From the Guidelines
The management of acute and chronic hepatitis B differs significantly, with acute hepatitis B typically requiring supportive care and chronic hepatitis B often necessitating long-term antiviral therapy to prevent liver damage and reduce the risk of complications. The approach to managing acute and chronic hepatitis B is distinct due to the different natural histories of the two conditions. Acute hepatitis B usually resolves on its own within 6 months without specific antiviral treatment, focusing instead on supportive care such as rest, hydration, and symptom management, alongside monitoring for potential complications 1. In contrast, chronic hepatitis B, defined as infection lasting more than 6 months, frequently requires long-term antiviral therapy with medications like entecavir, tenofovir disoproxil fumarate, or tenofovir alafenamide to suppress viral replication and prevent liver damage 1.
Key differences in management include:
- Treatment Goals: For acute hepatitis B, the goal is to support the body's natural recovery process, while for chronic hepatitis B, the aim is to suppress viral replication, prevent liver damage, and reduce the risk of cirrhosis and hepatocellular carcinoma.
- Antiviral Therapy: Generally not recommended for acute hepatitis B due to the potential interference with the body's immune response and the high rate of spontaneous recovery 1, but is a cornerstone of chronic hepatitis B management to achieve long-term suppression of HBV replication.
- Monitoring: Regular monitoring is crucial for both conditions, but chronic hepatitis B requires more intensive surveillance, including liver function tests, viral load measurements, and periodic assessment for complications like cirrhosis and hepatocellular carcinoma through ultrasound and alpha-fetoprotein testing 1.
The most recent and highest quality guidelines, such as those from EASL 2017, emphasize the importance of long-term suppression of HBV replication in chronic hepatitis B and recommend the use of potent nucleos(t)ide analogues with a high barrier to resistance, such as entecavir, tenofovir disoproxil, or tenofovir alafenamide, as the treatment of choice 1. The choice of antiviral therapy should be based on the patient's viral load, liver enzyme levels, evidence of liver damage, and disease phase, with the ultimate goal of improving survival and quality of life by preventing disease progression and HCC development.
From the Research
Acute vs Chronic Hepatitis B Serology
- The main difference between acute and chronic hepatitis B is the duration of the infection and the body's response to it. Acute hepatitis B is a short-term infection that typically resolves on its own within six months, while chronic hepatitis B is a long-term infection that can last for years or even a lifetime 2.
- In terms of serology, acute hepatitis B is characterized by the presence of HBsAg, HBeAg, and IgM anti-HBc, while chronic hepatitis B is characterized by the presence of HBsAg, HBeAg (in some cases), and IgG anti-HBc 3.
Management and Treatment
- The management and treatment of acute and chronic hepatitis B differ significantly. Acute hepatitis B is typically managed with supportive care, such as rest, hydration, and nutrition, while chronic hepatitis B requires antiviral therapy to suppress viral replication and prevent liver damage 4, 5.
- For chronic hepatitis B, treatment is generally indicated in patients with HBV DNA >2000 IU/mL, elevated ALT, and/or at least moderate histological lesions. Treatment options include nucleos(t)ide analogues, such as entecavir and tenofovir, and pegylated interferon 3, 5.
- In contrast, treatment for acute hepatitis B is not usually necessary, as most patients recover on their own. However, in severe cases, antiviral therapy may be considered to prevent liver failure 2.
Treatment Goals
- The primary goal of treatment for chronic hepatitis B is to suppress viral replication and prevent liver damage. This can be achieved through the use of antiviral therapy, which can improve liver inflammation and fibrosis, and reduce the risk of hepatocellular carcinoma 5.
- For acute hepatitis B, the goal of treatment is to support the patient's recovery and prevent complications, such as liver failure. This can be achieved through supportive care and, in some cases, antiviral therapy 4, 2.