Introduction
Hepatitis B is one of the most common viral infections worldwide, affecting nearly 300 million people who live with chronic infection. Every year, hundreds of thousands of deaths are linked to complications such as cirrhosis and liver cancer. For many, the infection remains “silent,” showing no symptoms for years, while in others it leads to active liver disease.
Unlike hepatitis A, which is always acute, the hepatitis B virus (HBV) can persist and become chronic. The good news is that with vaccination, screening, and modern antiviral therapies, hepatitis B can be prevented, detected early, and managed effectively. This article provides a complete overview: what hepatitis B is, how it spreads, how it is diagnosed, the treatment options, prevention strategies, and practical advice for daily life.
1. What is Hepatitis B?
Hepatitis B is caused by the hepatitis B virus (HBV), a DNA virus from the Hepadnaviridae family. It primarily targets the liver, which plays vital roles in detoxification, energy storage, protein synthesis, and bile production. HBV can integrate its DNA into liver cells, making it difficult to completely eliminate and explaining why chronic infection is common.
Acute vs. Chronic Infection
- Acute infection: The first 6 months after exposure. Many adults clear the virus spontaneously.
- Chronic infection: The virus persists for more than 6 months, which can lead to long-term complications such as fibrosis, cirrhosis, and liver cancer.
Comparison with Other Hepatitis Viruses
- Hepatitis A: Transmitted through food and water, always acute, never chronic.
- Hepatitis C: Often chronic but now curable with direct-acting antivirals.
- Hepatitis D: Only occurs in people already infected with HBV.
- Hepatitis E: Foodborne, similar to hepatitis A, more common in developing countries.
2. Modes of Transmission
HBV is highly infectious—much more than HIV—and spreads through blood and certain bodily fluids. Understanding transmission routes is key to prevention.
Through Blood
- Sharing needles or syringes.
- Non-sterile tattoo or piercing equipment.
- Blood transfusions (rare today with strict screening).
- Contact with contaminated objects such as razors or nail clippers.
Sexual Transmission
The virus is present in semen and vaginal secretions. Unprotected sex increases the risk. Using condoms is essential if the partner is not vaccinated.
Mother-to-Child Transmission
Transmission happens mainly during childbirth. Without prevention, many babies become chronically infected. Vaccination plus immunoglobulins at birth reduces this risk to less than 5%.
Everyday Objects
Sharing toothbrushes, razors, or nail scissors can transmit the virus if contaminated with blood.
What Does Not Transmit HBV
- Handshakes, hugs, or kisses.
- Sharing meals.
- Coughing or sneezing (no airborne transmission).
3. Phases of Infection
Acute Phase (0–6 months)
Shortly after infection, hepatitis B can be silent or symptomatic. Most healthy adults clear the virus, while newborns are at high risk of developing chronic infection.
Chronic Hepatitis B
- Inactive carrier: Low viral load, normal liver enzymes. No treatment but regular monitoring.
- Active phase: High viral load, elevated liver enzymes, ongoing liver inflammation—treatment usually indicated.
- HBeAg-negative with replication: Virus active despite absence of HBeAg, requiring close follow-up.
Functional Cure
Rarely, some individuals lose the surface antigen (HBsAg) and develop protective antibodies (anti-HBs). This represents control of the infection.
Potential Complications
- Fibrosis (scarring of the liver).
- Cirrhosis (advanced, irreversible liver damage).
- Liver cancer (hepatocellular carcinoma).
4. Symptoms
Hepatitis B is often called the “silent enemy” because many carriers have no symptoms for years. Signs differ between acute and chronic phases.
Acute Hepatitis B
- Severe fatigue, mild fever.
- Nausea, vomiting, loss of appetite.
- Abdominal pain on the right side.
- Dark urine, pale stools.
- Yellowing of skin and eyes (jaundice).
Rarely, acute hepatitis can be fulminant, leading to acute liver failure—a medical emergency.
Chronic Hepatitis B
- Often no symptoms, except persistent fatigue.
- Advanced disease may cause abdominal swelling (ascites), edema, weight loss, or itchy skin.
5. Diagnosis and Tests
Blood Tests (Serology)
- HBsAg: Positive means active infection. If present for more than 6 months, chronic hepatitis B.
- Anti-HBs: Indicates immunity (from vaccination or past infection).
- HBeAg: Presence means high viral replication and contagiousness.
- Anti-HBe: Suggests lower viral activity.
- Anti-HBc: Shows past or present exposure to HBV.
Viral Load (HBV DNA)
Measures the amount of virus in the blood. Important for deciding on treatment and monitoring progress.
Liver Function Tests
- ALT, AST, Gamma GT, ALP.
- Elevated enzymes indicate liver inflammation.
Imaging
- Ultrasound to check liver size and structure.
- FibroScan (elastography) to measure fibrosis.
