Hepatitis B Virus

Hepatitis B virus is one of the deadly virus which effects the liver preferentially as compared to the simple virus infections which effect many organs of the body. Hepatitis B virus is known for many decades and has been controlled drastically in the western countries with the help of vaccine and the health measures. Unfortunately in Asian countries and in our India HBV is still showering its ill effect on us. More than 240 million people have chronic (long-term) liver infections and about 600 000 people die every year due to the acute or chronic consequences of hepatitis B world wide.

Hepatitis B virus stays and multiply in liver and is found in blood and other body secretions. It spreads from one person to other by following ways:

• Blood and blood product transfusion
• Sharing of needles or razors
• Sexual transmission
• From infected mother to baby

In India the transmission is also known between the small children the mode of which is still unclear.

Hepatitis B virus can affect the liver in many ways, that is:

1. On first exposure to the virus it causes Acute viral Hepatitis. In this condition patient may present with fever, body ache, malaise and taste change followed by Jaundice. Most of cases of acute hepatitis occurs in the adults when they are exposed to this virus and most of the adult patients will be able to get rid of the virus ( 5% will not be able to clear the virus and will go to chronic hepatitis)
2. Most of the children and few adults when they are exposed to hepatitis B virus have Chronic hepatitis. In this condition patients are either diagnosed incidentally while on routine investigation or due to investigation for some other symptoms. Some of patients may present with anorexia, low grade fewer, generalized weakness etc. Some are diagnosed on family screening
3. Chronic liver disease : many patients with hepatitis B infection are diagnosed in the late stage when the virus has already damaged the liver to the extent that liver is not able to perform its function normally. In this condition patients present with jaundice ( yellowing of eyes), fluid in abdomen that is abdominal distension, swelling of the feet , anorexia and weight loss or blood in the vomitus.
4. Hepatocellular carcinoma ( liver cancer): now a days many patient first time with the above described symptoms and when we evaluate them they have already developed cancer in there liver
5. Acute liver failure : this is a rare condition in which virus damage the liver badly and rapidly so that the function of liver fails. In this condition patient have short history of disease and becomes disoriented.

Prevention of the above described problems can be done with the following steps:

1. All new born should be vaccinated with the hepatitis B vaccination. This already is being done with the Delhi government as a routine vaccination with other vaccinations.
2. Avoid sexual activity with the people in whom the hepatitis status is not known or should use barrier method ( condom)
3. Family screening of the patient of HBV should be done
4. For preventing chronic liver disease from chronic hepatitis one should get timely and appropriate treatment of chronic hepatitis
5. For preventing the cancer in the liver disease once the liver disease is known than regular investigation should be done

Treatment of Hepatitis B infection

• Acute viral infection: no specific therapy is required for this condition.
• Chronic hepatitis: there are medications available to treat this condition. The medications are in the form of injections that is Peginterferon or oral medications such a entecavir, telbuvidine, tenofovir etc.
• Chronic liver disease: In such condition one has to treat the symptoms with medication and the virus has to be treated with oral medications as described above. Once the patient develop symptoms or have complication one has to consider for liver transplantation or stem cell therapy.
• Liver cancer: there are different modalities to treat the liver cancer depending on many factors. The different modalities are ; liver transplantation , resection of the tumor, radiofrequency ablation therapy (RFA), TACE or oral medications.
• Acute liver failure: this is a emergency treatment which require urgent admission of the patient to the ICU and if condition permits and medical parameter meets than liver transplantation