HEPATITIS

B KRONIK
Disusun oleh: Fizal Gunawan (01073190166)
Dibimbing oleh: dr. Ignatius Bima Prasetya, Sp.PD
 PENDAHULUAN
1 42 3
HBsAg >6 bulan 8-20%  orang
240 juta sirosis Di Indonesia infeksi
pasca infeksi1,2  karsinoma
21%terinfeksi VHB3 sekitar 4-
hepatoselular6 20.3%4,5

1 Kementrian kesahatan RI. InfoDATIN Pusat Data dan Informasi Kementrian Kesehatan RI Situasi dan Analisis Hepatitis [Internet]. Jakarta:
Kemenkes RI; 2014. [cited 24 Agustus 2020]. Available from:
https://www.kemkes.go.id/resources/download/pusdatin/infodatin/Infodatin-situasi-penyakit-hepatitis-B-2018.pdf.
2 Yuen MF, Chen DS, Dusheiko GM, Janssen HLA, Lau DTY, Locarnini SSA et al. Hepatitis B virus infection. Nature Reviews Disease Primers.
2018;4(1).
3 Ning Q, Wu D, Wang GQ, Ren H, Gao ZL, Hu P et al. Roadmap to functional cure of chronic hepatitis B: An expert consensus. Journal of Viral
Hepatitis. 2019;26(10):1146-1155.
4 Setiawan PB, Maimunah U, Zein K. Clinical Utility of Quantitative Hepatitis B Surface Antigen (HBsAg) in Chronic Hepatitis B Infection. The
Indonesian Journal of Gastroenterology, Hepatology dan Digestive Endoscopy [Internet]. 2019 [cited 24 Agustus 2020];20(3):169 - 176. Available
from: http://www.ina-jghe.com/index.php/jghe/article/download/715/582
5 Imro'ati TA, Mainunah U. The Management Problems of Patient with Chronic Hepatitis B Infection and Its Reactivation. The Indonesian
 ETIOLOGI 7

7 Wu CC, Chen YS, Cao L, Chen XW, Lu MJ. Hepatitis B virus

infection: Defective surface antigen expression and
pathogenesis. World J Gastroenterol, 2018 [cited 26 Agustus
2020];24(31):3488–99. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6102499/
 PATOFISIOLOGI 2

2 Yuen MF, Chen DS, Dusheiko GM, Janssen HLA, Lau DTY, Locarnini
SSA et al. Hepatitis B virus infection. Nature Reviews Disease Primers.
2018;4(1).
 PERJALANAN PENYAKIT
• Inkubasi 60-90 hari  hepatitis B akut 1
• Lesu, nafsu makan berkurang, demam ringan, nyeri abdomen kanan, icterus, urin pekat
• 5% dewasa dan 90% bayi  hepatitis B kronik 11
• Immune tolerance  Immune Reactive  Low Replicative  Inaktif 6,10

1 Kementrian kesahatan RI. InfoDATIN Pusat Data dan Informasi Kementrian Kesehatan RI Situasi dan Analisis Hepatitis [Internet]. Jakarta:
Kemenkes RI; 2014. [cited 24 Agustus 2020]. Available from:
https://www.kemkes.go.id/resources/download/pusdatin/infodatin/Infodatin-situasi-penyakit-hepatitis-B-2018.pdf.
6 Gani RA, Hasan I, Djumhana A, Setiawan PB, Prasetya IB, Indriani A. Konsensus Nasional Penatalaksanaan Hepatitis B di Indonesia.
Perhimpunan Peneliti Hati Indonesia; 2012.
10 Sarin S, Kumar M, Lau G, Abbas Z, Chan H, Chen C et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015
update. Hepatology International. 2015;10(1):1-98
11 Hepatitis B [Internet]. Who.int. 2020 [cited 29 Agustus 2020]. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-
 PERJALANAN PENYAKIT
• Immune tolerance 10
• HBeAg positif persisten tanpa nekroinflamasi hari
• ALT normal persisten, DNA VHB >2x107 IU/mL, perubahan histologi minimal
• Serokonversi <40 tahun, laju clearance 10-15% per tahun

• Immune Reactive 10
• Muncul gejala
• Serokonversi HBeAg dan HBsAg menjadi anti-HBe dan anti-HBs
• Sirosis  frekuensi dan keparahan hepatitis flare

