Chronic Hepatitis B: Risks, Diagnosis, and Treatment Options

Q: Chronic Hepatitis B: Risks, Diagnosis, and Treatment Options

Hello： (1) Liver roughness/liver fibrosis should be assessed for severity; if it is mild, it is not serious. <br>(2) Aging or fatty liver can lead to liver fibrosis. <br>If there is no hepatitis B virus carrier status, there is no need for excessive concern. <br>(3) As long as im

Hepatitis B issues?

Hello, Dr.
Tsai, I apologize for bothering you again! I was infected with hepatitis B in my twenties or even earlier, and at that time, the doctor said no treatment was needed.
Recently, an ultrasound revealed that my liver is rough, and I have liver fibrosis.
My hepatitis B surface antigen is negative, surface antibody is positive, and core antibody is positive.
I am now 40 years old.

1.
Could you please explain why natural seroconversion can lead to such severe liver damage?
2.
How can I identify the underlying cause to prevent further progression? My outpatient doctor only mentioned that as long as liver function is normal, everything is fine, but I have seen many reports indicating that normal liver function does not necessarily mean the liver is healthy.

3.
I want to pursue treatment.
Is it true that only hepatitis B can be treated with medication, while other liver diseases are completely untreatable? Additionally, there are reports of a small number of hepatitis B virus carriers with very unusual serological profiles, including negative surface antigen and positive antibodies against the core and surface antigens, yet they still have viral replication with positive HBV DNA.
"Do I need to test for this?" Currently, it is believed that these hepatitis B virus carriers may have mutations in the S or pre-S regions, and due to the negative surface antigen, they are often misdiagnosed, hence termed occult chronic hepatitis B.
Some individuals with naturally seroconverted hepatitis B "I have naturally seroconverted" may fall into this category of occult chronic hepatitis B due to S region mutations.
Is it possible for someone like me, who has naturally seroconverted, to experience liver damage after the surface antigen has turned negative?
Dr.
Tsai, I am currently monitoring my liver function, alpha-fetoprotein, and ultrasound every three months.
Given my situation, do I need to check for esophageal varices to prevent bleeding? Thank you for your assistance, Dr.
Tsai!

Ms. Li, 40~49 year old female. Ask Date: 2016/05/13

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: (1) Liver roughness/liver fibrosis should be assessed for severity; if it is mild, it is not serious.
(2) Aging or fatty liver can lead to liver fibrosis.
If there is no hepatitis B virus carrier status, there is no need for excessive concern.
(3) As long as immune function is normal and there has been no excessive use of steroids, chemotherapy, or immunosuppressants, there is no need to worry about occult viruses.
(4) If there is no cirrhosis, there is no need to check for esophageal varices.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2016/05/13

More Info

Hello! Thank you for your detailed questions regarding chronic Hepatitis B and your current health status. Let's break down your concerns and provide some clarity on each point.

1. Natural Seroconversion and Liver Damage: It is indeed possible for individuals who have experienced natural seroconversion (where HBsAg becomes negative and anti-HBs becomes positive) to still have significant liver damage. This can occur due to several factors, including the duration of the infection, the presence of ongoing inflammation, and the extent of fibrosis or cirrhosis that may have developed during the chronic phase of the infection. Even after seroconversion, if there was significant liver injury prior, it may not fully reverse, leading to persistent liver damage.
2. Identifying Underlying Causes: To understand the reasons behind your liver damage, it is essential to conduct a thorough evaluation. This includes not only routine liver function tests but also imaging studies like ultrasound or FibroScan to assess liver stiffness and fibrosis. Additionally, tests for other potential liver diseases (such as hepatitis C, autoimmune hepatitis, or fatty liver disease) should be considered, especially if your liver function tests appear normal but you have symptoms or imaging findings suggesting liver damage. A liver biopsy may also be warranted in certain cases to assess the degree of inflammation and fibrosis.

3. Treatment Options: Chronic Hepatitis B is indeed treatable, and antiviral medications such as tenofovir or entecavir are effective in suppressing the virus and preventing further liver damage. While Hepatitis B is a significant concern, other liver diseases can also be treated, depending on their nature. It is crucial to have a comprehensive evaluation to determine the best course of action. If you are considering treatment, it is advisable to consult with a hepatologist who specializes in liver diseases.

Regarding the phenomenon of "occult Hepatitis B," where individuals may have negative HBsAg but positive HBV DNA, it is essential to test for HBV DNA if you suspect this condition. This can occur in patients who have undergone seroconversion but may still harbor the virus in a dormant state, potentially leading to liver damage.
In your case, since you have a history of Hepatitis B and are experiencing liver issues, it is prudent to monitor your liver health closely. Regular check-ups every three months, as you are currently doing, are essential. Additionally, assessing for esophageal varices through an endoscopy may be warranted if there is evidence of significant liver fibrosis or portal hypertension, as this can help prevent complications such as variceal bleeding.

In summary, while your current liver function tests may be normal, the presence of liver damage necessitates a thorough evaluation to understand the underlying causes and to determine the most appropriate treatment options. Engaging with a specialist in liver diseases will provide you with the best guidance tailored to your specific situation. Thank you for your questions, and I wish you the best in your health journey!

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