Every minute, two people in the world lose their lives to hepatitis B. This could be from severe liver damage (cirrhosis), liver failure or liver cancer. Although most immune systems can clear off the virus on their own, 30% of people infected with the virus end up with serious and chronic liver disease.
To prevent the liver from reaching a point of irreversible injury, patients with chronic hepatitis B are given medicines that slow the progression of the disease. But years and years of real-world experience has shown us that even after recovery from initial hepatitis B infection, a person can still end up with liver damage.
Once a person is infected with hepatitis B, the virus can linger in his or her blood for decades after treatment and recovery. It can then reactivate from its dormant state under certain circumstances, such as decreased immunity, use of some drugs or through random genetic mutation.
Most people are unaware of this ‘reactivation risk’ and assume they are fully cured after treatment is completed. If the virus does reactivate, such patients are at a high risk of further liver damage and they pose a threat of infecting others around them.
Experts now agree that every person who has had a bout of hepatitis B and has recovered should continue to monitor the viral load in the blood during and after treatment, to ensure that the virus stays suppressed and that disease management is under control.
Moreover, hepatitis B causes noticeable symptoms only after significant liver damage has occurred. This is why patients should not track symptoms but instead, rely on regular monitoring to prevent further liver damage. Many of the tests used to track viral load and a person’s infection status are also used for long-term monitoring of liver health. Some key ones are:
Complete blood count (CBC): tracks the levels of blood cells and platelets, with abnormal levels indicating possible infection.
ALT test: high levels of an enzyme called Alanine Aminotransferase (ALT) in the blood indicate liver damage.
HBsAg and antibodies: checks for the hepatitis B surface antigen (HBsAg) and its antibodies in the blood, which indicate both a present or past infection.
HBV DNA: a rapid test that shows the total viral load in the bloodstream. The goal of hepatitis B treatment is to suppress HBV replication until HBV DNA is undetectable in the body.
Alpha fetoprotein (AFP): checks for liver cancer and is usually performed if both the viral load and ALT levels are high.
Biopsy: doctors recommend a liver biopsy to evaluate the stage of liver disease, especially if there are signs of liver damage or if a patient has been infected for many years.
Fibroscan: a non-invasive imaging device that assesses the liver’s ‘hardness’ or stiffness through vibration waves generated on the skin. It accurately determines liver health in under five minutes, allowing us to prevent damage before the disease has a chance to further progress.
If you are recently diagnosed with hepatitis B or have had the infection in the past, check with your doctor on how frequently you need to do these tests to monitor your liver health.
• Regardless of age, all chronic hepatitis B patients with a family history of liver cancer should be regularly screened for possible signs of liver cancer.
• People co-infected with HIV and/or hepatitis C or D are at greater risk of liver disease progression. They also have a higher chance of developing liver cancer, so regular screening becomes critical for this group.
• Patients with cirrhosis must be regularly monitored for liver cancer with the help of tests such as abdominal ultrasonography.
• Every person who comes in sexual or household contact with an HBV-infected individual must be vaccinated against hepatitis B.
We still do not understand why HBV infection progresses in some patients and clears off on its own in others. Research shows that this variability depends on many factors such as the patient’s own immune system, the replicating activity of the virus and certain environmental factors that ‘reactivate’ the virus.
On our part, we would like to ensure that every person with hepatitis B completes the full treatment course, adheres to regular monitoring checkups as decided by the doctor and does not pose a threat to infecting others in the community. Together, these checks will allow us to better control the hepatitis B epidemic and bring down India’s burden of chronic HBV infections.
(The writer is Consultant Gastroenterologist and Hepatologist, BGS Global Hospitals, Bengaluru)