Understanding the Prevention and Treatment of Chronic Hepatitis B

Chronic hepatitis B is a common infectious disease that, if left unmanaged, can progress to serious liver conditions such as cirrhosis and hepatocellular carcinoma. Understanding how to prevent hepatitis B and how to manage the condition effectively is essential for public health and individual well-being.

Hepatitis B virus (HBV) is primarily transmitted through three main routes: perinatal transmission, blood contact, and sexual exposure. Perinatal transmission occurs during the birth process when the virus is passed from an infected mother to her newborn through blood or bodily fluids. The risk of transmission is closely related to the mother's HBV DNA levels. Pregnant women with high viral loads may benefit from antiviral therapy during pregnancy, and newborns should receive both hepatitis B immune globulin (HBIG) and the hepatitis B vaccine shortly after birth to significantly reduce infection risk.

Bloodborne transmission can occur through small cuts or mucosal exposure, such as during tattooing, ear piercing, or sharing personal items like razors and toothbrushes. Healthcare workers are also at risk due to accidental needle-stick injuries. To minimize the risk, individuals should avoid procedures performed in unregulated or unsanitary environments, such as nail salons, dental clinics, or cosmetic centers with poor hygiene standards. Practicing safe sex with partners of unknown hepatitis B status is also highly recommended, using condoms to prevent transmission. Vaccination remains the most effective preventive measure against hepatitis B infection.

Not all individuals diagnosed with hepatitis B require immediate antiviral treatment. Medical professionals assess several factors, including HBV DNA levels, ALT (alanine aminotransferase) levels, liver damage severity, age, family history, and coexisting conditions to determine the risk of disease progression. Antiviral therapy is typically recommended for patients with chronic hepatitis B who have persistently elevated ALT levels and detectable HBV DNA, especially after ruling out other causes of liver injury.

Key scenarios where treatment is advised include:
1) Chronic HBV carriers with consistently abnormal ALT levels and confirmed viral presence, with no other identifiable cause of liver damage such as drug-induced liver injury, alcohol use, fatty liver disease, or autoimmune conditions.
2) Patients with cirrhosis, regardless of HBeAg status or ALT levels, should receive antiviral therapy if HBV DNA is detectable. For those with decompensated cirrhosis and HBsAg positivity, treatment is strongly recommended.
3) Individuals with a family history of liver cancer or cirrhosis should be considered for antiviral treatment due to increased genetic risk.
4) Patients experiencing extrahepatic manifestations like glomerulonephritis, vasculitis, polyarteritis nodosa, or peripheral neuropathy linked to hepatitis B should also undergo treatment.

Currently, the main antiviral therapies include nucleoside analogs such as entecavir and tenofovir, as well as interferon-based treatments. Patients undergoing therapy should be regularly monitored for viral response and potential drug resistance by specialists in gastroenterology or hepatology. Those without clear indications for treatment should still undergo routine follow-ups to monitor for signs of liver inflammation or fibrosis. All care should be conducted through licensed and reputable medical institutions to ensure accurate diagnosis and appropriate management.