Hepatitis B is one of the leading causes of liver disease in World as well as India. Leading cause of hepatitis B in India is due to vertical transmission from parents to child. Let us learn how hepatitis B can be transmitted to the person.
Transmission of hepatitis B:
Hepatitis B is blood borne virus transmitted from infected person’s blood or body fluids.
Perinatal transmission-infected mother/parent transmit virus to the newborn at the time of child birth or during pregnancy. It is predominantly seen in Indian patients
Sexual route- Unprotected sex with a person having hepatitis B infection
Exposure to blood – Direct contact of infected blood with hepatitis B virus through needlesticks, open cuts/wound or sores.
Contaminated equipment- Sharing personal items that might have traces of blood like razors, toothbrush, or through non sterile medical, dental or piercing /tattooing equipment
Sharing needles and syringes- Using contaminated needles, syringes with infected person or other drug injection equipment
How do I know if I am suffering from Hepatitis B or not?
*Routine screening for hepatitis B is not done. If a person has family member who is suffering from hepatitis B, Liver disease, or Liver cancer, then one should get report of hepatitis B virus i.e. HBsAg and Total Anti HBc according to doctor’s advice
*If anyone is suffering from cancer or other disease where chemotherapy or immunosuppression (the medication which suppress the body’s immunity) is planned then he or she must get the reports done for Hepatitis B and consult Liver specialist as and when required.
What all reports are required for hepatitis B check up ?
This entirely depends on if you are getting checked for screening or have hepatitis B report positive.
To begin with most commonly, HBsAg is done from your blood. If this report is negative, most of the time you don’t need any more reports to check hepatitis B infection.
In special situation your doctor may advice Total anti HBc and Anti HBs report to know more about your hepatitis B infection status and immunity.
In case of HBsAg positive person, viral load needs to be quantified based on HBV DNA report. Also, person needs HBeAg , Anti HBe
Is Fibroscan® necessary for Hepatitis B infected patient?
It is important to document fibrosis at base line when you are first time detected with hepatitis B. It is also important to see the progress or regression of fibrosis during disease. Fibroscan® is one of the best available non-invasive methods to quantify fibrosis stage in your liver.
What damage can hepatitis B virus do to my liver?
Hepatitis B virus may remain asymptomatic slowly damaging your liver for years together or it can precipitate acute liver failure, acute on chronic liver failure or even liver cancer. In most of the patient, hepatitis B is detected as chronic infection during pre-operative work up-before major or minor surgery or detected incidentally during health checkup.
Hepatitis B and liver cancer
Chronic Hepatitis B virus can cause liver cirrhosis and liver cancer. It is one of the leading causes for liver cancer in India. Screening with Ultrasound and blood reports (AFP-alpha feto protein and or PIVKA II) can detect cancer in early stage.
Prevention of Hepatitis B and liver cancer
Yes, you heard it right. It is possible to prevent hepatitis B transmission and thereby we can prevent liver cancer. Family screening and vaccination with 3 doses of hepatitis B vaccine can make you immune from getting infected with Hepatitis B virus. This way you are protected from liver cancer due to hepatitis B.
Hepatitis B treatment
Hepatitis B treatment depends upon stage of virus, stage of liver disease, extent of fibrosis and presence of comorbid condition. History of liver disease related to hepatitis B or liver cancer is also an important point when we consider treatment for hepatitis B. Overall, the aim of treatment is to reduce or regress fibrosis and prevent further liver damage and reduce incident of HCC.
Patient needs to be on long term treatment for hepatitis B without defaulting as defaulters are at risk for virus flare and faster liver damage. One should not discontinue Hepatitis B medicine before consulting liver specialist.
The drug used for hepatitis B are few as of now
Tenofovir – Tenofovir disoproxil fumarate or Tenofovir Alafenamide
Entecavir
PEG interferon can be used in selected cases but the disadvantage of this medicine is its side effects and requirement of injections subcutaneously.
How frequently do I need check up for my hepatitis B?
This depends upon whether you are on treatment or not. Routinely patient is required to follow up every 3rd monthly with blood reports.
Does the patient with chronic hepatitis B require regular screening for liver cancer?
Chronic hepatitis B infection will lead to gradual damage to your liver. This makes your liver a fertile soil where cancer can grow. Person who is infected with hepatitis B needs to be on regular periodic surveillance for HCC.
Interval of HCC surveillance – 6 monthly
Reports- Blood reports – AFP and Ultrasound abdomen
WHO goal of eliminating Hepatitis B
The World Health Organization (WHO) aims to eliminate hepatitis B as a public health problem by 2030, with a 90% reduction in new infections and a 65% reduction in deaths compared to 2015 levels. To achieve this, the strategy focuses on key service coverage targets: diagnosing 90% of cases, treating 80% of eligible individuals, and implementing 90% coverage for the hepatitis B vaccine series in infants and the birth dose vaccine.
If you or your near one is suffering from hepatitis B, this is the right time to contact Hepatologist.