Preventing and Managing Chronic Hepatitis B Infections

Chronic hepatitis B is a common infectious disease that can lead to severe liver conditions such as cirrhosis and hepatocellular carcinoma. Understanding how to prevent hepatitis B in daily life and how to manage the condition for those already infected is crucial for public health.

Hepatitis B virus (HBV) is primarily transmitted through three main routes: mother-to-child transmission during the perinatal period, blood contact (including microscopic skin or mucosal injuries), and sexual contact. Mother-to-child transmission occurs through exposure to the mother's blood and bodily fluids during childbirth, and the risk level correlates with the maternal HBV DNA levels. Pregnant women with high viral loads may benefit from antiviral therapy during pregnancy, while timely administration of hepatitis B immune globulin and vaccination for the newborn can significantly reduce transmission risk.

The virus can also spread through skin or mucosal exposure to contaminated instruments, such as during pedicures, tattooing, ear piercing, or through shared personal items like razors and toothbrushes. Healthcare workers are also at risk due to occupational needle-stick injuries. To reduce infection risks, it is advisable to avoid services at facilities with poor hygiene standards, including nail salons, dental clinics, and cosmetic centers. Practicing safe sex with partners of unknown hepatitis B status is also a key preventive measure. Vaccination remains one of the most effective ways to prevent hepatitis B infection.

Not all individuals diagnosed with hepatitis B require immediate antiviral treatment. Clinical decisions are based on several factors including HBV DNA levels, alanine aminotransferase (ALT) levels, liver disease severity, age, family history, and the presence of other medical conditions. Treatment recommendations include:

Patients with chronic hepatitis B and consistently elevated ALT levels, after excluding other causes such as drug-induced liver injury, alcohol use, non-alcoholic fatty liver disease, autoimmune liver disease, or other systemic illnesses, should consider antiviral therapy.

Patients with evidence of liver cirrhosis should receive antiviral treatment regardless of HBeAg status or ALT levels, especially if HBV DNA is detectable. Those with decompensated cirrhosis and HBsAg positivity should also be treated.

Individuals with a family history of liver cirrhosis or liver cancer are advised to undergo antiviral therapy to reduce disease progression risk.

Patients presenting with extrahepatic manifestations of hepatitis B, such as glomerulonephritis, vasculitis, polyarteritis nodosa, or peripheral neuropathy, should also be considered for treatment.

Currently, the main antiviral therapies include nucleoside analogs such as entecavir and tenofovir, as well as interferon-based treatments. Physicians specializing in liver diseases monitor viral response and assess drug resistance during treatment. Patients without clear treatment indications should undergo regular follow-up evaluations to monitor for signs of liver inflammation or fibrosis. All monitoring and treatment should be conducted at licensed and reputable healthcare facilities.