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Medical content written by Dr Youssef BENNANI, hepato-gastroenterologist · Updated on

Hepatitis B

Hepatitis B

Hepatitis B is a viral infection of the liver. Most infected people recover spontaneously, but a chronic form can develop and requires follow-up.

How common is hepatitis B?

Viral hepatitis B is highly prevalent in developing countries (Africa, Southeast Asia): about 10% of the population carries the HBs antigen (HBsAg). In mainland France, the prevalence of HBsAg carriage is about 0.3%, i.e. 200,000 to 300,000 cases.

The hepatitis B virus is transmitted:

  • Sexually
  • Through blood: blood transfusions, injected drug use
  • From mother to child: at birth

Hepatitis B virus infection always causes acute hepatitis, after which the body recovers spontaneously in 90% of cases. Only 10% of infected people develop chronic hepatitis B. One third of infected patients are inactive carriers and need no treatment (except in special situations such as chemotherapy…). Untreated active chronic hepatitis B can progress to cirrhosis.

To assess the severity of the infection:

  • Blood tests: HBeAg, anti-HBe antibodies, quantitative hepatitis B viral DNA, prothrombin time, AST/ALT, total bilirubin, serology for hepatitis C, D and HIV, protein electrophoresis
  • Abdominal ultrasound
  • FibroScan, ± liver biopsy

Treatment of chronic hepatitis B has improved considerably in recent years. It is indicated for active chronic hepatitis B with viral replication (quantitative DNA) and liver fibrosis (confirmed by FibroScan or biopsy), or for cirrhosis with viral replication.

Many treatments are available: pegylated interferon, nucleoside analogues (lamivudine, entecavir, telbivudine) and nucleotide analogues (adefovir, tenofovir). Analogues with a high barrier to resistance are preferred: tenofovir and entecavir.

Most chronic hepatitis B infections are acquired at birth, through so-called "vertical" transmission. Systematic screening is recommended during pregnancy. Treatment of pregnant women is recommended in the third trimester only in cases of high viral load (DNA > 10⁸ log).

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