• Low replicative 10
• HBeAg negative, anti-HBe positif
• ALT normal persisten,
• Fibrosis minimal 6 Gani RA, Hasan I, Djumhana A, Setiawan PB, Prasetya IB,
Indriani A. Konsensus Nasional Penatalaksanaan Hepatitis B
di Indonesia. Perhimpunan Peneliti Hati Indonesia; 2012.
10 Sarin S, Kumar M, Lau G, Abbas Z, Chan H, Chen C et
• Inaktif 6 al. Asian-Pacific clinical practice guidelines on the
• DNA VHB rendah management of hepatitis B: a 2015 update. Hepatology
• ALT normal International. 2015;10(1):1-98
PERJALANAN PENYAKIT 9

9 Burns GS, Thompson AJ. Viral

Hepatitis B: Clinical and
Epidemiological Characteristics. Cold
Spring Harb Perspect Med. 2014;4(12)
ALGORITMA PENGOBATAN 10

10 Sarin S, Kumar M, Lau G,

Abbas Z, Chan H, Chen C et al.
Asian-Pacific clinical practice
guidelines on the management
of hepatitis B: a 2015 update.
Hepatology International.
2015;10(1):1-98
ALGORITMA PENGOBATAN 10

10 Sarin S, Kumar M, Lau G,

Abbas Z, Chan H, Chen C et al.
Asian-Pacific clinical practice
guidelines on the management
of hepatitis B: a 2015 update.
Hepatology International.
2015;10(1):1-98
ALGORITMA PENGOBATAN 10

10 Sarin S, Kumar M, Lau G,

Abbas Z, Chan H, Chen C et al.
Asian-Pacific clinical practice
guidelines on the management
of hepatitis B: a 2015 update.
Hepatology International.
2015;10(1):1-98
PENGOBATAN

6 Gani RA, Hasan I, Djumhana A, Setiawan PB, Prasetya IB, Indriani A.

Konsensus Nasional Penatalaksanaan Hepatitis B di Indonesia. Perhimpunan
Peneliti Hati Indonesia; 2012.
13 Terrault N, Lok A, McMahon B, Chang K, Hwang J, Jonas M et al. Update on
prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018
hepatitis B guidance. Hepatology. 2018;67(4):1560-1599.
 PENGOBATAN 6

INTERFERON NUKLEOS(T)IDA
• Mengaktifkan sel T sitotoksik, sel NK, makrofag
 menghambat sintesis protein
•
ANALOG
DNA VHB <2.000 IU/mL, HBeAg positif, ALT
>3x ULN
• Waktu paruh 3-8 jam • Lamivudin (dosis 100 mg/hari)
• Interferon konvensional (dosis 5 atau 10 MU • Telbivudin (dosis 600 mg/hari)
3x/minggu) • HBeAg negative, ALT tinggi, tanpa gangguan
• Peg-IFN α-2a (dosis 180 mcg/minggu) fungsi ginjal
• Peg-IFN α-2b (dosis 1-1.5 mcg/kgBB/minggu) • Adefovir (10 mg/hari)
• Indikasi • Efektivitas tinggi, resistensi rendah, hepatitis
• Memenuhi indikasi terapi tanpa penyakit dengan sirosis
penyerta dan cukup biaya • Entecavir (dosis 0.5 mg/hari; 1 mg/hari)
• VHB genotype A atau B • Tenofovir (dosis 300 mg/hari)
• Kontraindikasi
• Sirosis dekompensata
• Gangguan psikiatri
• 6 Gani RA, Hasan I, Djumhana A, Setiawan PB, Prasetya IB,
Hamil
Indriani A. Konsensus Nasional Penatalaksanaan Hepatitis B di
• Autoimun aktif Indonesia. Perhimpunan Peneliti Hati Indonesia; 2012.
 PENCEGAHAN 6

