Hepatitis B: Global Insights on Transmission and Treatment

This episode of JAMA Clinical Reviews explores the global burden, transmission, and management of hepatitis B, a DNA virus affecting an estimated 254 million people worldwide. Dr. Anna Locke from the University of Michigan Medical School discusses the virus's varied transmission patterns across regions—mother-to-child in Asia, early childhood exposure in Africa, and adult-acquired infection in Western countries—highlighting how transmission route dramatically influences chronicity risk, with up to 90% chronicity in infants born to infected mothers. The episode emphasizes hepatitis B's 'silent' nature, often causing no symptoms until advanced liver disease, and underscores the importance of universal screening, especially given that 1.2 million deaths occur annually due to undiagnosed or untreated infection. Dr. Locke details the virus's unique replication mechanism involving reverse transcription, immune-mediated liver damage, and dual pathways to hepatocellular carcinoma. Treatment options include oral antivirals like tenofovir and entecavir (mainstay therapy) and interferon (less commonly used due to side effects), both of which suppress but do not cure the virus, often requiring lifelong use. Prevention through vaccination—particularly the birth dose within 24 hours of life, combined with hepatitis B immune globulin for infected mothers—is highlighted as the most effective strategy, especially in reducing mother-to-child transmission to less than 1% with antiviral use during pregnancy.