Chronic Hepatitis B Chronic Hepatitis B (CHB), also known as chronic HBV infection, is a chronic disease characterized by persistent infection with the hepatitis B virus (HBV) for over 6 months, leading to varying degrees of inflammation, necrosis, and/or liver fibrosis. This is an infectious disease, with HBV carriers and hepatitis B patients being the main sources of transmission, although infectivity is closely related to the disease state.

Chronic hepatitis B (CHB) is a chronic liver disease caused by persistent infection with the hepatitis B virus (HBV). It can be transmitted through blood, mother-to-child transmission, and sexual contact. Vaccination against hepatitis B is the most effective preventive measure.

Hepatitis B is a viral liver disease caused by the hepatitis B virus. It can be classified as acute or chronic, with the latter being more commonly referred to as "chronic hepatitis B" by the general public.

Chronic hepatitis B (CHB) occurs when the hepatitis B virus (HBV) persists in the body for more than 6 months, leading to varying degrees of liver inflammation, necrosis, and/or fibrosis. This infectious disease is primarily transmitted by hepatitis B patients and HBV carriers, and the infectiousness is closely related to the disease state.

According to the status of hepatitis B e antigen (HBeAg), chronic hepatitis B can be divided into two types: HBeAg-positive chronic hepatitis B and HBeAg-negative chronic hepatitis B.

HBeAg-positive chronic hepatitis B: HBsAg positive, HBeAg positive, HBV DNA positive, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) persistently or repeatedly elevated, liver histological examination showing liver inflammation, necrosis, and/or fibrotic changes.

HBeAg-negative chronic hepatitis B: HBsAg positive, HBeAg negative, anti-HBe positive, HBV DNA positive, persistently or repeatedly elevated ALT, liver histological examination showing liver inflammation, necrosis, and/or fibrotic changes.

Chronic hepatitis B is caused by infection with the hepatitis B virus (HBV). HBV is highly resistant, tolerating heat, low temperatures, dryness, ultraviolet light, and general disinfectants. It can be transmitted through mother-to-child transmission, blood and blood products, damaged skin and mucous membranes, and sexual contact. Hepatitis B patients and HBV carriers are the main sources of infection.

Certain specific work environments and lifestyle habits may increase the risk of HBV infection, including: unsafe sexual practices, sharing of injection needles and syringes, and close contact with the blood and body fluids of hepatitis B patients. It is important to note, however, that HBV is not transmitted through the respiratory or digestive system, and the possibility of HBV transmission through blood-sucking insects (such as mosquitoes and bedbugs) is extremely low.

Typical symptoms of chronic hepatitis B include fatigue, dizziness, decreased appetite, aversion to oily food, yellow urine, mild discomfort or tenderness in the liver area, and poor sleep. In some cases, symptoms and signs may not be obvious, with only mild abnormalities in one or two indicators in liver function tests.

Chronic hepatitis B is diagnosed when the course of acute hepatitis B exceeds six months, or when there is a recurrence of hepatitis symptoms, signs, and abnormal liver function in patients with acute hepatitis B. The condition can be classified into three degrees: mild, moderate, and severe.

Mild chronic hepatitis B:

The condition is relatively mild and atypical, with symptoms such as recurrent fatigue, dizziness, decreased appetite, aversion to oily food, yellow urine, mild discomfort or tenderness in the liver area, and poor sleep.

Moderate chronic hepatitis B:

Symptoms are of intermediate severity between mild and severe cases.

Severe chronic hepatitis B:

Patients exhibit significant or sustained symptoms of hepatitis, such as fatigue, loss of appetite, abdominal distension, yellow urine, and loose stools. Specific symptoms include a "liver disease face" with a dull complexion, rough and dry skin, and sometimes a "bronze" appearance; "liver palms" with reddened interdigital areas or red spots and patches that turn white upon pressure; "spider nevi" characterized by the appearance of new "moles" with a red center and radiating capillaries resembling a spider, disappearing upon pressure; and enlargement of the spleen, which may cause a sense of fullness under the left rib or be asymptomatic, typically detected during a medical examination. Corresponding laboratory tests may show repeated or sustained elevation of transaminases, decreased albumin, and significant elevation of gamma globulin.

Chronic hepatitis B needs to be distinguished from other conditions such as liver damage caused by other pathogens, alcoholic liver disease, autoimmune hepatitis, fatty liver, acute fatty liver of pregnancy, and Wilson's disease.

