By Odewoye Yetunde Theresa
In my practice as a Medical Laboratory Scientist (MLS), there is one question people always ask me. They ask, why is it that someone would have hepatitis B since childhood, no symptoms, nothing, he is very healthy, it is only when he went for test they confirmed it, while in another person it started showing symptoms. I decided to write on this topic because I see this confusion almost everyday in the lab.
Hepatitis B is caused by the hepatitis B virus (HBV), which infects the liver. When your HBsAg (Hepatitis B Surface Antigen) result remains positive for more than six months, the infection is classified as chronic hepatitis B.
In our environment, most people acquire the infection at birth or during childhood from their mothers. At that tender age, the child’s immune system does not fight the virus strongly, allowing it to remain in the body for many years. This is one of the reasons the virus can behave differently in different people.
The Silent Group: The Inactive Carrier Phase
The first phase is what we call the inactive carrier phase. This is the silent group. These are the people who will tell you they have had hepatitis B since childhood but have never felt anything unusual. They look very healthy and continue going to work and school as usual.
The virus is still present in their liver, but its activity is low. There is limited viral replication and little or no significant liver inflammation at that time.
When you check their laboratory results, you will typically see something like this: HBsAg (Hepatitis B Surface Antigen) will be positive, HBeAg (Hepatitis B e-Antigen) will be negative, and HBeAb (Hepatitis B e-Antibody) will usually be positive. Their HBV DNA (Hepatitis B Virus Deoxyribonucleic Acid) viral load, which measures the amount of virus in the blood, will generally be low, often less than 2,000 IU/mL (International Units per millilitre). Their ALT (Alanine Aminotransferase), a marker used to assess liver inflammation, will usually be normal.
In simple terms, HBV DNA is the genetic material of the virus, while the viral load tells us how much of the virus is present in the blood. A low viral load means the virus is not multiplying rapidly. Because there is little or no significant liver inflammation, these individuals may not experience symptoms such as yellow eyes, abdominal pain or persistent tiredness.
That is why many people only discover they have hepatitis B during routine tests for blood donation, antenatal care or travel abroad.
However, being in the inactive phase does not mean the virus has left the body. The virus is still present, the person may still transmit it to another person, and the infection can become active later in life. That is why we advise them to keep going for regular check-ups.
The Symptomatic Group: The Active Phase
The second phase is what we commonly refer to as the active phase. This is the group in which the virus may be actively multiplying and the body’s immune system is responding to the infection in the liver. This immune response can cause liver inflammation, which may lead to abnormal liver test results.
Their laboratory results will look different. HBsAg (Hepatitis B Surface Antigen) will remain positive, while HBeAg (Hepatitis B e-Antigen) may be positive or negative, depending on the type of infection. Their HBV DNA viral load may be high, and their ALT (Alanine Aminotransferase) levels may be elevated, sometimes to more than twice the upper limit of normal.
Because of the inflammation, the person may begin to experience symptoms. Some will feel very tired, lose their appetite, experience nausea, have dark urine or pale stools, develop yellow eyes, experience pain on the upper right side of the abdomen, or have joint pain.
It is important to understand that not everyone with active hepatitis B will experience symptoms. Some people may have significant liver inflammation even when they feel perfectly healthy. It is still the same hepatitis B virus, but the difference lies in the level of viral activity, the body’s immune response and the stage of the infection.
How Laboratory Tests Tell the Difference
As a Medical Laboratory Scientist (MLS), I always tell people that doing an HBsAg (Hepatitis B Surface Antigen) test alone is not enough. HBsAg only tells you that the infection is present; it does not tell you whether the disease is active or inactive.
To understand the state of the infection, other tests need to be considered together. These include HBeAg (Hepatitis B e-Antigen), HBV DNA viral load to measure the amount of virus in the blood, and liver function tests, especially ALT (Alanine Aminotransferase) and AST (Aspartate Aminotransferase).
Sometimes, the doctor may also request a liver scan or other assessments to determine the condition of the liver. These investigations are very important because they help guide the doctor on what to do next.
Some people in the inactive phase may not need immediate treatment, but they still require regular monitoring, often every six to twelve months, depending on their clinical assessment. This is because someone who is in the inactive phase today can move into an active phase later. Regular follow-up helps identify such changes early.
What to do if you test positive
If you test positive for hepatitis B, whether you have symptoms or not, please do not panic. Worry and anxiety will not help you. What you should do is seek a full medical evaluation.
Have your viral load checked and undergo liver function tests as advised by your doctor. Avoid things that can damage the liver, such as alcohol, and do not smoke. Avoid taking unprescribed herbal concoctions or other products that may harm your liver.
Tell your spouse, children and close family members to go for screening and vaccination where appropriate. Vaccination is an important way to protect people who have not acquired the infection.
Please do not take any drug that claims to cure hepatitis B completely without proper medical advice. There are medicines that can effectively control the virus and reduce the risk of liver complications, but you must consult a qualified doctor for proper assessment, treatment and follow-up.
To my fellow health workers, let us try to explain laboratory results to patients in simple language they can understand. Do not just hand them a piece of paper; take the time to explain what the results mean and what they need to do next
In summary, hepatitis B can remain silent in some people and cause symptoms in others because the infection can exist in different phases. The inactive phase is often associated with a low viral load and normal ALT levels, while the active phase may involve increased viral replication, elevated ALT levels and, in some cases, noticeable symptoms.
Understanding these differences is one of the reasons everyone should consider testing for hepatitis B, even when they feel healthy. Early detection, proper evaluation, and regular follow-up can make a significant difference in managing the infection.