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 go on to develop cirrhosis of the liver and hepatocellular carcinoma. Antiviral treatment is effective in about one third patient 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 (Hepatitis B surface antigen (HBsAg): Marker of current infection (acute or chronic)
Hepatitis B surface antibody (anti-HBs): Marker of recovery or immunity (acquired through natural HBV infection, vaccination, or passive antibody immunisation)
Hepatitis B core antibody (anti-HBc): Marker of present or past infection
- IgM - indicative of infection in the previous six months
- IgG - indicative of more distant HBV infection that may have been cleared by the immune system or that may persist;
A positive HBsAg and anti-HBc IgG indicates persistent chronic HBV infection
Hepatitis Be antigen (HBeAg): Marker of active current infection (correlates with a high level of viral replication and is also called a ‘marker of infectivity’
Hepatitis Be antibody (anti-HBe): Marker of inactive virus (correlates with low rates of viral replication)
HBV DNA: Measures virus activity (correlates with active replication) and is useful in monitoring response to treatment of HBV infection. Most major hospitals in Bangalore have a department of Gastroenterology and you need to consult a doctor there.