\nDark urine, pale stools.<\/p>\n<\/li>\n<\/ul>\n
Note: Infants infected at birth rarely develop acute symptoms but almost always develop chronic infection.<\/p>\nYellowing of skin is a noticaeble symptom of Hepatitis B<\/figcaption><\/figure>\n<\/span>4.2. Chronic Hepatitis B<\/b><\/span><\/span><\/h3>\nOccurs when the body cannot clear the virus (>6 months). Many are asymptomatic for decades. Advanced symptoms indicate severe liver damage:<\/p>\n
\n\nPersistent fatigue.<\/p>\n<\/li>\n
\nAbdominal pain.<\/p>\n<\/li>\n
\nUnexplained weight loss.<\/p>\n<\/li>\n
\nRecurrent jaundice.<\/p>\n<\/li>\n
\nSwelling in legs\/ankles (edema).<\/p>\n<\/li>\n
\nEasy bruising\/bleeding.<\/p>\n<\/li>\n<\/ul>\n
<\/span>5. Risk Factors<\/b><\/span><\/h2>\nRisk factors may include:<\/span><\/p>\n\n\nBorn to an infected mother\/father.<\/p>\n<\/li>\n
\nLiving with or having sex with an infected person.<\/p>\n<\/li>\n
\nSharing needles or personal hygiene items.<\/p>\n<\/li>\n
\nMultiple sexual partners.<\/p>\n<\/li>\n
\nMen who have sex with men (MSM).<\/p>\n<\/li>\n
\nHealthcare workers.<\/p>\n<\/li>\n
\nHemodialysis patients.<\/p>\n<\/li>\n
\nHistory of other STIs (especially HIV).<\/p>\n<\/li>\n<\/ul>\n
<\/span>6. Complications<\/b><\/span><\/h2>\nWhile acute cases often resolve, chronic Hepatitis B is life-threatening:\n\nCirrhosis:<\/strong> Liver scarring leading to loss of function.<\/p>\n<\/li>\n\nLiver Cancer (HCC):<\/strong> HBV is the leading cause of primary liver cancer worldwide.<\/p>\n<\/li>\n\nLiver Failure:<\/strong> The liver stops working.<\/p>\n<\/li>\n\nHepatic Encephalopathy:<\/strong> Toxins build up in the blood affecting the brain (confusion, coma).<\/p>\n<\/li>\n\nPortal Hypertension:<\/strong> High pressure in liver veins causing esophageal varices (bleeding).<\/p>\n<\/li>\n\nCo-infection:<\/strong> With Hepatitis D (HDV), worsening liver disease.<\/p>\n<\/li>\n<\/ul>\n<\/span>7. Diagnosis<\/b><\/span><\/h2>\nIn addition to thoroughly assessing the history of increased risk factors for Hepatitis B infection, the signs and symptoms of the disease, the diagnosis of Hepatitis B is usually based on blood tests to find viral antigens and antibodies, along with tests to evaluate liver function.<\/p>\n
\nBlood Tests (Serology):<\/span><\/strong>\n\nHBsAg (Hepatitis B surface antigen):<\/strong> This test shows whether you have an active infection. A positive result means you have Hepatitis B and can transmit the virus to others. A negative result means you are not currently infected with Hepatitis B. This test does not distinguish between chronic and acute infection. This test is used for screening.<\/li>\nAnti-HBs (Antibody to HBsAg):<\/strong> If positive, it indicates the person has immunity to HBV (due to vaccination or past infection and recovery).<\/li>\nAnti-HBc<\/strong> (Antibody to Hepatitis B core antigen):\n\nAnti-HBc IgM: Indicates acute HBV infection or an acute flare of chronic Hepatitis B.<\/li>\n Anti-HBc Total\/IgG: Indicates past HBV infection (may have recovered or have chronic infection).<\/li>\n<\/ul>\n<\/li>\n HBeAg and Anti-HBe:<\/strong> A positive HBeAg indicates that the virus is actively replicating and has a high infectivity potential. A positive Anti-HBe usually indicates that the virus is less active but can still be infectious.<\/li>\nHBV DNA (Viral Load):<\/strong> Measures the amount of virus in the blood, indicating the level of viral activity and used to monitor treatment effectiveness.<\/li>\n<\/ul>\n<\/li>\nLiver Function Tests:<\/span><\/strong>\u00a0Measures the levels of liver enzymes (ALT, AST), bilirubin, albumin, and total protein to assess the extent of liver damage and function. High liver enzyme levels indicate liver damage or inflammation. These results can also help determine which parts of your liver may be functioning abnormally.<\/span><\/li>\nImaging Tests:<\/span><\/strong>\u00a0Liver ultrasound, FibroScan (measures liver stiffness to assess the degree of fibrosis), CT scan, or liver MRI may be performed to assess the liver’s condition and detect cirrhosis or tumors.