Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). It can range from a mild, short-term illness (acute) to a lifelong, chronic condition that may lead to liver cirrhosis, liver failure, or even liver cancer. According to the World Health Organization, over 250 million people around the world are living with chronic hepatitis B. Fortunately, modern medicine offers effective treatment options to manage the disease and prevent complications.
What makes hepatitis B particularly concerning is that many infected people may not experience symptoms for years, making it a “silent” disease that continues to damage the liver quietly over time. For some, the infection clears up on its own within a few months (acute hepatitis B), while for others, it becomes chronic, requiring long-term medical care and monitoring.
What is Hepatitis B?
Before diving into treatment, it’s important to understand the difference between acute and chronic hepatitis B.
Acute hepatitis B is a short-term illness that occurs within the first six months after exposure to HBV. In many healthy adults, the immune system successfully clears the virus on its own without medical treatment. Symptoms may include fatigue, nausea, vomiting, abdominal pain, dark urine, and jaundice. These typically resolve within weeks or months.
Chronic hepatitis B, on the other hand, lasts longer than six months and occurs when the immune system cannot eliminate the virus. It is more common in people infected at birth or in early childhood. Chronic infection can cause long-term liver damage and must be actively managed to prevent complications.
Goals of Hepatitis B Treatment
The primary goal of treating hepatitis B is to suppress the virus, reduce liver inflammation, and prevent liver-related complications such as cirrhosis and hepatocellular carcinoma (a type of liver cancer). While a complete cure is rare for chronic hepatitis B, treatment can significantly lower viral load and improve liver health.
Treatment of Acute Hepatitis B
In most cases of acute hepatitis B, no specific antiviral treatment is necessary. Doctors usually recommend supportive care, which includes rest, hydration, and proper nutrition to help the body recover. Pain relievers and anti-nausea medications may be prescribed to manage symptoms.
However, in rare cases where the infection becomes severe and causes acute liver failure, hospitalization and intensive care may be needed. In such cases, antiviral medications might be considered.
Treatment of Hepatitis B
Chronic hepatitis B often requires long-term treatment. The choice of therapy depends on various factors such as liver function, age, risk of liver disease progression, and viral load. Here are the main treatment options:
- Antiviral Medications
The cornerstone of chronic hepatitis B treatment is antiviral therapy. These medications suppress HBV replication and reduce liver inflammation. The most commonly prescribed antivirals include :-
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Tenofovir disoproxil fumarate (TDF)
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Tenofovir alafenamide (TAF)
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Entecavir (ETV)
These drugs are highly effective, taken orally once daily, and have a strong resistance barrier. They are well-tolerated by most patients and are suitable for long-term use.
- Interferon Therapy
Another treatment option is pegylated interferon alfa-2a, administered via injection once a week for 6 to 12 months. Interferon boosts the body’s immune system to fight the virus, and in some cases, it can lead to long-term remission or even viral clearance.
However, interferon therapy is not suitable for everyone. It often causes more side effects than antiviral pills, including flu-like symptoms, mood changes, and fatigue. It’s typically recommended for younger patients without significant liver damage who prefer a finite course of therapy.
Monitoring and Follow-Up
Even if treatment is not initiated, regular monitoring is essential for anyone with chronic hepatitis B. This includes :-
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Blood tests to check liver function and viral load
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Imaging studies like ultrasound to monitor liver health
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Screening for liver cancer (especially in high-risk patients)
Patients on antiviral therapy should have their response monitored regularly to ensure the virus remains suppressed and to assess for any drug resistance.
Lifestyle Modifications to Support Treatment
While medications play a crucial role in managing hepatitis B, lifestyle changes can further support liver health and reduce complications :-
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Avoid alcohol, which can accelerate liver damage
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Maintain a healthy weight to reduce fatty liver risk
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Follow a balanced diet rich in fruits, vegetables, and lean proteins
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Avoid unnecessary medications that may burden the liver
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Get vaccinated against hepatitis A and other liver infections
Additionally, individuals with chronic hepatitis B should inform their close contacts so they can be tested and vaccinated if needed. Safe practices such as using condoms and avoiding sharing personal items like razors or toothbrushes can help prevent transmission.
When Is a Liver Transplant Needed?
In some cases of advanced liver disease or liver cancer resulting from chronic hepatitis B, a liver transplant may become necessary. Although this is typically a last-resort treatment, it can be life-saving. After transplantation, patients will need to take medications to prevent both organ rejection and recurrence of the virus.
Is There a Cure for Hepatitis B?
Currently, there is no guaranteed cure for chronic hepatitis B, but research is ongoing. Some patients treated with interferon therapy may achieve a “functional cure,” where the virus becomes undetectable and liver function returns to normal. However, the vast majority of patients will require lifelong antiviral therapy to control the infection and prevent complications.
That said, new therapies are in development, including combination treatments and immune-based therapies, raising hopes for a cure in the near future.
Hepatitis B in India: Access to Care and Cost
India has a high burden of hepatitis B, with millions affected. The good news is that affordable treatment options are widely available. Generic versions of tenofovir and entecavir are accessible in most parts of the country, making long-term treatment financially viable for many.
Moreover, government programs and awareness campaigns have helped improve vaccination rates and early diagnosis. Many major hospitals and liver specialists across cities like Delhi, Mumbai, Bangalore, and Chennai offer comprehensive care for hepatitis B patients.
Conclusion
Hepatitis B may be a lifelong condition, but with the right treatment and regular follow-up, most people can lead healthy, productive lives. Early diagnosis, adherence to antiviral therapy, and lifestyle modifications play a crucial role in managing the disease and preventing serious complications.
