2.1.2 Chronic Hepatitis B

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Chronic hepatitis B presents with chronically elevated transaminases and the presence of hepatitis B DNA. Worldwide, there are an estimated 315 million carriers. Hepatitis B is a highly contagious virus. This poses a great risk to cohabitants. It is a sexually transmitted disease, it is also transmitted from mother to child (vertical transmission) and it is also transmitted via needle stick injuries. The diagnosis is made based on the presence of hepatitis B surface antigen. Based on hepatitis B DNA and transaminase, different forms can be distinguished. One form can progress to another.

1) HBe antigen positive

2) HBe antigen negative

Chronic hepatitis B (hepatitis B antigen positive and negative forms) leads to cirrhosis after 10 years in 30% of infected patients. Carriers with high viral replication have no risk of developing cirrhosis, but from middle age onwards have an increased risk of developing hepatocellular carcinoma. Carriers with low viral replication have a very favorable prognosis. These patients are infectious. Flare-ups of the disease can occur with cytostatics and corticosteroids.

Patients with chronic active (meaning: disturbed transaminases) hepatitis B (hepatitis B antigen positive and negative form) are best treated with polymerase inhibitors (anti-viral effect). A therapy that best lasts until the hepatitis B surface antigen has become negative. However, this can take years.

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