Have you read many medical journals? Have you perused through any articles in the Journal of Gastroenterology? Let me tell you, I’m not completely convinced they’re written in English. So when my big kids started asking questions about their sister’s hepatitis, I had to get creative. If you happen to be a pediatric gastroenterologist/hepatologist, just look away.
There’s a party going on in Cholita’s liver. It’s been going on most likely since she was born. These party-goers (Hepatitis B virus) are not the type your parents would want at their house. One look at them, and you know they’re trouble.
The dad sitting on the porch (immune system) is unfortunately clueless. This is a newbie dad (a baby’s immune system) and he just hasn’t had enough life experience to know a bad actor when he sees one…..Seem like nice young men….. A more experienced dad (adult’s immune system) would have seen these guys coming from a mile away and gotten rid of them before they could even step foot through the picket fence (acute infection= less than 6 months).
But this dad is naive and the thugs soon have a rip roaring party going on in the liver house. The partiers are having such a great time, they keep texting their friends (replication) and pretty soon the house is bursting at the seams (high viral load). So the party goes on and things start to get a bit messy (inflammation). Dad continues to think all is hunky dory (immune tolerant phase). This can go on for years.
Eventually, Dad wises up and when he does, he’s not pleased with what he sees. He grabs his water gun and starts shooting. Unfortunately, these thugs have jumped onto the backs of his sweet little babies–the liver cells. So, he’s shooting at the thugs, but when he hits a thug, he also hits a liver cell. Virus thugs and liver cell babies are falling in large numbers (high ALT). Thankfully this dad has LOTS of liver cell babies and when one of them goes down, another one grows and takes its place. He keeps shooting and the party seems to be clearing out (viral load going down). Unfortunately, the thugs don’t really want to leave. They love the liver house and keep texting their friends. It’s an all out battle (immune clearance stage). Can the immune system dad shoot faster than the virus thugs can text? Sometimes he can, but most often he can’t.
The immune system dad is working hard, killing off thugs in large numbers, but sometimes he needs to rest. Sometimes he needs to refill his water gun. When that happens, the thugs go into texting overdrive. Dad comes back with his full water gun and sees that the party is even bigger than before. And so the battle goes on. With thugs and liver cells dropping like flies, you can imagine that the carnage gets a bit messy and the liver house is starting to show some wear and tear (fibrosis). Poor dad isn’t making progress and the neighbors are complaining, so we need to send in reinforcements. We have two options: mercenaries (interferon) or cell phone smashers (antivirals).
The mercenaries are well-muscled killing machines. They make dad’s water gun look seriously wimpy. Now, we like having Rambo on our side, but frankly, he makes us a little nervous too. He’s shooting away at the virus thugs and mowing them down in great numbers, but he’s also a little unstable and sometimes he shoots at completely innocent party-goers, just hanging out at the punch bowl (platelets, neutrophils, red blood cells, etc.). Anyway, what we hope the mercenaries can do is put an end to this party all together (stop replication, HBeAg-). The very BEST thing that could happen would be if the mercenaries, with the help of dad and his water pistol, could wipe the thugs out so thoroughly that a permanent guard is placed on the porch (surface antibodies) and the party can never start again.
If mercenaries aren’t your cup of tea, there’s also the option of the cell phone smashers. They’re trying to stop all of this texting-your-friends nonsense (replication). The only problem with this, is that the thugs are determined to keep the party going. Maybe you can smash most of the cell phones, but now a few have showed up with steel-plated cell phones and our antiviral cell-phone smashers can’t seem to stop them (mutations). Pretty soon, everyone has the steel-plated cell phones and we need to try a different breed of antiviral cell phone smasher. It might work, it might not. There are only so many cell phone smashers and the virus keeps making stronger cell phones that are harder and harder to smash.
So Cholita’s party was out of control. She had so many thugs crammed into her liver, we couldn’t even count them anymore. Somewhere over 5 billion. Daddy immune system shot millions of them down, hundreds of millions as a matter of fact, but when he took a break to reload his water gun, a billion snuck back in. The doctor took a little sample of Cholita’s liver house (biopsy) and it confirmed that the party was making a mess (fibrosis). We knew Rambo could be dangerous, and yes, he made us nervous, but Daddy immune system needed help. If he was willing to keep shooting with his water pistol, we’d send in the machine guns.
At the start, the machine guns seemed to be winning. But as time went on, the partiers just turned up the music and texted faster than ever. At the very end, somehow, miraculously, not a single thug could be found. It was time for the mercenaries to clear out too, and so once again, we’re left with only Dad on the porch with his water pistol.
In two months we’ll check to see if the thugs are still gone and if a permanent guard has been installed at Cholita’s garden gate. For now at least, the party’s over. We’re hoping forever.
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