The diagnosis of hepatitis B virus is a major issue as it has an impact on every part of life for the person who receives the diagnosis. It is a potentially chronic and life-limiting illness associated with considerable social stigma, effects on quality of life, and consequences for decisions about work, relationships and having children.
Hepatitis profile/viral markers: There are six parameters used in the diagnosis of HBV.
HBsAg – This is a marker of current infection or recent vaccine. Positive result means that the person is either infected or recently immunised. This is the first test and the beginning of the management. Every patient with positive result must be tested for the remaining HBV markers.
Anti-HBs – This is the marker of immunity from resolved infection or vaccine. Any patient with this is fully immunised either from the Hepatitis B vaccine or from total recovery from virus. This category of people don’t require treatment
Anti-HBc – This is a marker of current or past infection. It will show those that are recently infected (acute HBV) or those infected in the past (chronic carrier).
HBeAg – This is a marker of viral replication and infectivity. Any patient with a positive result is highly infected and may need adequate treatment.
Anti-HBe – This is a marker of the immune control in chronic hepatitis B
HBV DNA – This is a marker of viral replication commonly called viral load. Any patient with high viral load result is highly infected and will need adequate treatment. It is also used to monitor the progress with treatment.
ALT – This is a marker of liver inflammation, not a viral marker but a liver function test. When it is high, it shows the liver is undergoing inflammation.
Other tests are complete blood count, fasting blood sugar, lipid profile, alfa fetoprotein and abdominal scan, liverscan or fibroscan
Treatments for acute and chronic infection are considered separately. The majority of hepatitis B virus encountered in Nigeria is due to chronic infections.
Treatment of acute hepatitis B virus is supportive in most cases, consisting of bed rest, nutritional support and symptomatic management.
The treatment of chronic HBV can be life-long and it is explained below:
General (lifestyle modification): Alcohol consumption should be ceased, cigarette smokers should be advised to quit, weight reduction with sound nutritional advice is ideal.
Eat plenty of vegetables, legume, fruits, cereals, preferably whole grain, lean meat, fish, poultry, milk, yoghurt, cheese and regularly drinking water. Groundnuts NOT properly preserved contain toxins (aflatoxin) that are poisonous to the liver.
Vaccination: The diagnosis of hepatitis B is also an opportunity to prevent its spread through vaccination. The standard regime is at three doses at between zero and six months respectively.
Post-vaccine laboratory test is required to be sure the person is fully immune.
For the person who has already acquired hepatitis B, it is too late to vaccinate against HBV, but further liver injury by another virus hepatitis A can be prevented.
Hepatitis B immune globulin is indicated as a post exposure prophylaxis for people at risk of developing hepatitis B because they have been recently exposed to body fluids of individuals who have hepatitis B.
Newborn treatment: Up to 90 per cent of infants born to HBeAg-positive mothers acquire the infection if untreated. The concurrent administration of two injectables hepatitis B immunoglobulin and the hepatitis B vaccine to the newborn immediately after birth is effective in preventing vertical transmission of the virus. If the neonate has taken the two injectables, the mother with HBV infection can breastfeed the neonate safely because there is no increased risk of transmission. Sexual partners of HBV positive persons should be counseled to protect themselves from sexual exposure to infectious body fluids such as semen and vaginal secretions, by using condoms; or by receiving full immunisation against hepatitis B virus.
Medication: There are effective drug therapies that can control and even stop the hepatitis B virus from further damaging a liver. There are also promising new drugs in the research pipeline that could provide a cure in the very near future. The long-term aim of treatment is to arrest or reverse the progression of liver damage, with the ultimate goal of preventing cirrhosis, cancer of the liver and liver failure.
Schedule regular visits every six months (or at least every year) to a liver specialist or a health care provider knowledgeable in hepatitis B so they can monitor your liver. Get screened for liver cancer during regular visits since early detection equals more treatment options and a longer life. Avoid or limit alcohol and smoking since both cause a lot of stress to your liver; Eat a healthy diet with lots of vegetables.
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