Response:

Hepatitis B is an infectious disease caused by the hepatitis B virus (HBV), which can manifest as acute or chronic. Not all individuals with chronic hepatitis B need lifelong antiviral medication, but many chronic cases require treatment for many years. The duration depends on the virus's activity level and the extent of liver damage.

In the acute phase (within six months), most patients can naturally clear the virus through their immune response. During this period, doctors primarily monitor liver enzymes and liver function, without needing specific antiviral treatment. However, if the virus persists for over six months, the condition is classified as chronic hepatitis B, requiring long-term management.

Doctor Thanh consults a patient. Illustration: Tam Anh General Hospital

A crucial factor in treating chronic hepatitis B is evaluating the extent of viral replication and existing liver damage. An HBV DNA quantitative test helps determine the viral load in the blood. When HBV replicates rapidly, causing prolonged elevation of liver enzymes (ALT, AST), there is an increased risk of progressing to cirrhosis, liver failure, and liver cancer. At this point, patients require antiviral medication to suppress HBV replication and protect liver cells.

Current antiviral drugs effectively control the virus but cannot completely eliminate HBV from the body. Therefore, if medication is stopped without proper medical guidance, the virus can reactivate, posing a risk of acute liver failure. This is why many patients must maintain prolonged treatment to keep the virus at a stable, suppressed level.

The natural progression of chronic hepatitis B involves several stages: immune tolerance, chronic active hepatitis, inactive carrier state, and reactivation. For inactive virus carriers (normal liver enzymes, low HBV DNA, no signs of liver fibrosis), doctors may recommend regular monitoring instead of immediate treatment. Conversely, when the disease enters an active phase, patients need medication to prevent progressive liver damage.

Liver status is assessed through liver enzyme tests, liver elastography (FibroScan), or other specialized methods. If significant fibrosis (F2 or higher) or cirrhosis is present, patients often require long-term, almost lifelong, treatment to prevent complications such as cirrhosis and liver cancer.

In some instances, when a patient achieves sustained viral suppression over a long period, maintains normal liver enzymes, and shows no signs of cirrhosis, a specialist may consider discontinuing medication. However, patients require close monitoring after stopping treatment due to the ongoing risk of relapse.

Your husband should have regular follow-up appointments for the doctor to monitor and assess his condition. The duration of treatment depends on the disease stage, the extent of liver damage, and individual response.

Doctor, Level I Specialist Hoang Dinh Thanh

Department of Gastroenterology

Center for Endoscopy and Gastrointestinal Endoscopic Surgery

Tam Anh General Hospital, TP HCM