Infectious diseases specialists diagnose and treat infections from bacteria, viruses, fungi, and parasites, focusing on fevers, antibiotics, and vaccines.
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The management of Hepatitis B is a sophisticated clinical endeavor that balances viral suppression with preservation of liver histology. At Liv Hospital, the treatment strategy is individualized, guided by international algorithms that consider the patient’s viral load, liver enzyme levels, and hepatic fibrosis. The primary therapeutic goal is to achieve a “functional cure”—the sustained loss of HBsAg—although long-term viral suppression remains the most common and realistic endpoint. Treatment protocols are designed not only to reduce liver inflammation but also to reverse fibrosis and prevent the development of decompensated cirrhosis and hepatocellular carcinoma.
Not all patients with chronic Hepatitis B require immediate pharmacological intervention. Treatment is typically indicated for patients who exhibit evidence of active liver disease. This is defined by elevated ALT levels (indicating inflammation) and a high viral load (HBV DNA > 2,000 or 20,000 IU/mL, depending on HBeAg status). Additionally, patients with established cirrhosis are treated regardless of their viral load or enzyme levels to prevent further decompensation. Patients in the “immune-tolerant” or “inactive carrier” phases are often monitored closely rather than treated, as current therapies have limited efficacy in these biological states.
The pharmacopeia for Hepatitis B consists primarily of two categories: Nucleos(t)ide Analogues (NAs) and Interferon-based therapies.
Pegylated Interferon (Peg-IFN):
This is an immunomodulatory therapy administered via subcutaneous injection for a finite duration (usually 48 weeks). Unlike NAs, interferon aims to stimulate the host’s immune system to target infected cells. It offers a higher likelihood of HBsAg loss (functional cure) than NAs. Still, it is associated with a more significant side effect profile, including flu-like symptoms, bone marrow suppression, and neuropsychiatric effects. It is contraindicated in patients with decompensated cirrhosis.
Once therapy is initiated, rigorous monitoring is essential to ensure efficacy and safety.
Renal and Bone Safety: Patients on Tenofovir-based regimens require monitoring of kidney function and bone density, as long-term use can affect these systems. TAF offers a safer profile for bone and kidney health compared to TDF.
For patients who present with advanced liver disease, management extends beyond antiviral therapy.
Hepatocellular Carcinoma (HCC) Surveillance: All cirrhotic patients and certain non-cirrhotic carriers (based on age and family history) must undergo ultrasound screening every six months. Early detection of liver nodules allows for curative treatments such as ablation, resection, or liver transplantation.
Co-infection: Patients co-infected with HIV or Hepatitis D require specialized combination regimens managed by experts familiar with drug-drug interactions and complex virology.
Lifestyle modifications complement medical treatment. Absolute abstinence from alcohol is recommended, as alcohol acts synergistically with HBV to accelerate liver damage. Management of metabolic risk factors—obesity, diabetes, and hyperlipidemia—is also prioritized to prevent “fatty liver” (steatosis), which can exacerbate HBV-related injury.
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For most patients prescribed oral antiviral medications (nucleoside analogues), treatment is long-term and potentially lifelong. These drugs suppress the virus effectively but rarely eliminate it from the liver. Stopping the medication often leads to a “rebound” where the virus returns rapidly, which can cause severe liver damage. However, stopping rules exist for specific patients who achieve durable serological markers, but this must be done under strict medical supervision.
Currently, a “sterilizing cure” (complete removal of the virus from every cell in the body) is not available with standard treatments because the virus’s genetic template (cccDNA) hides in the liver cells. However, a “functional cure” is possible, where the virus is suppressed so profoundly that blood tests for the surface antigen become negative. Current research is intensely focused on developing new drugs to achieve a complete cure.
The modern first-line oral medications (Entecavir, Tenofovir) are generally very well tolerated with few immediate side effects. Long-term use of Tenofovir Disoproxil (TDF) can rarely affect kidney function or bone density. The newer Tenofovir Alafenamide (TAF) has an improved safety profile. Pegylated Interferon has more noticeable side effects, including flu-like symptoms, fatigue, and mood changes, but is taken for a shorter, fixed duration.
Yes, liver transplantation is a life-saving option for patients with end-stage liver failure or liver cancer caused by Hepatitis B. In the past, reinfection of the new liver was a significant problem. However, with the use of potent antiviral drugs and Hepatitis B immunoglobulin (HBIG) before and after transplant, outcomes are now excellent, and viral recurrence in the new liver is effectively prevented.
While no specific food treats the virus, diet plays a crucial role in liver health. A balanced diet helps prevent fatty liver disease, which can lead to further inflammation. Avoiding aflatoxin (a mold toxin produced on grains/nuts) is crucial, as it increases cancer risk. Most critically, avoiding alcohol is essential, as alcohol significantly reduces the effectiveness of the liver’s regenerative capacity and accelerates scarring.
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