Chronic Hepatitis B: Risks, Monitoring, and Treatment Options

Chronic Hepatitis B

I am currently 40 years old and have been living with chronic hepatitis B for nearly 20 years.
My most recent blood tests and ultrasound results are as follows: fatty liver, EAG/EAB: -/+, AST/ALT: 36/58, AFP: -, HBsAg: +.
The doctor said that I do not need medication and only require regular follow-up examinations.
Is there no more proactive treatment option available? If I am only undergoing passive monitoring, isn't that equivalent to slowly waiting for hepatitis B to progress to cirrhosis or liver cancer? What is the likelihood of my condition progressing to cirrhosis or liver cancer?

dandy, 40~49 year old female. Ask Date: 2000/11/15

Dr. Yang Guojun reply Internal Medicine

Liver cancer has a widely varying incidence rate around the world, but it is recognized as one of the most common malignant tumors in humans.
In Taiwan, the incidence of liver cancer remains alarmingly high.
According to statistics from the Department of Health, malignant tumors were the leading cause of death in the year 1995, with liver cancer ranking first among malignant cancers in men and second among women.
Approximately 5,000 people die from liver cancer each year, highlighting the severe threat it poses to public health.
Research in Taiwan has identified several risk factors for liver cancer, including chronic infection with hepatitis B and C viruses, smoking, alcohol consumption, aflatoxin exposure, a family history of liver cancer, and elevated levels of testosterone in the blood.
In the past, patients typically sought medical attention only after symptoms appeared, often when the tumor had grown to the size of a papaya.
In such advanced cases, less than one-tenth are eligible for surgical resection, and those who cannot receive treatment have a very poor prognosis, with an average survival time of less than six months.
The primary reason for this delay in seeking treatment is the general public's lack of knowledge about cancer prevention, leading to late diagnoses and limited treatment options.
Due to the high mortality rate associated with liver cancer, many people view it as a terminal illness.
When diagnosed, they often refuse conventional medical treatment in favor of alternative remedies, which can lead to tragic outcomes and accelerated death.
Therefore, early diagnosis and treatment are crucial in the prevention and management of liver cancer.
In recent years, the use of ultrasound and monitoring of serum alpha-fetoprotein levels for long-term follow-up of patients in specific high-risk groups has led to the detection of many asymptomatic small liver cancers.
These tumors, typically smaller than 5 cm, have a very high long-term survival rate.
It is recommended that you regularly follow up with a gastroenterologist for monitoring.
Essentially, this condition is similar to your blood type; it does not necessarily mean you will have a shorter lifespan than others.
Individuals with hepatitis B have a hundred times greater chance of developing liver cancer, but there are now three new treatments available for hepatitis B.
You may consult Dr.
Yang Guojun at our internal medicine clinic, who has previously served as a research physician in the Gastroenterology and Hepatology Department at National Taiwan University Hospital for treatment options.

Reply Date: 2000/11/15

More Info

Chronic Hepatitis B (CHB) is a significant global health issue, affecting millions of individuals worldwide. Understanding the risks, monitoring, and treatment options for CHB is crucial for managing the disease effectively and preventing complications such as liver cirrhosis and hepatocellular carcinoma (liver cancer).

Understanding Chronic Hepatitis B
Chronic Hepatitis B is characterized by the persistence of Hepatitis B virus (HBV) in the body for more than six months. The virus can lead to chronic liver inflammation, which may progress to liver fibrosis, cirrhosis, and ultimately liver cancer. The risk of developing these complications is influenced by several factors, including the age at which the infection was acquired, the presence of co-infections (such as Hepatitis D or HIV), the level of liver inflammation, and the individual’s overall health.

Risks and Monitoring
In your case, with a history of chronic Hepatitis B for nearly 20 years and recent lab results indicating fatty liver, normal liver enzyme levels (GOT/GPT: 36/58), and positive HBsAg, it is essential to understand the implications of these findings. The presence of e-antigen (HBeAg) and its corresponding antibody (Anti-HBe) can provide insight into the level of viral replication and the immune response to the virus. In your case, the negative HBeAg and positive Anti-HBe suggest that the virus may be less active, which is generally a favorable sign.

However, the presence of fatty liver can complicate the situation. Fatty liver disease can be associated with metabolic syndrome, obesity, and excessive alcohol consumption, which can further increase the risk of liver damage. Regular monitoring of liver function tests, ultrasound examinations, and possibly liver biopsy or elastography may be warranted to assess the degree of liver fibrosis and the risk of progression to cirrhosis.

Treatment Options
The decision to initiate antiviral therapy in chronic Hepatitis B is typically based on several criteria, including liver enzyme levels, the presence of liver inflammation or fibrosis, and the overall risk of complications. In your case, since your liver enzymes are within a relatively normal range, your physician may have determined that the risks of treatment do not outweigh the benefits at this time. However, it is understandable to feel anxious about the potential for progression to cirrhosis or liver cancer.

Current antiviral treatments for Hepatitis B, such as tenofovir and entecavir, are highly effective at suppressing viral replication and can significantly reduce the risk of liver disease progression. If you have concerns about your current management plan, it is essential to have an open discussion with your healthcare provider. You may want to consider asking about the following:
1. Liver Biopsy or FibroScan: To assess the degree of liver fibrosis and determine if treatment is warranted.

2. Lifestyle Modifications: Addressing fatty liver through diet, exercise, and weight management can significantly impact liver health.

3. Regular Monitoring: Discuss the frequency of follow-up appointments and tests to ensure that any changes in your condition are detected early.

Conclusion
While it may seem that a conservative approach of regular monitoring is passive, it is essential to recognize that not all patients with chronic Hepatitis B require immediate antiviral therapy. The decision should be individualized based on the risk of disease progression and the patient's overall health. If you have concerns about your risk of developing cirrhosis or liver cancer, do not hesitate to seek a second opinion or discuss more aggressive treatment options with your healthcare provider. Early intervention can make a significant difference in managing chronic Hepatitis B and improving long-term outcomes.

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