Differences and insights into acute and chronic forms of hepatitis B infection
Article Title: Understanding Acute and Chronic Hepatitis B: Differences, Management, and Prevention
Hepatitis B is a liver infection caused by the hepatitis B virus (HBV). This contagious disease can be transmitted through direct contact with bodily fluids, including sexual contact, sharing needles, or birth from someone who has the infection [1].
Acute HBV, which refers to the newly acquired HBV infection that lasts for a short duration, typically less than 6 months, is often a self-limiting illness that often resolves on its own without lasting liver damage [1][3][4]. Symptoms of acute HBV may include jaundice, fatigue, abdominal pain (particularly on the right side below the ribs), nausea and vomiting, fever, dark urine, and pale stools [2]. For most adults, an acute HBV infection does not progress to the chronic stage [3].
Chronic HBV, on the other hand, occurs when the body's immune system cannot clear the HBV after the initial infection, causing a long-term infection. Chronic HBV is a major global health issue, leading to significant liver-related morbidity and mortality [1].
While acute HBV often requires supportive care only, such as rest, adequate nutrition, and plenty of fluids, chronic HBV necessitates lifelong monitoring and antiviral treatment to prevent serious liver complications. Chronic HBV can lead to progressive liver damage that can result in cirrhosis (scarring of the liver), liver failure, and hepatocellular carcinoma (liver cancer) [1][3][4].
Management strategies for acute and chronic HBV differ significantly. Acute HBV management often involves supportive care as many adults clear the infection spontaneously and develop immunity [4]. Treatment focuses on managing symptoms and monitoring for rare severe outcomes like liver failure.
Chronic HBV requires long-term management including regular monitoring of viral activity, liver function, and liver damage progression through blood tests, imaging, and clinical evaluation [3][4]. Antiviral therapy, such as Pegylated interferon-alpha or nucleos(t)ide analogues, is used to suppress viral replication, prevent liver damage, and reduce the risk of complications [2][3]. A structured post-treatment monitoring plan lasting at least 5 years after therapy cessation is also crucial, involving periodic assessment of HBV markers, liver function tests, and liver ultrasounds to detect relapses and liver cancer early [2].
Individualized treatment duration for chronic HBV is based on viral response and risk factors such as cirrhosis, with careful decision-making on stopping therapy guided by antibody levels (anti-HBs ≥100 mIU/mL indicating a better prognosis) [2].
Preventing hepatitis B infection is crucial. Strategies include the hepatitis B vaccine, safe blood transfusions and organ transplants, using sterile, disposable needles and syringes, using condoms and other barrier methods during sexual activity, avoiding sharing personal items, and following universal precautions [5]. Experts recommend vaccination for unvaccinated adults at high risk of infection, healthcare workers, people with multiple sexual partners, people with other sexually transmitted infections, people who inject drugs, and those with chronic liver disease [6].
In conclusion, while acute HBV is generally self-limited and resolves spontaneously in most adults, chronic HBV necessitates lifelong monitoring and antiviral treatment to prevent serious liver complications and requires individualized management to achieve a functional cure or remission [1][2][3][4].
References: [1] Centers for Disease Control and Prevention. (2021). Hepatitis B. Retrieved from https://www.cdc.gov/hepatitis/hbv/index.htm [2] World Health Organization. (2021). Hepatitis B. Retrieved from https://www.who.int/news-room/fact-sheets/detail/hepatitis-b [3] American Liver Foundation. (2021). Hepatitis B. Retrieved from https://www.hepatitisb.org/ [4] National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Hepatitis B. Retrieved from https://www.niddk.nih.gov/health-information/liver-disease/hepatitis-b [5] World Health Organization. (2019). Hepatitis B prevention. Retrieved from https://www.who.int/news-room/fact-sheets/detail/hepatitis-b-prevention [6] Centers for Disease Control and Prevention. (2021). Who should get vaccinated against hepatitis B. Retrieved from https://www.cdc.gov/vaccines/vpd/hep/hbv-vaccination-recommendations.html
