Q: I was diagnosed with Hepatitis B when I donated blood 5 years ago. I consulted the doctor and he told me that I am a carrier and I may infect others. There is no harm to me. I did a blood test last year and found that I am still a carrier. My liver functions are normal. Can I get relief of this virus completely from my body? Will I remain a carrier throughout my life? What precautions should I take to stop the disease from getting transmitted to others?

A:Hepatitis B virus (HBV) is transmitted by blood and sexually. The outcome of the infection depends on the interaction between the virus and the host’s immunity and may manifest as an acute symptomatic disease (acute hepatitis) or an asymptomatic disease (immune to HBV or a chronic carrier state). Some of these patients do go on to develop cirrhosis of the liver and hepatocellular carcinoma. Antiviral treatment is effective in about one third patients while liver transplant may be the only treatment option for late stages of the disease (in select cases). Chronic hepatitis may be of 2 types - chronic inactive hepatitis B (healthy carriers) or chronic active hepatitis B. Healthy carriers have normal liver enzymes (AST and ALT) and the markers of infectivity (HBeAg, HBV DNA) may be negative. But HBsAg, HBcAb of IgG type, and HBeAb are present in the blood. Patients with chronic active hepatitis B have mild-to-moderate elevation of the liver enzymes (<5 times the upper limit of normal), high HBV DNA levels and presence of HBsAg and HBcAb (IgG or IgM) in the blood. Treatment is recommended for patients with chronic active hepatitis and the drugs currently used include interferon alfa, lamivudine, and adefovir dipivoxil. Many other agents (entecavir, emtricitabine, DAPD, clevudine etc) are being actively investigated. There is no diet restriction for patients with acute and chronic hepatitis. Healthy carriers should have annual blood tests to check the liver enzyme levels while those with chronic active hepatitis should have blood tests (liver enzyme levels, HBV serology and viral load), a liver biopsy and be put on treatment. Review with your physician all medicines you take as some can damage the liver, and avoid alcohol. People can get HBV infection from you by coming in contact with your blood, serum or semen. Cover all cuts and open sores with a bandage, wash your hands well after touching your blood or body fluids and throw away used personal items such as tissues etc. in a bag, so others will not be exposed to your blood. Do not share toothbrushes, razors, nail clippers/scissors, washcloths, or anything that may have come in contact with your blood or body fluids. Do not donate blood. You would need to tell your partner that you are infected and she would need to see a doctor for HBV testing and appropriate immunisation. All household members must see the doctor and be tested for the disease.