Biography
Biography: Dr. Ehab Abd-El-Atty
Abstract
HBV is the second known carcinogen after smoking. Two billion worldwide had past HBV infection at a time. 350 millions have Chronic HBV. HBV has ten genotypes (A-J). Genotypes A and D have higher rates of chronicity than genotypes B and C. Genotypes C and D have high rates of cirrhosis and HCC as compared with genotype A and B. HBV may be presented as acute HBV or chronic HBV (Immune tolerant, HBe Ag+ve immune active, HBe Ag–ve immune active, carrier or occult). Egypt has 90% genotype D and 90% HBeAg –ve. Vaccination against HBV in infancy is the most effective approach to prevent HBV-related HCC. HBV patients should be screened for HCC every 6 month by US±AFP. Also each HBsAg-positive patients should be screened for anti-HDV. Goals of treatment of HBV are long-term suppression of HBV replication and decrease hepatic necroinflammation and fibrosis to prevent progression to cirrhosis and HCC. In the future, clearance of HBs Ag and cccDNA (covalently closed circular DNA). Candidates eligible for treatment according to are HBe Ag+ve or -ve immune active phases (PCR<2000 and elevated ALT or with moderate to severe liver inflammation), cirrhotic patients with PCR+ve, carrier and occult HBV with PCR+ve under immune suppression, acute fulminated HBV and decompensated cirrhosis. Candidates ineligible for treatment are immunotolerant, carrier and occult phases. Future strategies to eradicate HBV are targeting the host (immune therapy) and targeting the virus (inhibitors of cccDNA formation and inhibitors of HBV entry into the hepatocyte).
