Introduction

Hepatitis B virus is a common cause of hepatitis infection in our population. It is a serious illness that can cause inflammation and scarring of the liver which can be long-lasting.

It can cause acute liver failure where it severely disturbs the liver functions, thereby requiring hospital admission and management which sometimes may include referral for liver transplant.

Chronic infection carries the risk of cirrhosis (scarring of liver), liver failure and liver cancer.

If acquired in infancy and childhood, it is more likely to become chronic (long-lasting). Not everyone who acquires the chronic infection needs treatment but a regular follow up with hepatologist (a doctor with expertise in dealing with the liver problems) is warranted.

Sometimes, hepatitis B can co-exist with another virus called hepatitis D virus causing co-infection which needs different treatment and management.

Risk Factors

The main modes of transmission are by:

Sexual contact

Needle stick injury

Needle sharing

From mother to child during delivery

Symptoms and Signs

Depending upon the mode of presentation, hepatitis B can be asymptomatic (no symptoms at all) or may manifest as:

Jaundice (yellow eyes/skin)

Nausea and vomiting

Tiredness and lethargy

Upper abdominal pain

Drowsiness especially in cases with persistent (chronic) liver disease and is a sign of worsening disease

Fluid in the abdomen especially in cases with persistent (chronic) liver disease, also a sign of worsening disease

Prevention

Vaccination is an important strategy to prevent the infection. An effective and safe vaccine exists for hepatitis B. It is usually given in three doses over a period of 6 months and should be given to every non-infected individual including children. It is a usual part of birth vaccination schedule.

Hepatitis B vaccine and immunoglobulins are given at birth to children born to mothers with positive hepatitis B virus. It is best to know your hepatitis B status before travelling. If a partner is affected, it is imperative to screen the other one, followed by vaccination if found negative for the virus.

Similarly, if one of the parents is affected, the whole family should be screened out, followed by vaccination if found negative for the virus and not already given before.

Vaccine gives lifelong protection so don’t miss the chance of getting vaccinated for hepatitis B if not received before.

Pakistan remains a high zone for hepatitis B and C. Avoiding high risk behaviours, propagating the culture of vaccination and screening are some of the ways which can help eliminate these viruses.

Treatment

Safe oral drugs are available for hepatitis B that can effectively suppress the virus. They are usually given in patients with chronic (long-lasting) hepatitis B and are to be taken for a long period of time because the virus may show up again despite effective suppression if treatment stopped without consulting the doctor. Once started, treatment should be taken on regular basis without any gap.

Not all patients require drug therapy as most have the virus in an inactive phase which requires frequent monitoring. Hepatitis B patients under follow-up spend a normal life and unnecessary restrictions should not be imposed like avoid sharing meals. Avoid risk factors such as sharing needles and shaving kits etc.

Those cases who develop hepatitis B associated cirrhosis (scarring of liver) require different management steps along with antivirals. They may also require liver transplant at some point and should strictly follow up with their doctor.