Igna Laurensus Sitorus

1765050158
 Penyakit hepatitis merupakan masalah kesehatan di dunia
 Indonesia merupakan negara dengan endemisitas yang tinggi hepatitis B, terbesar
kedua di negara South East Asian Region setelah Myanmar

Infodatin hepatitis Kemenkes 2014

 Hepatitis" terjadi inflamasi pada organ hati.

 Di Amerika Serikat, jenis hepatitis virus yang paling umum adalah Hepatitis A, Hepatitis B,
dan Hepatitis C
 Hepatitis B dapat menjadi penyakit hati serius yang disebabkan oleh infeksi HBV
 Hepatitis B akut mengacu pada infeksi jangka pendek yang terjadi dalam 6 bulan pertama setelah
seseorang terinfeksi virus.
 Hepatitis B kronis mengacu pada infeksi virus Hepatitis B lebih dari 6 bulan.

U.S Department of health and human services 2016

• HBV merupakan kelompok virus
DNA dan tergolong dalam family
Hepadnaviridae
• HBV berupa partikel dua lapis
dengan diameter 42-47 nm yang
disebut “Partikel Dane”
• Lapisan luar terdiri atas antigen
HBsAg yang membungkus partikel
inti. HBsAg terdiri atas lipoprotein.
• Pada inti terdapat DNA VHB
Polimerase. Pada partikel ini
terdapat HBcAg dan HBeAg.
• Masa inkubasi HBV bervariasi (30-
180 hari) rata-rata 75 hari.
Acute HBV
• Subclinical infection in 70% of adults and 90% of
children
• Prodromal phase: Typical hepatitis symptoms,
anorexia, nausea, flu-like symptoms, ALT and AST
elevate
• Icteric phase: Jaundice and dark urine set in
• Convalescent phase: Symptom resolution, appetite
returns, sense of wellness increases
• Treatment is supportive, usually lasting 1-3 months
• Fulminant liver failure and hepatocellular necrosis
in 1% of all cases with high mortality; liver
transplant may be the only option
Chronic HBV
• Chronic HBV begins where the convalescent
phase ends after acute infection
• If HBsAg persists longer than 10 weeks after initial
exposure in serologic testing, it may signal the onset
of chronic HBV – definitive if >6 months
• HBeAg is an indicator of viral replication and
infectivity – if HBeAg remains, this predicts the
continued development of chronic disease
• Positive liver biopsy
• Up to 30% of individuals with unresolved, chronic
HBV will progress to cirrhosis and hepatocellular
carcinoma (HCC)
As the blood becomes exposed to HBV, the
body mounts a cell-mediated immune response
by sending cytotoxic T cells and natural killer
cells to the virus and release inflammatory
cytokines. The greater the immune response,
the greater the chance of fighting the virus.

Attachment Penetration Uncoating

Release Assembly Replication

 Contact with infected blood or body fluids through contaminated needles,
such as IV drug users or needle stick injuries by healthcare workers
 Sexual transmission – oral and/or genital contact

 Patients undergoing hemodialysis, receiving numerous blood transfusions,

or on immunosuppressive therapies at higher risk, as are first generation
immigrants from southeast Asia, China, and the Middle East
 Mother-to-child HBV Transmission

 Higher risk for exposure when traveling to countries where infection rates
are higher
 Pemeriksaan fisik : Pembesaran hati mungkin minimal, dengan sedikit nyeri
pada palpasi atau perkusi. Namun, pada beberapa pasien, pemeriksaan mungkin
tidak memiliki tanda yang jelas
HBsA anti- anti- anti- HBeAg anti- Interpretation
g HBc- HBc HBs Hbe
total IgM
+ + + - Acute or chronic HBV infection
+ + - - + - Likely chronic carrier state; highly infectious
+ + - - - + Likely chronic carrier state; infectivity lower
- + + Past hepatitis B infection; immune unless immunosuppressed which can
result in reactivation
- + - - Remote or past hepatitis B or false positive; resolved infection, probably
immune
- - - + HBV vaccine induced immunity
- - - - No evidence of HBV infection

