Hepatitis B: A very real health danger

Hepatitis B infection causes an immune system reaction that damages the liver and its cells. An infection lasting for longer than 6 months is referred to as chronic liver inflammation. This condition can cause fibrosis in the liver, which may lead to liver cirrhosis and, eventually, liver cancer. Here in Thailand we have found that a large number of liver cancer cases – around 90% – have a history of viral hepatitis, meaning that it is entirely reasonable to associate hepatitis B directly with chronic liver inflammation and liver cancer.

Hepatitis B is generally transmitted through one of four channels:

• From mother to baby: the risk of a child contracting the virus from its mother is particularly high during birth, meaning that blood tests should take place throughout a pregnancy. If a pregnant woman is found to have the virus, the child should be given a vaccination and autoimmune medication (immunoglobulin) at birth in order to protect them against the virus.
• Blood: the virus can be spread through receipt of blood from an infected patient. However, the current number of infections resulting from blood transfusions has been lowered significantly due to stringent blood screening.
• Sexual contact: Hepatitis B patients have a 30 – 50% chance of transmitting the virus to their partner during sexual contact.
• Sharing contaminated equipment: this includes needles used to inject drugs, razor blades, toothbrushes and tattoo equipment.

Approximately 10% of infants and 30–50% of adults who get the hepatitis B virus will experience acute symptoms during the first 1–3 months. These symptoms will come and go, and other illnesses are also likely to appear at this time. The most obvious symptoms of hepatitis B infection are:

• Loss of appetite
• Low fever
• Exhaustion
• Vomiting and nausea
• Jaundice
• Dark urine

Should no other complications arise, these symptoms tend to go away by themselves. However, some patients will experience hepatitis B infections lasting more than 6 months. Although there may not be any visible symptoms, these long-duration infections are referred to as the chronic stage of the illness. Some patients may experience prolonged chronic liver inflammation that causes liver cirrhosis, which has a number of symptoms including:

• Jaundice
• Enlarged abdomen
• Digestive system bleeding due to burst blood vessels
• Feeling down and depressed
• Numbness

Ultimately, liver failure and death are likely to occur, whether the infection is acute or chronic. Moreover, hepatitis B sufferers are at risk of spreading the disease through contact with blood or bodily secretions.

Treatment for hepatitis B involves inhibiting viral replication, thereby reducing the amount of liver inflammation. This can slow the disease’s progression and decelerate the onset of liver cirrhosis or liver cancer. Additionally, some treatments can reduce liver fibrosis.

It is crucial for hepatitis B patients to understand that not all chronic hepatitis B sufferers are suited for treatment, and that special consideration will be given to cases where the virus is spreading, liver inflammation is occurring, or for those with existing liver disorders. There are some points at which the disease is more responsive to treatment, meaning the doctor will consider treating patients who possess certain key indicators.

The doctor will be responsible for determining when antiviral medication treatment can be discontinued, using a number of key indicators to make that decision. Current treatment techniques mean that some patients may be required to take medication for the long-term, or even for the remainder of their lives. Patients should not be the ones who decide when to halt their medication. Medical staff will also monitor the situation of patients who do not yet require such treatment to enable a rapid response should any indicators become apparent, as well as to enable early detection for the onset of liver cancer.

1. Orally administered medication designed to halt the spread of hepatitis B infection.
2. Intravenous administration of the autoimmune drug pegylated interferon. This drug is designed to aid the body’s immune system in its fight against hepatitis B and also has properties that halt the spread of the virus. Pegylated interferon treatment takes 48 weeks to complete and offers benefits lasting 6 months. Once the course has been completed, 33–40% of recipients experience a stabilization of their immune system in its fight against the virus. These patients experience an approximate 14% increase in responsiveness to treatment one year after the course has been concluded. Responsiveness to pegylated interferon treatment tends to last longer and reduce the occurrence of repeated infections when compared to orally administered antiviral drugs.