Q: I am a 23 years old female. I had a blood test done a few weeks back, which found me positive for hepatitis B (HBsAg) but my further tests showed that I am HBeAg negative. So, the doctor told me that I am suffering from chronic hepatitis B, which has no treatment. The doctor asked me to undergo ALT tests after every three months and DNA test after every year. I am planning to get married. What are the ill effects of Hepatitis B? What if I get pregnant? Can hepatitis B be transmitted to my child and partner?

A:Chronic infection with HBV is a relatively common infection in India. According to estimates from the WHO (World Health Organisation) about 2-7% of the Indians are carriers of this virus, which on blood tests is revealed as a positive reactivity against the hepatitis B surface antigen (HBsAg). Acute infection is however much more common than chronic infection and the disease/virus is transmitted through sex, through contaminated injection needles and syringes, contaminated blood and blood products (although this is uncommon currently because of universal screening of blood donors against HBV), and from mother to babies during delivery (peri-natal transmission). Chronic infection passes through various phases characterised changes in serological and virological markers (demonstrable through the serological test of various HBV markers and quantification of HBV DNA through molecular tests), changes in liver histology, and by changes in liver function demonstrable through the liver function tests (albumin, bilirubin, AST/SGOT, ALT/SGPT, alkaline phosphatase, INR). Many chronic infections are silent or asymptomatic, so the only reliable way to know if somebody is infected with HBV or not is to do a blood test for HBsAg (which is positive in both acutely infected patients as well as those who are chronic carriers). A person is said to be a carrier or have chronic infection with HBV if the HBsAg persists in the blood tests for more than 6 months. One has to remember that like many other infections and diseases managing a patient effectively, does not necessarily mean giving a medicine or a drug. Regular follow-up by clinical examination and appropriate investigations (blood tests, ultra-sound scanning, liver biopsy, etc) are also part of effective management. This is because in many cases the treatment is either not needed or not in the best interest of the patient, and periodic clinical follow-up and regular investigation is all that is required. However, during these checks if there are indications that treatment will change the course of disease or is in the best interest of the patient then only treatment with anti-viral medication is started. There are currently many anti-viral drugs to effectively treat HBV infection. However, these should never be taken without the advise of physicians experienced in the management of HBV. The duration of treatment is often for several months to years, so antiviral medication related treatment decisions are only taken after due consideration to the advantages and disadvantages of therapy. Sexual transmission of HBV could be prevented if the sexual contact is protected against HBV by vaccination. For effective immunity against HBV three doses of HBV vaccine are required given at 0, 1 month and 6 month, and a single booster dose at 5 years. Prior to commencing the vaccination it is appropriate to do a blood test for: hepatitis B core total antibody (HBcAb). If a person is positive for HBcAb (and negative for HBsAg) no vaccination is needed, and such individuals can be considered to be naturally immune because of previously resolved HBV infection. However, if a person is negative for HBcAb vaccination could be commenced. Effective immunity against HBV following vaccination is demonstrable by doing a blood test (about 6 weeks following the 3rd dose of vaccine) to look for hepatitis B surface antibody (HBsAb) levels. A HBsAb level of greater than 10 miu/mL is considered adequate, and level greater than 100 miu/mL is indicative of good immunity. To prevent mother to child transmission of HBV, all pregnant ladies should be routinely screened during pregnancy for HBsAg. Babies of mothers found to be positive for HBsAg through blood tests should be vaccinated against HBV. Generally 4 doses HBV vaccine is recommended for the babies: first within 24 hours of birth, then at 1 month, at 2 month and at 12 months of age. Babies should also get a single dose of HBIG (hepatitis immuno-globulin) along with the vaccine in the opposite limb if their mothers suffer from acute HBV in pregnancy, if the HBV makers (HBcIgM, HBcAb, HBeAg, HBeAb) of the mother is unknown, if the mother is positive for HBeAg in addition to HBsAg, if the HBeAb is negative, or if the mother has a high level of circulating HBV DNA in the blood. All babies who receive HBV vaccination (for prevention of mother to child transmission) should get a blood test at 12 months for HBsAg (before the 4th dose of vaccine is administered). This is to ensure that the vaccine has been effective in the baby and no transmission has taken place.