been shown to result in benefit. But people in the second and fourth phases should be actively monitored for antiviral therapy, as treatment then can lead to a reduction in liver damage and reduced rates of liver failure and liver cancer. This monitoring can be done by assessing the levels of liver enzymes, hepatitis B DNA levels, and by liver biopsy. Regardless of what phase, anyone with cirrhosis and detectable hepatitis B DNA may benefit from treatment.
Everybody who has chronic hepatitis B needs to remain in long-term follow-up to ensure they are properly assessed regularly. This will help detect the movement from one phase of chronic hepatitis B to another so that treatment can be offered when it can give the most benefit.
Care and monitoring
Nobody with chronic hepatitis B should be considered a ‘healthy carrier’ and be dismissed from regular follow-up. If you have chronic hepatitis B and have no arrangement for regular monitoring of your liver health and disease progression, see your GP immediately to set up six-monthly liver check-ups.
Remember, there is no such thing as a ‘healthy carrier’ of hepatitis B.
For more information, call 1800 437 222 or visit www.hepsa.asn.au.
There’s no such thing as a ‘healthy carrier’
Have you been told that you have hepatitis B but are a ‘healthy carrier’? We now know that there is no such thing as a healthy hepatitis B carrier. Anyone who has chronic (long-term) hepatitis B is at risk of liver damage.
What is hepatitis B?
Hepatitis B is a virus which infects the liver. It is present in both the blood and body fluids of people who have it. It can spread through blood-to-blood or sexual contact. Adults who are infected may have no symptoms or they may become ill. Hepatitis B symptoms may include fever, abdominal pain, dark urine, nausea and jaundice (yellow skin and eyes). After infection, most adults recover and become immune to the virus. However, some people do not clear the virus and go on to have chronic hepatitis B.
About 400 million people worldwide are thought to be living with chronic hepatitis B. Most people acquire the infection at the time of birth or in early infancy, when there is a much greater chance of developing chronic infection than for adults.
Where did the term ‘healthy carrier’ come from?
In a person with chronic hepatitis B, the virus goes through stages where it is sometimes less active than others, even as liver damage progresses. During the stages of lower viral activity, people can seem healthy.
In the past, these people have been called ‘healthy carriers’— it was thought they themselves did not suffer any damage from the virus even though they could infect others with hepatitis B. However, it is now known that anyone who has detectable levels of hepatitis B is at risk of progressive liver disease.
The four stages of chronic hepatitis B
It is the body’s immune response to the virus which causes damage to the liver. There are four phases of chronic hepatitis B. These include:
1. an immune tolerance phase in childhood and adolescence when virus levels are high but there is no liver disease because the immune response has not yet developed;
2. an immune clearance phase in which the immune system attempts to clear the virus, potentially resulting in liver damage;
3. an immune control phase characterised by low or even undetectable levels of the virus and no obvious liver damage; and
4. an immune escape phase, during which the virus mutates, evades the immune system and causes more liver damage.
During the first and third phases, patients have no obvious ongoing liver damage, and so in the past they were called “healthy carriers” or “inactive carriers”. But now we know that people living with hepatitis B do not always stay in these states—they can move from one phase to another, and are always at risk for hepatitis flareups or progressive liver damage, which can lead to cirrhosis.
People in the first (immune tolerance) or the third (immune control) phases are generally not offered antiviral therapy, as therapy has never