+ + + +/- +/- Very racely patients will display HBsAg, anti-HBc-total & anti-HBs. Such
patients are typically chronically infected or may be resolving their
infection. They are considered infectious
 Rekomendasi APASL (Asia Pacific Association for Study of the Liver), anak dengan
HBV dipertimbangkan untuk mendapat terapi antiviral bila nilai ALT lebih dari 2
kali batas atas normal selama lebih dari 6 bulan, terdapat replikasi aktif (HBeAg
dan/atau HBV DNA positif).
 Interferon dan lamivudin telah disetujui untuk digunakan pada terapi hepatitis B
kronis. Bila hanya memakai interferon (dosis 5-10 MU/m2, subkutan 3x/minggu)
dianjurkan diberikan selama 4-6 bulan, sedangkan bila hanya digunakan
lamivudin tersendiri diberikan paling sedikit selama 1 tahun atau paling sedikit 6
bulan bila telah terjadi konversi HBeAg menjadi anti HBe.
Primary Treatments:
 Interferon-α (INF-α): Standard treatment up to 12-24 weeks, many side effects (flu-like,
fatigue, neutropenia), injected medication, cannot be used in patients with
decompensated liver disease, ok to use if planning on becoming pregnant, less chance
of resistance, may cause neutropenia.
 Pegylated Interferon-α (pegINF-α): Standard treatment is 48 weeks. Many side effects
(flu-like, fatigue, neutropenia). More convenient administration and sustained viral
suspension than INF-α. Injected. Cannot be used in decompensated state.
 Lamivudine: Standard treatment 48-52 weeks. Cost effective for oral medication, high
incidence of resistance, may be used during pregnancy, used for patients coinfected
with HIV, can be used in patients with decompensated liver disease.
 Entecavir: Standard treatment 48 weeks. High efficacy primary treatment, low rate of
resistance, can be used in patients with decompensated liver failure.
Secondary Treatments (or may be primary treatments if above primary treatments
not indicated):
 Adefovir: Standard treatment 48 weeks. Good for patients with lamivudine-resistant
HBV, but lower efficacy rate at eradicating the virus (only 25% response in some
studies/patients).
 Tenofovir: Standard treatment is 48 weeks. Higher potency than adefovir and is
effective at suppressing lamivudine-resistant HBV and wild-types.
 Telbivudine: Standard treatment is 52 weeks. Better efficacy than lamivudine and
adefovir, but has same resistance and is expensive. Limited role as a primary
therapy.
Transplantasi hati tetap menjadi pilihan bagi pasien yang berkembang menjadi
penyakit hati stadium akhir. Seiring waktu, tingkat kelangsungan hidup telah
meningkat dan tingkat kekambuhan HBV telah menurun setelah transplantasi hati
 Agen untuk profilaksis terhadap infeksi virus hepatitis B
 Globulin imun hepatitis B (HBIG), yang memberikan perlindungan sementara
dari HBV
 vaksin hepatitis B,

 Skrining universal HBsAg pada wanita hamil dilakukan dan

imunoprofilaksis diberikan kepada bayi yang lahir dari ibu yang
berpotensi infeksius untuk mencegah infeksi perinatal
 Kemenkes RI. Infodatin; Situasi dan Analisis Hepatitis. Jakarta: Infodatin. 2014:1. [dikutip pada 11 Januari 2019] diunduh
dari http://www.depkes.go.id/resources/download/pusdatin/infodatin/infodatin-hepatitis.pdf
 Kemenkes RI. Sebagian Besar Kematian Akibat Hepatitis Virus Berhubungan dengan Hepatitis B dan C Kronis. Jakarta :
2016. [dikutip pada 11 Januari 2019] diunduh dari http://www.depkes.go.id/article/view/16042700001/sebagian-
besar-kematian-akibat-hepatitis-virus-berhubungan-dengan-hepatitis-b-dan-c-kronis.html
 WHO. What is Hepatitis. 2018. [dikutip pada 11 Januari 2019] diunduh dari https://www.who.int/features/qa/76/en/
 Johns Hopskins Medicine. Viral Hepatitis B. Maryland : 2019. [dikutip pada 11 Januari 2019] diunduh dari
https://www.halstedsurgery.org/GDL_Disease.aspx?CurrentUDV=31&GDL_Cat_ID=024CC2E1-2AEB-4D50-9E02-
C79825C9F9BF&GDL_Disease_ID=554180E5-387E-4246-9AB9-D29E025D417F
 CDC. Hepatitis B. United States: U.S Department of Health and Human Services. 2016:1. [dikutip pada 11 Januari 2019]
diunduh dari https://www.cdc.gov/hepatitis/hbv/pdfs/hepbgeneralfactsheet.pdf
 Soemohardjo, S. Gunawan, S. Hepatitis B Kronik. Dalam Buku Ajar Ilmu Penyakit Dalam. Edisi IV. Pusat Penerbitan
Fakultas Kedokteran Universitan Indonesia. Jakarta. 2006.
 EMI Guidelines. Hepatitis B virus: epidemiology and transmission risks. 2016:71. [dikutip pada 11 Januari 2019]
diunduh dari http://www.hpsc.ie/a-z/EMIToolkit/appendices/app21.pdf