Vomiting blood, confusion, or rapidly deepening jaundice need emergency care today. Never stop hepatitis B antiviral medication suddenly — it can cause a dangerous flare. Also seek urgent care for severe abdominal pain with fever.
A virus that infects the liver and, in a proportion of those who carry it, causes progressive damage over decades. It cannot usually be cured, but it can be suppressed almost completely with a daily tablet.
Two things matter most and both are frequently missed: not everyone with hepatitis B needs treatment, and everyone with it needs monitoring for liver cancer.
Hepatitis B is a virus transmitted through blood and body fluids, and most importantly from mother to baby at birth. Infection acquired in infancy almost always becomes chronic; infection acquired in adulthood usually clears. This is why the disease is concentrated in regions where mother-to-child transmission was common before vaccination programmes.
Chronic infection follows phases over decades, and the amount of liver damage varies enormously between people carrying the same virus. Some have high viral levels with no inflammation and no damage. Others have active inflammation progressing steadily to cirrhosis. Blood tests and sometimes liver stiffness measurement establish which phase you are in.
Treatment with antiviral tablets suppresses the virus to undetectable levels in most patients, halting inflammation and allowing scarring to improve. It is usually continued indefinitely, because stopping frequently allows the virus to rebound. Complete cure, meaning clearance of the virus, is uncommon.
The point most often missed is cancer surveillance. Hepatitis B can cause liver cancer even without cirrhosis, which is not true of most other liver diseases. Six-monthly ultrasound is recommended for those at risk, and it is what finds tumours early enough to cure.
Stopping antiviral medication abruptly can allow the virus to rebound sharply, provoking a severe flare of liver inflammation that in patients with existing damage can precipitate liver failure. This happens when people run out of tablets while travelling, or assume that undetectable virus means cure. Treatment is generally lifelong, and any change must be supervised by a doctor with blood test monitoring. Take more medication than you need on any journey.
A panel of blood tests establishes the phase and whether treatment is needed.
HBV DNA level and ALT together, ideally over time rather than a single reading, determine whether you need treatment or monitoring. Add HBeAg status, a Fibroscan result if you have one, and your most recent ultrasound. Also tell us whether anyone in your family has had liver cancer — it raises your own risk and changes the surveillance recommendation.
The first decision is treatment or monitoring, and it is not obvious without the numbers.
For patients in phases where the virus is present but causing no inflammation or damage, regular monitoring rather than treatment is correct. Treating unnecessarily commits you to lifelong tablets without benefit. Monitoring means ALT and viral load at intervals, plus cancer surveillance.
Tenofovir or entecavir suppress the virus to undetectable levels in most patients, halting inflammation and allowing fibrosis to regress over years. They are taken daily, generally indefinitely, are well tolerated, and generic versions made in India are inexpensive. Kidney function and bone density need periodic monitoring on some agents.
Six-monthly liver ultrasound, often with alpha-fetoprotein. This applies to everyone with cirrhosis and to many without it, because hepatitis B causes liver cancer directly. It is the single measure most likely to save your life, and it is inexpensive and available in your own country.
Where cirrhosis has decompensated, liver transplant with a near-relative living donor is the treatment. Antiviral therapy continues afterwards to prevent the new liver becoming infected, and this is highly effective.
Together these determine the phase and whether treatment will benefit you. A single reading is not enough.
Fibroscan or elastography. Significant fibrosis shifts the balance strongly towards treating.
A family history of liver cancer, or long-standing infection acquired in infancy, both lower the threshold for treatment and raise the importance of surveillance.
If your ALT is normal and you have no fibrosis, we will recommend monitoring rather than treatment — and we will tell you exactly what monitoring means.
A flare after stopping treatment can be severe and needs restarting antivirals urgently, wherever you are. Do not wait to arrange travel.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
Rarely, in the sense of clearing the virus completely. But it can be suppressed almost entirely with a daily tablet, which stops inflammation, allows scarring to improve over years, and greatly reduces the risk of cirrhosis and cancer. In practical terms, well-controlled hepatitis B is a manageable long-term condition.
Not necessarily. Many carriers have no inflammation and no damage and need monitoring rather than tablets. But feeling well is not the test — ALT, viral load and liver stiffness are. Some people with normal-feeling health have active inflammation progressing to cirrhosis, which is why the blood tests matter.
Because hepatitis B can cause liver cancer even without cirrhosis, which is unusual among liver diseases. Six-monthly ultrasound finds tumours while they are still small and curable. This is probably the single most valuable thing you can do for yourself, and it can be arranged near your home inexpensively.
Yes, through blood and body fluids, and from mother to baby at birth. Everyone in your household should be tested and, if not immune, vaccinated — the vaccine is highly effective and inexpensive. A baby born to an infected mother should receive vaccine and immunoglobulin at birth, which prevents transmission in the great majority of cases.
Not in India. Generic tenofovir and entecavir are manufactured here and cost a fraction of the price in Europe or North America. For many patients this alone justifies a consultation — establishing whether you need treatment, starting it correctly, and then continuing with medication sourced affordably.
It matters, and it is worth testing for. Hepatitis D only occurs alongside hepatitis B and makes the disease considerably more aggressive, with faster progression to cirrhosis. Treatment differs. If you have hepatitis B and your liver disease is progressing faster than expected, ask whether hepatitis D has been excluded.
Send your HBV DNA viral load and ALT, ideally several readings over time, with any Fibroscan and ultrasound results.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
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Coordinators available 9:00–20:00 IST. We speak Arabic, English, Russian and Bengali.