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Hepatitis B

Hepatitis B is a viral infection that attacks the liver. It’s caused by the Hepatitis B virus (HBV) and spreads through infected blood, sexual contact, and from mother to child during childbirth. India has one of the highest burdens globally – an estimated 40 million people are chronically infected, and most don’t know it.

Acute vs. Chronic Hepatitis B

When someone first gets infected, they have acute hepatitis B. Most adults (95%) clear the virus within 6 months. But about 5% don’t – and their infection becomes chronic. In children, it’s the reverse: infants infected at birth have a 90% chance of developing chronic infection. This is why vaccination at birth is so important.

How It Spreads

  • Sexual contact with an infected person
  • Sharing needles or syringes
  • Blood transfusions with unscreened blood
  • From an infected mother to her baby (perinatal transmission)
  • Sharing personal items like razors or toothbrushes with someone who is infected

It does not spread through casual contact, hugging, sharing food, or coughing.

Symptoms

Most people with chronic Hepatitis B have no symptoms for years. When symptoms do appear: fatigue (often the first thing noticed), nausea and poor appetite, abdominal discomfort on the right side, jaundice, dark urine, and pale stools. Regular testing is the only reliable way to know your status.

Diagnosis

  • HBsAg – the primary screening test; positive means the virus is present
  • HBeAg and Anti-HBe – help determine how actively the virus is replicating
  • HBV DNA (Viral Load) – measures the amount of virus in the blood; guides treatment
  • LFTs – assess liver inflammation
  • Ultrasound and FibroScan – assess liver damage and fibrosis

Treatment

Not everyone with chronic Hepatitis B needs immediate antiviral treatment. The decision depends on viral load, liver enzyme levels, degree of liver damage, and age. For those who do need treatment:

  • Tenofovir (TDF or TAF) and Entecavir – preferred first-line antivirals; effective with low resistance risk
  • Pegylated Interferon – injectable; defined treatment duration but more side effects

Treatment is often lifelong, but it keeps the virus suppressed and dramatically reduces the risk of cirrhosis and liver cancer.

Vaccination – The Best Prevention

The Hepatitis B vaccine is safe, effective, and available as a 3-dose series. Newborns should receive the first dose within 24 hours of birth. Unvaccinated adults at risk and household contacts of infected individuals should also be vaccinated.

There is currently no complete cure for chronic Hepatitis B, but a 'functional cure' - where the HBsAg surface antigen is cleared from the blood - is achievable in a small number of patients on long-term treatment. Antiviral therapy suppresses the virus effectively and prevents progression to cirrhosis and cancer. Research into a true cure is ongoing and progressing quickly.

Yes, with appropriate precautions. Household contacts should be tested, and if not immune, vaccinated. Avoid sharing razors, toothbrushes, or any item that could have blood on it. Casual contact - sharing meals, hugging, using the same toilet - poses no risk.

For most patients, treatment is indefinite. Stopping antivirals prematurely can cause the virus to rebound and trigger a severe hepatitis flare, which can be dangerous. A small number of patients who achieve HBsAg clearance under treatment may be eligible to stop - this is determined by a specialist.

Not always, but it significantly raises the risk. Chronic HBV infection is responsible for roughly 50–55% of liver cancer cases globally. With antiviral treatment and regular 6-monthly surveillance (ultrasound + AFP), the risk of developing cancer is substantially reduced, and any early tumour can be caught at a treatable stage. Living with Hepatitis B or want to get tested? A hepatologist can guide you through monitoring, treatment options, and long-term care.

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