VAKSINASI POST-EXPOSURE
• Dibuat dari HBsAg yang sudah
dimurnikan •
PROPHYLAXIS
• HBIg 0.06 mL/kgBB + vaksin hepatitis B
Lakukan pemeriksaan HBsAg pemberi paparan
• Menghasilkan anti-HBs dengan induksi dan anti-HBs penerima oaoaran
sel T spesifik HBsAg dan sel B dependen
terhadap sel T
• Konsentrasi HBsAg 2.5 – 40 mcg
• Diberikan pada orang resiko tinggi
• Paparan darah saat kerja
• Staf pasien cacat mental
• Hemodialisa
• Konsentrat faktor VIII dan IX
• Kontak seksual dengan pasien hepatitis B
• Homoseksual atau biseksual aktif
6 Gani RA, Hasan I, Djumhana A, Setiawan PB, Prasetya IB,
• Endemis hepatitis B Indriani A. Konsensus Nasional Penatalaksanaan Hepatitis B di
• Banyak pasangan Indonesia. Perhimpunan Peneliti Hati Indonesia; 2012.
• Penyalahgunaan injeksi
• Petugas Kesehatan
 KESIMPULAN
• Inflamasi pada sel hati oleh infeksi VHB setelah inkubasi 60-
90 hari
• Hep B kronik melalui 4 fase: Immune tolerance, immune
reactive, low replicative, inaktif
• Pengobatan memiliki algoritma yang berbeda untuk setiap
fase, tetapi pilihan obat tetap 2: Interferon (IFN) dan NA
• Interferon: Interferon konvensional, peg-IFN α-2a, peg-IFN α-
2b
• NA: lamivudin, adefovir (dipivoxil), entecavir, telbivudine,
tenofovir (disoproxil fumarate)
• Pencegahan melalui vaksin dan menghindari kontak langsung
dengan cairan penderita
• Post-exposure prophylaxis menggunakan injeksi HBIg disusul
 REFERENSI
1. Kementrian kesahatan RI. InfoDATIN Pusat Data dan Informasi Kementrian
Kesehatan RI Situasi dan Analisis Hepatitis [Internet]. Jakarta: Kemenkes RI; 2014.
[cited 24 Agustus 2020]. Available from:
https://www.kemkes.go.id/resources/download/pusdatin/infodatin/Infodatin-situasi-p
enyakit-hepatitis-B-2018.pdf
.
2. Yuen MF, Chen DS, Dusheiko GM, Janssen HLA, Lau DTY, Locarnini SSA et al.
Hepatitis B virus infection. Nature Reviews Disease Primers. 2018;4(1).
3. Ning Q, Wu D, Wang GQ, Ren H, Gao ZL, Hu P et al. Roadmap to functional cure of
chronic hepatitis B: An expert consensus. Journal of Viral Hepatitis.
2019;26(10):1146-1155.
4. Setiawan PB, Maimunah U, Zein K. Clinical Utility of Quantitative Hepatitis B
Surface Antigen (HBsAg) in Chronic Hepatitis B Infection. The Indonesian Journal
of Gastroenterology, Hepatology dan Digestive Endoscopy [Internet]. 2019 [cited 24
Agustus 2020];20(3):169 - 176. Available from:
http://www.ina-jghe.com/index.php/jghe/article/download/715/582
5. Imro'ati TA, Mainunah U. The Management Problems of Patient with Chronic
Hepatitis B Infection and Its Reactivation. The Indonesian Journal of
 REFERENSI
6. Gani RA, Hasan I, Djumhana A, Setiawan PB, Prasetya IB, Indriani A.
Konsensus Nasional Penatalaksanaan Hepatitis B di Indonesia. Perhimpunan
Peneliti Hati Indonesia; 2012.
7. Wu CC, Chen YS, Cao L, Chen XW, Lu MJ. Hepatitis B virus infection:
Defective surface antigen expression and pathogenesis. World J
Gastroenterol, 2018 [cited 26 Agustus 2020];24(31):3488–99. Available
from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6102499/
8. Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo Dl, Loscalzo J.
Harrison’s principles of internal medicine 20th ed. McGraw Hill. 2018.
9. Burns GS, Thompson AJ. Viral Hepatitis B: Clinical and Epidemiological
Characteristics. Cold Spring Harb Perspect Med. 2014;4(12)
10. Sarin S, Kumar M, Lau G, Abbas Z, Chan H, Chen C et al. Asian-Pacific
clinical practice guidelines on the management of hepatitis B: a 2015 update.
Hepatology International. 2015;10(1):1-98.
 REFERENSI

11. Hepatitis B [Internet]. Who.int. 2020 [cited 29 Agustus 2020]. Available

from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-
b#:~:text=In%20adults%3A,cirrhosis%20and%2For%20liver%20cancer.
12. Information Sheet Observed Rate of Vaccine Reactions Hepatitis B Vaccine
[Internet]. Who.int. 2012 [cited 29 Agustus 2020]. Available from:
https://www.who.int/vaccine_safety/initiative/tools/Hep_B_Vaccine_rates_in
formation_sheet.pdf?ua=1
13. Terrault N, Lok A, McMahon B, Chang K, Hwang J, Jonas M et al. Update
on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018
hepatitis B guidance. Hepatology. 2018;67(4):1560-1599.
TERIMAK
ASIH
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