Hepatitis B virus (HBV) infection is continues to be a serious worldwide health problem, particularly in developing countries. It is primarily spread through contact with infected body fluids, e.g., blood, semen, and vaginal secretions, and can lead to chronic liver disease, cirrhosis, and liver cancer if left untreated.
In this article, we will condense all you need to know about hepatitis B—symptoms, diagnosis, treatments, and how to treat chronic infection.
What Is Hepatitis B?
Hepatitis B is a viral liver infection that is acute or chronic, based on the host immune response. The virus infects liver cells and results in inflammation, which ultimately causes severe damage to the liver.
How Is Hepatitis B Spread?
HBV is transmitted by:
- Having unprotected sex with an infected person
- Sharing syringes or needles
- Blood transfusions (in parts of the world where screening is not adequate)
- From mother to baby at birth
- Direct exposure to open wounds or blood
What Are Ground-Glass Cells in Hepatitis B?
Microscopically, liver tissue in chronic hepatitis B often shows "ground-glass" hepatocytes, identifiable in 50–75% of patients. The cells are most often stained positive for hepatitis B surface antigen (HBsAg) using immunohistochemistry. Ground-glass cells form a hallmark histological feature of chronic HBV infection.
Symptoms of Hepatitis B: Acute vs. Chronic
Acute Symptoms of Hepatitis B
A few individuals might not have any symptoms at all, while others develop acute, flu-like symptoms, including:
- Loss of appetite
- Nausea and vomiting
- Low-grade fever
- Muscle aches (myalgia)
- Fatigue
- Disturbance of taste or smell (distaste for food or cigarettes)
- Right upper quadrant abdominal pain
- Jaundice (yellow skin and eyes)
Severe Cases: Fulminant Hepatitis
In severe, but rare cases (subfulminant or fulminant hepatitis), these symptoms occur:
- Hepatic encephalopathy (coma, somnolence, confusion)
- Ascites (fluid in the belly)
- Gastrointestinal bleeding
- Sleep disturbances
- Coagulopathy (blood clotting abnormalities)
Chronic Hepatitis B Symptoms
The majority of patients with chronic infection are asymptomatic, especially during the initial phase. Over time, if the disease advances, they may develop:
- Jaundice
- Muscle wasting
- Fatigue
- Abdominal distension
- Easy bruising
- Spider angiomas
- Gynecomastia (in males)
How Is Hepatitis B Diagnosed?
Physical Exam Findings
Depending on the stage of the disease, physical findings may range from minimal to manifestations of liver decompensation, which include:
- Hepatomegaly (enlarged liver)
- Splenomegaly (spleen enlargement)
- Palmar erythema
- Spider nevi
- Peripheral edema
Laboratory Tests
The following blood tests are requested by physicians to monitor liver function and HBV activity:
- ALT and AST levels (liver function tests)
- Bilirubin levels
- Albumin and coagulation profile
- HBsAg and HBeAg
- Anti-HBc IgM and IgG
- HBV DNA (viral load)
Imaging and Biopsy
For severe liver disease or chronic disease follow-up, these imaging studies are utilized:
- Ultrasound
- CT scan or MRI
- Liver biopsy to assess the degree of liver damage
Hepatitis B Treatment Options
The goal of treatment is to reduce liver inflammation, prevent cirrhosis and liver cancer, and prevent transmission of HBV to others.
Antiviral Drugs
FDA-approved medications are:
- Tenofovir disoproxil fumarate (TDF)
- Tenofovir alafenamide (TAF)
- Entecavir
- Pegylated interferon alpha (PEG-IFN-α)
These medications slow HBV replication, slowing down the infection and reducing irreversible liver damage.
Dietary and Lifestyle Modifications
Cirrhotic or advanced liver disease patients may be aided by:
- Low-sodium diet (especially in edema or ascites)
- Protein-rich, low-fat meats (fish, turkey, chicken)
- Fluid restriction if there is hyponatremia
Steer clear of excess alcohol and unnecessary medication that stress the liver.
Where end-stage liver failure or fulminant hepatitis exists, liver transplantation is the sole life-saving procedure. Those with hepatocellular carcinoma secondary to HBV can also be transplanted.
Can Hepatitis B Be Cured?
There is no curative treatment for chronic hepatitis B, but modern medications can effectively manage the virus, suppress viral replication, and prevent complications. In some cases, therapy can lead to seroconversion (clearance of viral markers), especially in young patients or in those with early treatment.
Preventing Hepatitis B
Vaccination affords the optimal protection against HBV. The hepatitis B vaccine is safe, highly effective, and generally recommended for:
- All infants
- Unvaccinated children and adolescents
- Health care workers
- Individuals with risky behaviors (e.g., engaging in multiple sex partners, needle sharing)
Safe sex habits, not sharing needles, and testing blood products are other prevention measures.
Conclusion
Hepatitis B is a preventable yet serious liver infection that requires early diagnosis and proper management. Whether you’re newly diagnosed, managing a chronic case, or simply want to understand your risk, knowledge is key to protecting your liver and overall health.
Stay Informed. Stay Protected.
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