htm
NursingCentral. (2012). Interferon alpha-2b. Retrieved from
http://www.unboundmedicine.com/nursingcentral/ub/view/Davis-Drug-Guide/109637/all/interferon_alpha%C2%962b?q=interferon-alpha
NursingCentral. (2012). Lamivudine. Retrieved from
http://www.unboundmedicine.com/nursingcentral/ub/view/Davis-Drug-Guide/51432/all/lamiVUDine?q=lamivudine
Palmer, M. (2000). Hepatitis liver disease: what you need to know. United States of America: Avery.
Porth, C.M. (2011). Essentials of pathophysiology (4th ed.). China: Lippincott Williams & Wilkins.
Public Health Agency of Canada. (2006). Canadian immunization guide- Seventh edition 2006:
Recommended immunization schedules. Retrieved September 30, 2012 from
http://www.phac-aspc.gc.ca/publicat/cig-gci/p03-01-eng.php
Szabo, G., Mandrekar, P., & Dolganiuc, A. (2007). Innate immune response and hepatic
inflammation. Seminars in Liver Disease, 27(4), 339-350. doi: 10.1055/s-2007-991511
Talaro, K.P. & Chess, B. (2012). Foundations in microbiology (8th ed.). New York: McGraw-Hill.
University of Washington, 2012. Hepatitis web study: discussion in classification and phases of
chronic HBV infection. Retrieved from
http://depts.washington.edu/hepstudy/hepB/history/chronic/discussion.html
Yanfang, J., Zhenhua, M., Guijie, X., Hongqing, Y., Wanyu, L., Huining, X., Chunhai, H., Junqi, N., &
Pingwei, Z. (2012). Th1 and Th2 immune response in chronic hepatitis B patients during a long-term treatment with Adefovir and Dipivoxil. Mediators of inflammation, 2010(2010), 1-10. doi:10.1155/2010/143026
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