A  middle-aged man was recently diagnosed with liver cancer. He was astonished because he never had any sickness in past and had a disciplined life. Investigations revealed him to be positive for hepatitis B.

There would be others like him who have subclinical infections with hepatitis B, which remains subtle and is detected when complications arise.

Hepatitis B is caused by hepatitis B virus. There is chronic infection and inflammation of the liver cells.  The virus after entering the body multiplies and spreads in various body fluids, that is, blood, semen, etc.

The main mode of acquiring and transmitting the infection is through unprotected sexual intercourse. Transfusion of blood products contaminated with the virus, pricks by contaminated instruments  form another mode of spread of the infection. Patients of kidney failure often develop Hepatitis B, when put on dialysis.

Hepatitis B also spreads from mother to child through the placenta during pregnancy. HIV and Hepatitis B often coexist as both are spread by the same routes. Presence of one infection facilitates acquiring  another. 

In some persons, the infection  does not cause  any illness. But they still carry the virus and are capable of transmitting it. Acute illness is manifested in the form of yellow discoloration of the eyes and urine, loss of appetite, nausea, vomiting and weakness. Acute liver failure can occur leading to sudden death.

Further damage to the liver cells leads to chronic complications like cirrhosis of liver and liver cancer. This may develop years after the initial infection.   

Cirrhosis is manifested by swelling over the body, deficiency of clotting factors results in bleeding from various sites in the body. Kidney failure sets in the later stages and invariably progresses to coma, liver failure and death.

Alcoholism accelerates the liver damage and sickness due to hepatitis B. 

Diagnosis is established by serological tests.

Antiviral drugs are available for treatment of Hepatitis B infection, but are  not useful in advanced disease. Later on, only palliative treatment is possible, that is, keeping the patient well nourished and symptom free. Liver transplant is another option after chronic damage to the liver, but  remains a farfetched dream for many sufferers. 

Disciplined and prudent sexual activity is important in prevention of Hepatitis B. 

In Rwanda, blood   products are screened meticulously before being used for transfusion. But somewhere else one should be careful and take any transfusion only if unavoidable, lest it may carry Hepatitis B virus.  While taking a haircut or pedicure, cleanliness of the instruments should be ensured to prevent infection by Hepatitis B. 

If somebody is suffering from hepatitis B in the family, the caregivers should be careful in handling the patient. All body fluids should be disposed off after pouring some disinfectant. Soiled clothes and linen needs to be washed with hot water and dried adequately in strong sunlight or with hot iron. 

Hepatitis B vaccination is available for prevention of this disease. 

Dr Pande is a specialist in internal medicine