Interferons in chronic hepatitis B given in -
Early onset
HBV replication
Normal ALT
All the above
Hepatitis B may cause an acute viral hepatitis; however, acute infection is often asymptomatic, paicularly when acquired at bih. Many individuals with chronic hepatitis B are also asymptomatic. The risk of progression to chronic liver disease depends on the source and timing of infection . Veical transmission from mother to child in the perinatal period is the most common cause of infection worldwide and carries the highest risk of ongoing chronic infection. In this setting, adaptive immune responses to HBV may be absent initially, with apparent immunological tolerance. Several mechanisms contribute towards this: Firstly, the introduction of antigen in the neonatal period is tolerogenic. Secondly, the presentation of such antigen within the liver, as described above, promotes tolerance; this is paicularly evident in the absence of a significant innate or inflammatory response. Finally, very high loads of antigen may lead to so-called 'exhaustion' of cellular immune responses. The state of tolerance is not permanent, however, and may be reversed as a result of therapy, or through spontaneous changes in innate responses, such as interferon alpha (IFN-a) and NK cells, accompanied by host-mediated immunopathology Ref Davidson edition23rd pg872
G.I.T