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Hepatitis B: Causes, Symptoms and Treatment

Hepatitis B is a viral liver infection caused by the hepatitis B virus (HBV). It can be acute or chronic and may lead to serious liver damage if left untreated.

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Things worth knowing about "Hepatitis B"

Hepatitis B is a viral liver infection caused by the hepatitis B virus (HBV). It can be acute or chronic and may lead to serious liver damage if left untreated.

What is Hepatitis B?

Hepatitis B is an infectious liver disease caused by the hepatitis B virus (HBV). The virus attacks liver cells and can trigger acute or chronic inflammation of the liver. Chronic infection may lead to liver cirrhosis (scarring of the liver) or liver cancer (hepatocellular carcinoma) over time. According to the World Health Organization, approximately 296 million people worldwide live with chronic hepatitis B infection.

Causes and Transmission

The hepatitis B virus is transmitted through contact with infected bodily fluids. The most common routes of transmission include:

Sexual contact with an infected person
Sharing needles or syringes (e.g., during intravenous drug use)
Mother-to-child transmission during childbirth (perinatal transmission)
Exposure to infected blood through medical procedures, tattooing, or body piercing under unsanitary conditions

Hepatitis B is not spread through coughing, sneezing, shaking hands, or sharing food and drinks.

Symptoms

Many people with acute hepatitis B do not experience noticeable symptoms. When symptoms do occur, they may include:

Fatigue and general malaise
Yellowing of the skin and eyes (jaundice / icterus)
Dark urine and pale stools
Abdominal pain in the upper right area (liver region)
Nausea, vomiting, and loss of appetite
Joint pain and fever

In cases of chronic infection, symptoms may be minimal or absent for years, even as significant liver damage progresses silently.

Diagnosis

Hepatitis B is primarily diagnosed through blood tests that detect specific viral markers:

HBsAg (Hepatitis B surface antigen): Indicates an active infection.
Anti-HBs (antibodies to HBsAg): Indicates immunity, either from prior infection or vaccination.
HBeAg and Anti-HBe: Provide information about the level of viral replication activity.
HBV DNA (viral load): Measures the amount of virus in the blood and is essential for treatment decisions.
Liver enzymes (ALT, AST): Indicate the degree of liver damage.

Additional diagnostic tools such as ultrasound imaging or a liver biopsy may be used to assess the extent of liver damage in chronic cases.

Treatment

Acute Hepatitis B

Most adults with acute hepatitis B recover fully without specific antiviral treatment. Management is supportive and includes rest, adequate hydration, and avoidance of alcohol and liver-toxic medications. Medical monitoring is recommended to detect any complications early.

Chronic Hepatitis B

Chronic hepatitis B often requires long-term antiviral therapy to suppress viral replication and slow the progression of liver damage. Commonly used medications include:

Nucleos(t)ide analogues such as tenofovir and entecavir: These drugs inhibit viral replication and are typically taken on a long-term basis.
Pegylated interferon alfa-2a: An alternative option for selected patients who may respond to a time-limited course of therapy.

A complete cure of chronic hepatitis B is rarely achievable with currently available treatments; however, the disease can be effectively managed to prevent serious complications.

Prevention and Vaccination

The most effective way to prevent hepatitis B is through vaccination. The hepatitis B vaccine is safe, highly effective, and recommended by health authorities worldwide, including the World Health Organization (WHO), for infants, children, and at-risk adults. Immunity following a complete vaccination course is generally long-lasting. Additional preventive measures include:

Using condoms during sexual activity
Never sharing needles, syringes, or personal hygiene items
Ensuring hygienic standards in medical, tattooing, and body-piercing settings

References

World Health Organization (WHO): Hepatitis B Fact Sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/hepatitis-b (2023)
European Association for the Study of the Liver (EASL): EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. Journal of Hepatology, 2017; 67(2): 370–398.
Lok ASF, McMahon BJ: Chronic hepatitis B: Update 2009. Hepatology, 2009; 50(3): 661–662.

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