Hepatitis B

Hans Christian U
Penguji: dr. Ignatius Bima, Sp.PD
 Epidemiologi
• 2 milyar orang terpapar
dengan Hepatitis B 
680.000 kematian
• Prevalensi 4-23% di Indonesia
(PPHI)

MacLachlan et al, 2015

Virus Hepatitis B

Cusabio, 2017
 Replikasi

Balmasova et al, 2014

 Injeksi
Horizontal
Hubungan
Transmisi Seksual

Vertikal Maternal

Lamontagne et al, 2016

 HBsAg

Anti-HBs

Serologi HBeAg
Virus
Hepatitis B Anti-HBeAg

Anti-HBc

DNA VHB serum

Peters et al, 2015
Hepatitis B akut
• 2/3 pasien asimptomatik
• ALT > 500 IU/ml
• 5-10 % berkembang menjadi kronik (HBsAg positif minimal 6 bulan)

Jaundice
Demam
Mual & muntah
Ruam
Rasa tidak nyaman

Lamontagne et al, 2016

Burns et al, 2014
 + (1-12 minggu )
HBsAg ++++ +++ ++ +
- (1-19 minggu)

+ (1-3 minggu)
HBeAg + +/- - -
- (3 minggu)

Anti-HBe - - -/+ + +

DNA VHB + (1-12 minggu)

> 200,000 > 20000 < 2000 > 2000
Serum - (1-17 minggu)

Meningkat Meningkat
Meningkat dalam Normal Normal
ALT persisten atau persisten atau
41-77 hari persisten persisten
intermiten intermiten

Inflamasi dan
Inflamasi dan Inflamasi
Biopsi Inflamasi dan fibrosis tidak ada fibrosis sedang-
fibrosis ringan atau

Hepatitis B
Hepar atau minimal berat dengan
sedang-berat normal
sirosis

  Immune Immune Replikatif

Fase Reaktivasi
Tolerant Clearance rendah

Penyakit Hepatitis B akut Hepatitis B kronik

Burns et al, 2014

Du et al, 2017
Krugman et al, 1979
Liang et al, 2010
 Serologi

Serum albumin & bilirubin

ALT (SGPT)

AST (SGOT)

Pemeriksaan Waktu Prothrombin

Penunjang Hitung darah lengkap (CBC)

Alfa fetoprotein

Ultrasonografi

Endoskopi

Biopsi

WHO, 2015
Diagnosis
Hepatitis B Kronik Pengidap Inaktif Infeksi VHB resolved

 HBsAg seropositif > 6  HBsAg positif > 6 bulan  Riwayat infeksi VHB atau
bulan  HBeAg negatif dan anti- ada anti-HBc dalam darah
 DNA VHB serum > 20,000 HBe positif  HBsAg (-)
IU/ml untuk HBeAg positif  DNA VHB serum sangat  DNA VHB serum tidak
 DNA VHB serum < 2000- tinggi (> 1 juta IU/ml) terdeteksi
20000 IU/ml untuk HBeAg  ALT dalam batas normal  ALT serum dalam batas
negatif  Biopsi hati tidak normal
 ALT meningkat secara menunjukkan inflamasi
persisten atau intermiten dominan
 Biopsi hati menunjukkan
nekroinflamasi sedang
sampai berat

PPHI, 2012
Pengobatan
Pilihan Obat

Interferon Lamivudine

Tenofovir Entecavir

Gerlich, 2013
 HBeAg
Positif

PPHI, 2012
 HBeAg
Negatif

PPHI, 2012
Vaksin
Nama Dagang Cara Pemberian Dosis Interval Pemberian

Anak (<19 thn) 10mcg

Engerix B IM Bulan 0, 1, 6
Dewasa 20 mcg

Anak 10 mcg
Euvax IM Bulan 0, 1, 6
Dewasa 20 mcg

Anak 10 mcg
HB Vax II IM Bulan 0, 1, 6
Dewasa 20 mcg

Anak (0-10 thn) 10 mcg

Hepavax Gene IM Bulan 0, 1, 6
Dewasa 20 mcg
Hepatitis B IM Anak 10 mcg Bulan 0, 1, 6

Cahyono, 2010
Profilaksis pasca paparan

Fitzgerald et al, 2018

Komplikasi

Sirosis Hepatis

Karsinoma Hepatoseluler

Moon et al, 2015

Daftar Pustaka
1. MacLachlan JH, Cowie BC. Hepatitis B virus epidemiology. Cold Spring Harb
Perspect Med. 2015;5(5):1–12.

2. About hepatitis B, what do you need to know? - Cusabio [Internet]. [cited 2020 Jan
26]. Available from: https://www.cusabio.com/c-20128.html

3. Balmasova IP, Yushchuk ND, Mynbaev OA, Alla NR, Malova ES, Shi Z.
Immunopathogenesis of chronic hepatitis B. World J Gastroenterol. 2014;20(39).

4. Lamontagne RJ, Bagga S, Bouchard MJ. Hepatitis B virus molecular biology and
pathogenesis. Hepatoma Res. 2016;2(7):163.

5. Peters MG. Hepatitis B virus infection: What is current and new. Top Antivir Med.
2019;26(4):112–6.

6. Burns GS, Thompson AJ. Viral Hepatitis B: Clinical and Epidemiological

Characteristics. Cold Spring Harb Perspect Med. 2014;1–14.
7. Du X, Liu Y, Lu J, Jin Y, Ren S, He Z, et al. Virological and serological features of acute
hepatitis B in adults. Medicine (Baltimore). 2017;0(May 2016):4–8.

8. Krugman S, Overby LR, Mushahwar IK, Ling C-M, Frösner GG, Deinhardt F. Viral
Hepatitis, Type B — Studies on Natural History and Prevention Re-Examined. N Engl J
Med. 1979;300(3).

9. Croagh CMN, Lubel JS. Natural history of chronic hepatitis B: Phases in a complex
relationship. World J Gastroenterol. 2014;20(30):10395–404.

10. Liang TJ. Hepatitis B: The Virus and Disease. Hepatology. 2010;49:1–17.

11. WHO. Guidelines for the prevention, care and treatment of persons with chronic hepatitis
B infection. Guidel Prev care Treat Pers with chronic Hepat b Infect. 2015;(March):166.

12. Gerlich WH. Medical Virology of Hepatitis B : how it began and where we are now. Virol
J [Internet]. 2013;10(1):1. Available from: Virology Journal
13. Gani RA, Hasan I, Djumhana A, Setiawan PB. Konsensus Nasional Penatalaksanaan
Hepatitis B di indonesia. Perhimpunan Peneliti Hati Indonesia; 2012.

14. Cahyono JBSB. Hepatitis B: Cegah Kanker Hati. Yogyakarta: Kanisius; 2010. 120–
121 p.

15. Fitzgerald B, Kenzie W RS, Leahy J MA. Prevention of Hepatitis B Virus Infection in
the United States: Recommendations of the Advisory Committee on Immunization
Practices Recommendations and Reports Centers for Disease Control and Prevention
MMWR Editorial. Recomm Reports. 2018;67(1):1–36.

16. Moon JC, Kim SH, Kim IH, Lee CH, Kim SW, Lee SO, et al. Disease Progression in
Chronic Hepatitis B Patients under Long-Term Antiviral Therapy. Gut Liver.
2015;9(3):395–404.
Thank You