Hepatitis B virus (HBV) infection stands as a significant global health challenge, contributing substantially to worldwide morbidity and mortality. Chronic hepatitis B (CHB) infection is particularly concerning due to its strong link to severe liver conditions, including cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC). The risk of progressing to CHB is significantly influenced by the age at which HBV infection is acquired, with newborns of hepatitis B e antigen-positive mothers facing the highest risk (>90%) and adults the lowest.
The primary goal in treating CHB infection is to achieve clearance of HBV DNA, thereby preventing the development of these life-threatening complications. Currently, there are seven approved drugs for CHB treatment: five nucleos(t)ide analogues and two interferon-based therapies. Often, long-term treatment is necessary, and the decision to initiate therapy is based on a comprehensive clinical evaluation, considering the phase of CHB infection and the extent of existing liver damage.
Since the early 1980s, a safe and highly effective HBV vaccine has been available. Vaccination is a cornerstone of global hepatitis B prevention strategies. The introduction of universal HBV vaccination programs has led to a notable decline in both the incidence and prevalence of HBV infection in numerous countries, including the USA, parts of South East Asia, and Europe.
Post-exposure prophylaxis (PEP) with the HBV vaccine, potentially combined with hepatitis B immunoglobulin, demonstrates high effectiveness in preventing mother-to-child transmission. It is also crucial in preventing transmission following sharps injuries, sexual contact, and other exposures to infected blood and bodily fluids. In developed nations, HBV transmission within healthcare settings has become increasingly rare. However, it remains a significant risk in developing countries, reflecting the higher prevalence of CHB, limited access to HBV vaccination and PEP, and inconsistent adherence to standard infection control precautions.
