Hepatitis B

INTRODUCTION

Hepatitis B is a highly infectious yet vaccine-preventable liver disease caused by the hepatitis B virus (HBV). It can present as both acute (short-term) and chronic (long-term) infection.

If left untreated, approximately 15–40% of chronically infected individuals may progress to serious complications such as liver cirrhosis, end-stage liver disease, or hepatocellular carcinoma (HCC). It is considered one of the most common chronic infectious diseases worldwide.

EPIDEMIOLOGY

• Hepatitis B is a major global health concern, causing nearly 1.4 million deaths annually.
• India has over 40 million infected individuals, making it the second-highest burden globally after China.
• Around 15% of the global HBV burden is contributed by India.
• Higher prevalence is seen in tribal and rural populations.
• Approximately 600,000 deaths occur annually in the Indian subcontinent due to HBV- related complications.
• India has a large number of chronic carriers, contributing significantly to global transmission.

CAUSE

Hepatitis B is caused by infection with the hepatitis B virus, which primarily affects the liver.

HIGH-RISK GROUPS

Individuals at increased risk include:

• Persons having unprotected sexual contact with infected individuals
• Patients with sexually transmitted infections
• Men having sex with men
• Newborns of infected mothers
• Patients undergoing hemodialysis
• Travelers to high endemic regions
• Individuals born in or exposed to high prevalence areas during childhood
• People with family history of HBV or liver cancer
• Individuals exposed to infected blood through household or occupational contact
• Persons with multiple sexual partners
• Intravenous drug users sharing needles
• Individuals exposed to unscreened blood or blood products
• Use of unsterilized instruments (tattoos, piercings, procedures)
• Healthcare workers exposed to blood and body fluids

MODE OF TRANSMISSION

HBV spreads when infected body fluids enter another person’s body, including:

• Sexual transmission through contact with infected semen or vaginal secretions
• Sharing contaminated needles or drug equipment
• Occupational exposure (needle-stick injuries, blood splashes)
• Mother-to-child transmission during childbirth
• Use of unsterilized instruments for tattoos or piercings
• Sharing personal items such as razors or toothbrushes

INCUBATION PERIOD

The incubation period ranges from 45 to 180 days, with an average of 60–90 days.

SIGNS AND SYMPTOMS

Symptoms may appear after several weeks to months and include:

• Loss of appetite
• Fatigue
• Mild fever
• Muscle and joint pain
• Nausea and vomiting
• Jaundice and dark urine

In many cases, symptoms resolve spontaneously. However:

• Some individuals develop chronic hepatitis B, often without symptoms
• Over time, chronic infection may lead to cirrhosis or liver damage

Severe Acute Presentation

• Jaundice
• Altered mental status (hepatic encephalopathy)
• Abdominal swelling (ascites)

Chronic patients may experience disease flares, especially after stopping immunosuppressive therapy, leading to fulminant hepatitis.

DIAGNOSTIC TESTS

HBV Serological Markers

• HBsAg: Indicates active infection; persistence >6 months suggests chronic infection
• Anti-HBs: Indicates immunity (post-infection or vaccination)
• HBeAg: Reflects high viral replication and infectivity
• Anti-HBe: Suggests reduced viral activity

MANAGEMENT

Goals of Treatment

• Prevent progression to cirrhosis, liver failure, and HCC
• Reduce viral load and transmission
• Improve patient survival

Non-Pharmacological Management

• Low-sodium diet (especially in advanced disease)
• Adequate protein intake
• Fluid restriction in cases of hyponatremia
• Regular monitoring of liver function tests

Pharmacological Management

• Antiviral therapy to control viral replication
• Strict adherence to medication is essential

MANAGEMENT OF CHRONIC HEPATITIS B

Focus is on preventing disease progression by:

• Regular laboratory monitoring
• Identifying candidates for antiviral therapy
• Screening for cirrhosis and liver cancer
• Monitoring for portal hypertension
• Performing liver biopsy when required
• In severe cases, liver transplantation may be necessary.

COMPLICATIONS

• 1.Cirrhosis
  • Occurs in long-term infection
  • Symptoms include:
    • Fatigue
    • Weight loss
    • Abdominal swelling
    • Edema
• 2.Liver Cancer (Hepatocellular Carcinoma)
  • Increased risk in chronic HBV
  • Symptoms:
    • Weight loss
    • Loss of appetite
    • Early satiety
    • Nausea
    • Jaundice
• 3.Fulminant Hepatitis
  • Rare but life-threatening
  • Symptoms:
    • Confusion
    • Collapse
    • Severe jaundice
    • Ascites

PREVENTION OF TRANSMISSION

• Avoid sharing personal items (razors, toothbrushes)
• Do not donate blood, organs, semen or tissues
• Practice safe sex (condom use)
• Proper disposal of contaminated materials
• Clean blood spills with bleach solution
• Screen and vaccinate close contacts. Hepatitis B vaccine is available free of cost for susceptible contacts

SPECIAL CONSIDERATIONS

Pregnant Women

• Require evaluation to prevent mother-to-child transmission
• Newborns need Hepatitis B Immunoglobulin + HBV vaccine

Patient with Acute Hepatitis B Virus infection

• Usually does not require antiviral treatment
• Follow-up after 6 months is essential

Patients with Chronic Hepatitis B Virus infection

• Reducing the risk of liver damage (Fibrosis progression)
• Have liver enzymes monitored every 6-12 months.
• Avoid alcohol.
• Stop smoking, as it increases the risk of liver cancer.
• You may drink coffee; 3 or more cups per day may reduce the risk of liver cancer.
• Maintain a healthy weight.
• Get vaccinated against hepatitis A if you are not already immune
• Stick to your medication schedule and your regular lab testing and follow-up visits.
• Tell the physician before starting any immunosuppressive therapy.
• Regular ultrasound screening
• Tell the doctor about any complementary/alternative therapies or over the counter supplements including herbal remedies that you are taking.
• Follow the advice on how frequently you require abdominal ultrasounds.

Living well with HBV

• Enjoy physical activities. There are no restrictions on working out or sports, including contact sports.
• Eat a healthy diet.
• Allow children to go to school or day care and to play with other children.
• Kissing or sharing food/utensils pose no risk for transmission.