<\/span><\/li>\n<\/ul>\n<\/span>8. Treatment<\/b><\/span><\/h2>\n\nAcute Hepatitis B:<\/span><\/strong>\n\nOver 95% of acute Hepatitis B cases in adults will spontaneously resolve. Treatment is primarily supportive.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n\n\nRest, avoid strenuous work or exertion during the period of clinical symptoms.<\/span><\/li>\nDiet: reduce fat, abstain from alcohol. Temporary intravenous nutrition only when there is severe vomiting or inability to eat or drink.<\/span><\/li>\nAvoid using medications metabolized by the liver or herbal remedies (including acetaminophen or paracetamol).<\/span><\/li>\nIntensive internal medicine resuscitation for severe cases.<\/span><\/li>\nEnsure stable respiratory and circulatory function.<\/span><\/li>\nVitamin K1: 10 mg\/day intramuscularly or diluted for slow intravenous injection for 3 days when the prothrombin ratio is reduced to < 60%.<\/span><\/li>\nManagement of coagulopathy, anti-cerebral edema, plasma exchange… based on the assessment of specific clinical abnormalities.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\nIndications for Antiviral Drugs (Entecavir or Tenofovir) for acute Hepatitis B until HBsAg is negative when:<\/span><\/strong>\n\n\n\nFulminant Hepatitis B.<\/span><\/li>\nAcute Hepatitis B accompanied by at least 2 criteria:<\/span>\n\nHepatic encephalopathy.<\/span><\/li>\nSerum total bilirubin > 3 mg\/dL or > 51 \u00b5mol\/L (or direct bilirubin > 1.5 mg\/dL or > 25 \u00b5mol\/L).<\/span><\/li>\nCoagulopathy: INR > 1.5.<\/span><\/li>\n<\/ul>\n<\/li>\nIllness lasting longer than 4 weeks with an increasing trend in bilirubin.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\nChronic Hepatitis B:<\/span><\/strong><\/li>\n<\/ul>\nThe goal of chronic Hepatitis B treatment is to control viral replication, reduce liver inflammation, prevent progression to cirrhosis and liver cancer, and improve quality of life as well as prevent transmission within the community, especially from mother to child.<\/p>\n
\n\n\nAntiviral Drugs:<\/span><\/strong>\u00a0Oral antiviral drugs such as Entecavir (ETV), Tenofovir disoproxil fumarate (TDF), and Tenofovir alafenamide (TAF) are the main treatment options. These drugs help suppress viral replication, reduce viral load, and improve liver inflammation.<\/span><\/li>\nInterferon:<\/span><\/strong>\u00a0Pegylated interferon (Peg-IFN): This is an injectable drug, often used for a limited period of about 48 weeks and can cause more side effects. It may be considered for patients who desire short-term treatment; patients co-infected with HDV; or patients with low viral load and high ALT who do not want long-term treatment with NAs (nucleot(s)ide analogues).<\/span><\/li>\nTreatment Indications:<\/span><\/strong>\u00a0The decision to treat is based on multiple factors such as viral load (HBV DNA), liver enzymes (ALT), degree of liver fibrosis (FibroScan or biopsy), age, and pregnancy status. WHO recommends treatment for all adolescents (12-17 years old) and adults with evidence of significant liver fibrosis (F2 or greater) or cirrhosis, regardless of HBV DNA or ALT levels.<\/span><\/li>\nLiver Transplant:<\/span><\/strong>\u00a0This is the last resort for patients with end-stage liver failure due to Hepatitis B.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/span>9. Post-Treatment Monitoring<\/b><\/span><\/h2>\nRegular follow-up is extremely important for Hepatitis B patients, even while undergoing treatment or after stopping treatment.<\/p>\n
\nRoutine Testing:<\/span><\/strong>\n\nLiver Enzymes (ALT):<\/span><\/strong>\u00a0Checked regularly (every 6 months) to assess liver damage and determine the need for treatment.<\/span><\/li>\nViral Load (HBV DNA):<\/span><\/strong>\u00a0Measured periodically (every 6-12 months) to assess the level of viral activity, treatment effectiveness, and potential for drug resistance.<\/span><\/li>\nHBsAg and Anti-HBs:<\/span><\/strong>\u00a0Monitored to evaluate the possibility of seroconversion (loss of HBsAg and appearance of Anti-HBs), which is a sign of recovery or good disease control.<\/span><\/li>\nAlpha-fetoprotein (AFP):<\/span><\/strong>