Acute vs Chronic Hepatitis B: Your Diagnosis and Next Steps

Acute Hepatitis B or Chronic Hepatitis B?

Dear Dr.
Chen,
I apologize for the lengthy message, but I hope you can provide me with some advice.
Last month, I went to the hospital for an examination due to stomach discomfort.
The doctor ordered blood tests (first test on 5/13) which showed GOT 412 and GPT 1867.
The doctor asked if I wanted to be hospitalized, but I did not feel any discomfort at that time, so I declined.
A couple of days later, I had another test (second test on 5/15) which showed total bilirubin 4.7, direct bilirubin 2.43, glutamate transaminase 127, Hepatitis B surface antigen reactive, HBsAg 250, Anti-HAV IgM (0.09), and Hepatitis C antibody non-reactive.
The results also showed GOT 103, GPT 823, total bilirubin 2.4, glutamate transaminase 104, and albumin 3.8.

In the third test (on 5/18), the results were GOT 85, GPT 459, total bilirubin 1.8, creatinine (blood) 1.13, Hepatitis B surface antibody non-reactive, Anti-HBs (EIA) 0.08, Hepatitis B e antibody reactive, Anti-HBe (EIA) 0.05, Hepatitis B core antibody reactive, Anti-HBc (EIA) 8.74, Anti-HBc IgM positive, and Anti-HBc IgM 5.54.

In the fourth test (on 5/25), the results showed creatinine (blood) 0.93, GOT 44, GPT 130, total bilirubin 1.2, and albumin 4.4.
The doctor noted chronic Hepatitis B virus infection in my medical record, but I received a call from the CDC stating that I have acute Hepatitis B virus infection.
Later, a CT scan revealed a 1.2 cm tumor, which was not detected on ultrasound.
On 5/15, my alpha-fetoprotein level was 4.71.
The doctor then recommended that I be referred to a medical center, and I started taking the antiviral medication (Entecavir) prescribed by the doctor on 5/15.

After participating in an event organized by the Hepatitis Prevention Foundation on 8/11, the report indicated that the surface antigen was negative, the surface antibody was positive, and the alpha-fetoprotein level was 7.4.
Should I continue taking the antiviral medication? I had been a regular blood donor (40 times) before contracting Hepatitis B; am I no longer eligible to donate blood?
I would greatly appreciate your response.
Thank you.

Xie Xiao Le, 30~39 year old female. Ask Date: 2015/08/27

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, based on the clinical course and blood test follow-up, the likelihood of acute hepatitis B is the highest, and it seems that the patient has completely recovered from this acute hepatitis B episode, with the disappearance of surface antigens and the production of surface antibodies.
It may even be appropriate to discuss with the physician the discontinuation of hepatitis B medication.
Sincerely, Dr.
Chi-Feng Chen, Attending Physician, Department of Gastroenterology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2015/08/27

More Info

Understanding the distinction between acute and chronic Hepatitis B is crucial for managing your health effectively. Based on the information you provided, it appears that you have undergone a series of blood tests that indicate fluctuating liver enzyme levels, the presence of Hepatitis B surface antigen (HBsAg), and positive anti-HBc IgM, which suggests an acute Hepatitis B infection.

Acute vs. Chronic Hepatitis B
Acute Hepatitis B typically refers to a recent infection with the Hepatitis B virus (HBV), which can lead to symptoms such as fatigue, jaundice, and elevated liver enzymes (ALT and AST). In your case, the initial tests showed significantly elevated liver enzymes (GOT and GPT), which is indicative of liver inflammation. The presence of anti-HBc IgM suggests that this is a recent infection, as IgM antibodies are produced during the acute phase of the disease.

Chronic Hepatitis B, on the other hand, is defined as the persistence of HBsAg for more than six months. It can occur if the immune system fails to clear the virus during the acute phase. The presence of HBsAg along with the absence of anti-HBs (antibodies to the Hepatitis B surface antigen) in your tests suggests that you may have transitioned to a chronic state, but this needs to be confirmed by further testing and clinical evaluation.

Your Current Situation
The conflicting information regarding your diagnosis (acute vs. chronic) may stem from the timing of your tests and the interpretation of your results. The initial tests indicated acute Hepatitis B, while subsequent tests may have shown signs of recovery, such as the disappearance of HBsAg and the appearance of anti-HBs, which would indicate that your immune system has successfully cleared the virus. However, the presence of a tumor and elevated alpha-fetoprotein (AFP) levels raises concerns about potential complications, including hepatocellular carcinoma (HCC), especially in the context of chronic Hepatitis B.

Next Steps
1. Continue Antiviral Therapy: Given your history and the potential for liver damage, it is advisable to continue the antiviral medication as prescribed by your physician. This will help suppress the virus and reduce liver inflammation. Regular follow-ups are essential to monitor liver function and viral load.

2. Regular Monitoring: You should have regular blood tests to monitor liver enzymes, HBsAg, anti-HBs, and AFP levels. Imaging studies, such as ultrasound or CT scans, may also be necessary to evaluate the liver for any tumors or lesions.

3. Consult a Specialist: Given the complexity of your case, including the tumor and fluctuating liver function tests, it is crucial to work closely with a hepatologist or a liver specialist. They can provide a more comprehensive evaluation and tailor your treatment plan accordingly.

4. Blood Donation: As for blood donation, it is generally advised that individuals with active Hepatitis B infection refrain from donating blood to prevent transmission of the virus. You should discuss this with your healthcare provider to understand the specific guidelines based on your current health status.

5. Lifestyle Modifications: Maintaining a healthy lifestyle, including a balanced diet, regular exercise, and avoiding alcohol, can support liver health. Additionally, vaccination against Hepatitis A and other liver-related diseases may be beneficial.

Conclusion
In summary, your situation requires careful monitoring and management. The distinction between acute and chronic Hepatitis B is significant, and your healthcare team will guide you through the necessary steps to ensure the best possible outcomes. Regular communication with your healthcare provider is essential to address any concerns and adjust your treatment as needed.

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