🫀 Men's Health

Hepatitis B — Long-Term Management

Living with chronic hepatitis B — monitoring, treatment, and prevention of liver cancer.

Nigeria has one of the world's highest hepatitis B burdens — approximately 20 million Nigerians are chronically infected. Most acquired the virus at birth or in early childhood. Chronic hepatitis B can cause cirrhosis and liver cancer over decades, but with regular monitoring and appropriate antiviral treatment, these outcomes are largely preventable.

Signs and Symptoms

✓ Most people with chronic hepatitis B have NO SYMPTOMS for decades

✓ Fatigue — may be present during active inflammation phases

✓ Right upper abdominal discomfort

✓ Jaundice (yellow eyes/skin) — during hepatitis flares

✓ Loss of appetite and nausea during flares

✓ In cirrhosis: abdominal swelling (ascites), swollen legs, easy bruising, confusion

✓ In liver cancer (HCC): weight loss, abdominal mass, pain

✓ Annual monitoring is essential because disease often progresses silently

Risk Factors

Mother-to-child transmission (perinatal) — the most common route in Nigeria
Unvaccinated individuals exposed to infected blood (shared needles, unscreened blood transfusions, unsterilised medical equipment)
Sexual contact with infected individuals
Male sex — more likely to develop chronic infection and complications
HBeAg positivity — sign of high viral replication
High HBV DNA level — drives liver damage
Concurrent HIV, HCV, or alcohol — accelerates liver disease
Family history of liver cancer

When to Seek Help

SoonAnyone with a positive hepatitis B surface antigen (HBsAg) test — needs staging assessment to determine phase of infection and whether antiviral treatment is needed.

RoutineAnnual liver function tests, HBV DNA, and liver ultrasound for all people with chronic hepatitis B — to detect progression and screen for liver cancer.

SoonYellow eyes, swollen abdomen, confusion, or significant weight loss in someone with known hepatitis B — possible liver decompensation or hepatocellular carcinoma; urgent assessment.

Tests & Diagnosis

🧪 HBsAg, HBeAg, Anti-HBe, Anti-HBs

Full hepatitis B serology — determines phase of infection (immune tolerant, immune active, inactive carrier, immune escape) and guides treatment decisions.

🧪 HBV DNA (Viral Load)

Quantifies the amount of virus replicating — the primary marker for treatment decisions and monitoring response.

🧪 Liver Function Tests (ALT, AST, Bilirubin)

Elevated ALT indicates active liver inflammation — high levels (above 2x normal) combined with significant HBV DNA usually triggers treatment.

🧪 Liver Ultrasound

Every 6 months for people with cirrhosis or risk factors for liver cancer — screening for hepatocellular carcinoma (HCC). HCC is treatable when small.

🧪 AFP (Alpha-Fetoprotein)

Blood tumour marker — elevated in many liver cancers. Combined with ultrasound for HCC surveillance.

🧪 Fibroscan or Liver Biopsy

Assesses degree of liver fibrosis (scarring) — guides decision on whether to start antiviral treatment in borderline cases.

Treatment Options

Not All Chronic Hepatitis B Needs Immediate Treatment

The "immune tolerant" phase (young people with high HBV DNA but normal liver enzymes and no fibrosis) may be monitored rather than immediately treated. Treatment decisions are individualised.

Tenofovir (TDF) — Preferred First-Line Antiviral

Tenofovir disoproxil fumarate (300mg daily) — suppresses HBV replication effectively, does not induce resistance, and is safe long-term. It is the same drug used in PrEP for HIV prevention. It does not cure hepatitis B but prevents progression.

Entecavir — Alternative First-Line Antiviral

Equally effective to tenofovir — used when tenofovir is contraindicated (kidney impairment). Also taken daily, long-term.

HCC Surveillance

Every 6 months: liver ultrasound ± AFP. If a lesion is detected — CT or MRI for characterisation. Early HCC (single nodule below 3cm) is potentially curable with radiofrequency ablation or resection.

Vaccination of Household Contacts

All close contacts and sexual partners of HBV-positive individuals should be tested and vaccinated if not immune. The hepatitis B vaccine is very effective (95%+) and prevents infection and liver cancer.

Frequently Asked Questions

Does hepatitis B always cause liver damage?

No — many people with chronic hepatitis B remain in an "inactive carrier" state with minimal liver damage for decades. Regular monitoring identifies those who develop active disease requiring treatment.

Can I transmit hepatitis B to my family?

Yes — through blood contact (shared razors, toothbrushes) and sexual contact. Ensure all household contacts are tested and vaccinated if not immune. Babies born to HBsAg-positive mothers should receive hepatitis B vaccine and immunoglobulin within 12 hours of birth.

If I take antiviral medication, will I be cured?

Current antivirals suppress but do not cure hepatitis B — the virus persists in liver cells. Treatment must be continued long-term in most cases. True functional cure (sustained loss of HBsAg) occurs in only a small proportion on treatment.

Does drinking alcohol worsen hepatitis B?

Yes — significantly. Alcohol causes independent liver damage that accelerates the progression of hepatitis B to cirrhosis. Complete abstinence or minimal alcohol intake is strongly recommended.

Can hepatitis B cause liver cancer?

Yes — chronic hepatitis B is the leading cause of hepatocellular carcinoma (liver cancer) in Nigeria. Regular 6-monthly ultrasound surveillance allows early detection when treatment is curative. This is the most important reason for regular follow-up.