From the Guidelines
Most adults who contract hepatitis B will recover completely within 6 months of infection, with more than 95% of adults with acute HBV hepatitis not requiring specific treatment, as they will fully recover spontaneously 1.
Recovery Process
The recovery from hepatitis B is characterized by the development of antibodies called anti-HBs (hepatitis B surface antibodies) that provide lifelong immunity against future infections. This is confirmed through blood tests showing the presence of these protective antibodies and the absence of the virus itself.
Management and Follow-Up
After recovery, regular medical follow-up is generally not required unless liver damage occurred during the infection. In cases of severe liver inflammation, periodic liver function tests may be recommended to monitor for any long-term effects.
Risk of Reactivation
It's also important to note that patients with chronic HBV infection who are co-infected with HCV and undergo DAA therapy may be at risk of HBV reactivation 1. However, this is more relevant to patients with chronic HBV rather than those who have recovered.
Quality of Life and Morbidity
The main goal in managing acute hepatitis B is preventing the risk of acute or subacute liver failure, improving quality of life by shortening disease-associated symptoms, and lowering the risk of chronicity 1. For the majority of adults who recover, the quality of life is expected to return to normal, with no increased risk of morbidity or mortality related to hepatitis B.
Vaccination and Transmission
After recovery from hepatitis B, vaccination is unnecessary because the individual has developed natural immunity. Additionally, they cannot transmit the virus to others since the virus is no longer present in their body.
From the FDA Drug Label
Severe acute exacerbations of hepatitis B (e.g., liver decompensation and liver failure) have been reported in HBV-infected individuals who have discontinued emtricitabine and tenofovir disoproxil fumarate tablets. Individuals infected with HBV who discontinue emtricitabine and tenofovir disoproxil fumarate tablets should be closely monitored with both clinical and laboratory follow-up for at least several months after stopping treatment If appropriate, anti-hepatitis B therapy may be warranted, especially in individuals with advanced liver disease or cirrhosis, since posttreatment exacerbation of hepatitis may lead to hepatic decompensation and liver failure.
The management of recovered hepatitis B is not directly addressed in the provided drug labels. However, it can be inferred that individuals who have recovered from hepatitis B may still be at risk of severe acute exacerbations if they are taking or have taken medications such as entecavir 2 or tenofovir 3.
- Key points to consider are:
- Closely monitoring hepatic function for at least several months after stopping treatment
- Considering anti-hepatitis B therapy in individuals with advanced liver disease or cirrhosis
- HBV-uninfected individuals should be offered vaccination 3
From the Research
Recovered Hepatitis B
- There are several studies that have investigated the treatment and management of hepatitis B, including the use of antiviral medications such as entecavir and tenofovir 4, 5, 6, 7, 8.
- Entecavir has been shown to be effective in treating chronic hepatitis B in patients with decompensated liver disease, with significant reductions in HBV DNA levels and improvements in liver function 4.
- Tenofovir has also been shown to be effective in treating hepatitis B, with some studies suggesting that it may be associated with a lower risk of hepatocellular carcinoma (HCC) compared to entecavir 7, 8.
- A systematic review and meta-analysis found that tenofovir was associated with a lower risk of HCC recurrence and mortality compared to entecavir in patients with HBV-related HCC after curative therapy 7.
- Another systematic review and meta-analysis found that tenofovir may be associated with a lower risk of HCC compared to entecavir, although the overall confidence in estimates was very low due to the observational nature of the studies and high heterogeneity 8.
Treatment Options
- Entecavir and tenofovir are both first-line treatments for chronic hepatitis B, and the choice of treatment may depend on individual patient factors and the specific characteristics of the disease 4, 5, 6.
- A study comparing the efficacy and safety of tenofovir and entecavir in patients with HBV-related acute on chronic liver failure found that both treatments were effective in reducing HBV DNA levels and improving liver function, but that tenofovir may be associated with a higher survival rate 5.
- A systematic review and meta-analysis found that tenofovir and entecavir had similar efficacy and safety profiles in the treatment of chronic hepatitis B and HBV-related cirrhosis, although tenofovir may be associated with a higher risk of renal damage and hypophosphatemia 6.
Outcomes
- The outcomes of treatment for hepatitis B can vary depending on the individual patient and the specific characteristics of the disease 4, 5, 6, 7, 8.
- A study found that entecavir was generally well tolerated in patients with chronic hepatitis B and decompensated liver disease, with most reported adverse events consistent with decompensated liver disease 4.
- A systematic review and meta-analysis found that tenofovir was associated with a lower risk of HCC recurrence and mortality compared to entecavir in patients with HBV-related HCC after curative therapy, although further prospective randomized controlled studies are needed to validate these results 7.