Chronic Hepatitis B

Overview of Chronic Hepatitis B

Causes

• Hepatitis B Virus (HBV): A virus that infects the liver. It is transmitted through contact with infectious body fluids, including:
  • Blood: Sharing needles, blood transfusions, or needle-stick injuries.
  • Sexual Contact: Unprotected sex with an infected person.
  • From Mother to Baby: During childbirth if the mother is infected.
  • Other: Sharing personal items like razors or toothbrushes with an infected person.

Pathophysiology

• Acute Hepatitis B: The initial phase of infection. In many cases, the body clears the virus on its own within six months.
• Chronic Hepatitis B: When the infection persists for more than six months. Chronic infection can lead to ongoing liver inflammation and damage.

Symptoms

Chronic hepatitis B may be asymptomatic, particularly in the early stages. When symptoms occur, they can include:

• Fatigue: Persistent tiredness or weakness.
• Abdominal Pain: Discomfort or pain in the upper right side of the abdomen.
• Jaundice: Yellowing of the skin and eyes.
• Dark Urine: Urine may become darker than usual.
• Light-colored Stools: Stools may appear pale or clay-colored.
• Loss of Appetite: Reduced desire to eat.
• Nausea and Vomiting: Feelings of nausea and occasional vomiting.
• Joint Pain: Some individuals experience discomfort in the joints.

Diagnosis

1. Medical History and Physical Examination:

   • Assessment of symptoms, risk factors, and medical history.

2. Blood Tests:

   • Hepatitis B Surface Antigen (HBsAg): Indicates an ongoing infection.
   • Hepatitis B Surface Antibody (anti-HBs): Indicates recovery or vaccination.
   • Hepatitis B Core Antibody (anti-HBc): Indicates past or ongoing infection.
   • Hepatitis B e Antigen (HBeAg): Indicates active viral replication and higher infectivity.
   • Hepatitis B e Antibody (anti-HBe): Indicates reduced viral replication.
   • HBV DNA Levels: Measures the amount of virus in the blood.
   • Liver Function Tests: Assess liver enzyme levels (ALT, AST) to evaluate liver damage.

3. Imaging Studies:

   • Ultrasound: Evaluates liver size, texture, and detects liver abnormalities.
   • CT Scan/MRI: Provides detailed imaging, especially useful in assessing liver damage or tumors.

4. Liver Biopsy or FibroScan:

   • Biopsy: A procedure to take a sample of liver tissue for analysis.
   • FibroScan: A non-invasive test that measures liver stiffness to assess the degree of fibrosis or cirrhosis.

Treatment

Treatment for chronic hepatitis B aims to control the virus, reduce liver inflammation, and prevent complications:

1. Antiviral Medications:

   • Nucleos(t)ide Analogs: Medications like tenofovir (Viread), entecavir (Baraclude), and lamivudine (Epivir) help suppress viral replication.
   • Interferons: Pegylated interferon alfa (Pegasys) may be used to stimulate the immune system to fight the virus, though it is less commonly used due to side effects.

2. Monitoring and Follow-Up:

   • Regular Check-Ups: Regular blood tests and imaging to monitor liver function and viral load.
   • Liver Cancer Screening: Recommended for individuals at high risk, such as those with cirrhosis or a family history of liver cancer.

3. Lifestyle Modifications:

   • Avoid Alcohol: Reducing or eliminating alcohol intake to prevent further liver damage.
   • Healthy Diet: Eating a balanced diet to support liver health.
   • Vaccination: Hepatitis A vaccination is recommended for those with chronic hepatitis B, as hepatitis A can worsen liver disease.

4. Management of Complications:

   • Cirrhosis: Management includes addressing symptoms, managing portal hypertension, and considering liver transplantation if needed.
   • Liver Cancer: Treatment options include surgical resection, liver transplantation, and targeted therapies.

Prevention

Preventing hepatitis B involves:

• Vaccination: The hepatitis B vaccine is highly effective and is recommended for all infants, children, and high-risk adults.
• Safe Practices: Using protection during sexual activity, avoiding sharing needles or personal items, and ensuring safe medical practices.
• Screening and Early Detection: Regular screening for those at high risk of hepatitis B infection or who are living with chronic hepatitis B.

Prognosis

• Varies by Individual: The prognosis for chronic hepatitis B can vary based on factors such as the degree of liver damage, response to treatment, and overall health.
• With Treatment: Many individuals with chronic hepatitis B can achieve viral suppression and prevent significant liver damage or complications.
• Without Treatment: Chronic hepatitis B can progress to serious liver conditions, including cirrhosis and liver cancer.