Hepatitis B is a viral infection of the liver caused by the Hepatitis B virus (HBV). It can present as a short-term (acute) illness or lifelong (chronic) infection. Chronic HBV increases risk of liver inflammation, fibrosis, cirrhosis, and hepatocellular carcinoma if not adequately managed.
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Acute Phase (may be asymptomatic):
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Fatigue, low-grade fever, joint pain
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Jaundice (yellowing of skin/eyes)
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Dark urine, pale stools
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Abdominal discomfort (right upper quadrant)
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Chronic Phase (often silent):
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Mild liver enzyme elevations on blood tests
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Occasional fatigue or malaise
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Signs of advanced disease: ascites, spider angiomas, easy bruising
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Bloodborne Transmission: Shared needles, transfusions with unscreened blood
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Sexual Contact: Unprotected intercourse with an infected partner
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Perinatal Transmission: From mother to newborn during delivery
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Occupational Exposure: Healthcare workers via needlestick injuries
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Household Contact: Sharing razors or toothbrushes in rare cases
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Immunosuppression: Chemotherapy, corticosteroids, biologic therapies
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Co-Infections: HIV or Hepatitis C can accelerate HBV replication
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High Alcohol Intake: Exacerbates liver damage and viral activity
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Poor Glycemic Control: Diabetes may impair immune response to HBV
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Serologic Markers:
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HBsAg (Hepatitis B surface antigen): Indicates active infection
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Anti-HBc IgM: Marker of acute or recent infection
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Anti-HBs: Confirms immunity (past infection or vaccination)
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Viral Load Testing: HBV DNA quantification to assess replication
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Liver Function Tests (LFTs): ALT/AST levels gauge inflammation
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Ultrasound & Elastography: Evaluate liver fibrosis and cirrhosis
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Liver Biopsy (select cases): Histology for staging and treatment decisions
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Nucleos(t)ide Analogues (First-Line):
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Tenofovir disoproxil fumarate (300 mg once daily)
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Entecavir (0.5 mg once daily)
― Both offer high barrier to resistance and potent viral suppression.
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Other Oral Agents:
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Lamivudine, Telbivudine: Lower barrier—reserved when cost is a major constraint.
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Immune Modulator:
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Pegylated Interferon-α2a (180 μg weekly) for a finite course in select patients; can achieve seroconversion.
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Supportive Liver Care:
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Ursodeoxycholic Acid, Antioxidants (e.g., silymarin) to support hepatocyte health.
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Monitoring Protocol:
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Regular HBV DNA and LFTs every 3–6 months
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Surveillance ultrasound every 6 months in cirrhosis
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Q1: How long will I need antiviral therapy?
A: Most chronic HBV patients require long-term (often indefinite) treatment to maintain viral suppression and prevent relapse.
Q2: Can Hepatitis B be cured?
A: A true “cure” (HBsAg loss) is rare; treatment aims for sustained viral suppression and “functional cure.” Research into novel therapies is ongoing.
Q3: Are there side effects to these antivirals?
A: Tenofovir and entecavir are generally well-tolerated; potential effects include mild GI upset or headache. Renal function and bone density should be monitored with tenofovir.Q4: Can I stop medication once my viral load is undetectable?
A: Stopping therapy risks viral rebound; any discontinuation must be under specialist guidance with close follow-up.
Q5: How can I prevent spreading HBV?
A: Practice safe sex, avoid sharing needles or personal items, ensure household members are vaccinated, and follow infection-control precautions.