As for general treatment measures for chronic hepatitis B, patients should rest, maintain a balanced diet, and develop a positive attitude towards recovery. Patients with significant symptoms or severe conditions should rest in bed. They should abstain from alcohol and consume a high-protein, high-vitamin, and easily digestible diet, without overemphasizing nutrition to avoid developing fatty liver. For patients with severe hepatitis and hepatic encephalopathy, a low-protein diet should be strictly followed as per medical advice.

Surgical treatment is generally not necessary for chronic hepatitis B. However, in cases of end-stage liver disease and liver failure, liver transplantation may be considered. During liver transplantation, damaged liver tissue is removed and replaced with healthy liver tissue. Most transplanted livers come from deceased donors, but a small number come from living donors who donate a portion of their liver. Patients who undergo liver transplantation due to HBV infection require lifelong antiviral therapy to prevent hepatitis B recurrence.

Chronic hepatitis B may lead to various complications as the disease progresses. These complications include liver cirrhosis, liver cancer, and severe extrahepatic complications such as infections, upper gastrointestinal bleeding, hepatic encephalopathy, and hepatorenal syndrome.

Liver-related complications:

These primarily include fatty liver, liver cirrhosis, and hepatocellular carcinoma. There is a close association between HBV and hepatocellular carcinoma, with an annual incidence rate of 0.5%-1.0% in non-cirrhotic HBV-infected individuals and a high incidence rate of 3%-6% in cirrhotic patients. Prevention methods involve seeking timely medical care, receiving standardized treatment, and undergoing regular follow-ups.

Extrahepatic complications:

Hepatic encephalopathy:

Hepatic encephalopathy is a complication of chronic severe hepatitis and cirrhosis, manifesting as varying degrees of neuropsychiatric symptoms. Patients should maintain a low-protein diet, ensure regular bowel movements, and use lactulose orally or through enemas.

Upper gastrointestinal bleeding:

This is a common complication of chronic severe hepatitis and cirrhosis, presenting as hematemesis or melena. The causes include severe liver dysfunction, coagulation disorders, and portal hypertension resulting from cirrhosis, leading to widespread mucosal erosion, ulceration, or varices in the esophagus and stomach. Patients should avoid consuming rough and hard foods and taking nonsteroidal anti-inflammatory drugs on an empty stomach to reduce the risk of mucosal damage. Prophylactic measures such as using ranitidine, cimetidine, and proton pump inhibitors like omeprazole are recommended for preventing bleeding. Patients should also consider supplementing vitamin K and C appropriately.

Hepatorenal syndrome:

This is a complication of chronic severe hepatitis and often represents the terminal stage of severe liver disease, commonly accompanied by severe infections, bleeding, and electrolyte imbalances. Patients should avoid taking drugs that may potentially cause severe kidney damage and refrain from factors that could lead to decreased blood volume.

Family and friends should not distance themselves from or isolate individuals with chronic hepatitis B. Living together with patients does not lead to transmission, nor should there be any discrimination against them.

Patients receiving interferon-α treatment may experience depressive moods and even suicidal tendencies. Family members should pay special attention to this and accompany the patient to seek medical care if such symptoms appear, adjusting the treatment plan as necessary.

Rest and exercise:

Maintain regular routines, avoid staying up late, and pay attention to relieving mental stress.

Engage in moderate exercise, such as walking, for appropriate durations without feeling fatigued.

Diet:

Adjust dietary structure, ensure balanced nutrition intake each day.

Consume various fresh fruits and vegetables rich in vitamins and fiber.

Avoid overeating and binge eating.

Control the intake of fat and sugar to reduce the burden on the liver.

Avoid alcohol to minimize liver damage.

Avoid taking chemical drugs, biologics, traditional Chinese medicine, natural remedies, dietary supplements, and other products that may potentially harm liver function, to prevent sudden exacerbation of liver damage.

Patients and carriers of chronic hepatitis B can assess the infectiousness based on viral replication status and should refrain from working in food handling and childcare. Pay attention to blood product management and maintain good personal hygiene habits, as well as undergo relevant vaccinations.

Routine prevention:

Strengthen hygiene supervision in the food industry and childcare facilities.

Cultivate good hygiene habits, avoid sharing personal items such as toothbrushes, towels, and razors, and wash hands after contact with patients.

Enhance blood product management, pay attention to blood donation and transfusion safety, and ensure that blood donors undergo relevant chronic hepatitis B examinations.

Receive hepatitis B virus vaccinations, and if necessary, consider receiving an additional booster dose.

Related vaccines:

Vaccination against hepatitis B is the key measure for preventing and controlling the spread of hepatitis B in China. Newborns born to HBV-infected mothers and individuals exposed to HBV should receive an early injection of hepatitis B immunoglobulin.