- MRI or CT if tumors are suspected.
Liver Biopsy (less common today)
Used in complex cases to assess inflammation and scarring directly.
6. Treatment and Management
Currently, there is no cure that completely eliminates HBV, but effective therapies exist to control it. The goals are to reduce viral replication, protect the liver, and prevent complications.
When to Start Treatment
- High HBV DNA levels.
- Persistently elevated liver enzymes (ALT/AST).
- Presence of fibrosis or cirrhosis.
- Other risk factors (age, family history of liver cancer, co-infections).
Antiviral Medications
- Tenofovir (Viread, Vemlidy).
- Entecavir (Baraclude).
These oral drugs are taken daily, well tolerated, and often used long-term. They suppress the virus to undetectable levels but do not eradicate it.
Treatment Goals
- Reduce viral load to undetectable.
- Normalize liver enzymes.
- Stop or slow fibrosis progression.
- Prevent cirrhosis and liver cancer.
Special Situations
- Pregnancy: Tenofovir may be used if the mother has very high viral load.
- Cirrhosis: Treatment is almost always necessary.
- Co-infections: Require specialized management (HIV, hepatitis C, hepatitis D).
Follow-up
- Blood tests (liver enzymes and viral load) every 6–12 months.
- Regular ultrasound to screen for cancer, especially in cirrhotic patients.
- Ongoing medical monitoring by a liver specialist.
7. Prevention and Vaccination
Vaccination is the most effective way to prevent hepatitis B. It is safe, effective, and provides more than 90% protection.
Vaccination Schedule
- Infants: Usually 3 doses, for example at 2, 4, and 11 months (depending on country).
- Unvaccinated adults: 0, 1, and 6 months schedule (or accelerated: 0, 1, 2 months + booster at 12 months).
- Protection is confirmed if anti-HBs ≥ 10 IU/L.
Reducing Risk
- Use condoms if partner is unvaccinated.
- Do not share razors, toothbrushes, or nail scissors.
- Use sterile equipment for tattoos, piercings, and medical procedures.
Mother-to-Child Prevention
Pregnant women should be screened for hepatitis B. Newborns of infected mothers should receive the vaccine plus immunoglobulins (HBIG) within 24 hours of birth.
Who Should Be Vaccinated?
- Healthcare professionals.
- Dialysis patients and people receiving frequent transfusions.
- Household contacts of carriers.
- Travelers to high-risk regions.
8. Lifestyle and Daily Care
Avoid Alcohol
Alcohol greatly accelerates liver damage in people with hepatitis B. Total abstinence is recommended.
Be Careful with Medications
Some drugs are toxic to the liver (for example, high doses of paracetamol). Always inform your doctor and pharmacist that you have hepatitis B before taking new medications.
Healthy Diet
- Eat fruits, vegetables, legumes, whole grains, fish, lean meats, and healthy oils.
- Limit fried foods, saturated fats, and refined sugars.
- Maintain a healthy weight to prevent fatty liver disease.
Physical Activity
At least 30 minutes of moderate exercise (walking, cycling, swimming) 5 days per week strengthens the immune system and supports liver health.
Protect Others
- Use condoms if your partner is not vaccinated.
- Encourage household members to get vaccinated.
- Do not share sharp personal items.
9. Hepatitis B and Pregnancy
Risks
The main risk is mother-to-child transmission during childbirth. Without prevention, most infants will develop chronic infection.
Prevention
- All pregnant women should be screened.
- If the mother is infected, the newborn should receive the vaccine plus HBIG within 24 hours of birth.
Treatment During Pregnancy
If the mother has a very high viral load, tenofovir may be prescribed during the last trimester to further reduce transmission risk.
Breastfeeding
Breastfeeding is generally safe if the newborn has received proper prophylaxis (vaccine + HBIG).
10. Prognosis and Complications
Prognosis
With regular follow-up, vaccination, and antiviral treatment, many people with hepatitis B live long, healthy lives. Some remain in an inactive phase for life.
Complications Without Follow-Up
- Fibrosis, then cirrhosis.
- Liver cancer (hepatocellular carcinoma), especially in cirrhotic patients or those with long-term active infection.
Factors That Worsen Prognosis
- Alcohol consumption.
- Co-infections (HIV, hepatitis C, hepatitis D).
- Family history of liver cancer.
- Absence of regular medical monitoring.
Conclusion
Hepatitis B is a serious but manageable viral infection. With screening, vaccination, and effective antiviral treatments, the risks of cirrhosis and liver cancer can be greatly reduced. Healthy lifestyle choices and regular monitoring are essential for living well with hepatitis B.
Key message: Get tested, get vaccinated, and encourage your family and friends to do the same. Early detection and prevention save lives.
Note : This content is for informational purposes only and does not replace professional medical advice. If you test positive for hepatitis B, consult a healthcare professional for appropriate management.
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