Hepatitis B
A liver infection from the hepatitis B virus — preventable by vaccine, controllable with daily medication. Lifelong follow-up is essential to prevent cirrhosis and liver cancer.
Category
Chronic
Red flags
3
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Hepatitis B is a virus that infects the liver. After exposure, the immune system either clears it (acute infection that goes away) or fails to clear it (chronic infection lasting decades). Chronic hepatitis B is the major cause of cirrhosis and liver cancer in Saudi Arabia and globally.
How common is it?
Saudi Arabia introduced universal infant hepatitis B vaccination in 1989 — a huge public health success. Older Saudis (born before 1989) have higher rates of chronic infection — about 2-3% prevalence. Younger Saudis are largely protected.
Why does it happen?
Spread through blood and bodily fluids: mother-to-baby at birth (most common worldwide), unprotected sex, sharing needles, unsterilized medical/dental procedures, blood transfusion before 1992, sharing razors or toothbrushes. NOT spread by sharing food, hugging, kissing, or coughing.
Symptoms
- Most patients have NO symptoms — the infection is silent for decades
- Acute infection: jaundice, fatigue, nausea, abdominal pain (often mistaken for flu)
- Chronic infection symptoms (when they appear): fatigue, dark urine, yellow eyes
- Late stage: fluid in the abdomen, leg swelling, vomiting blood (cirrhosis complications)
Red flags — seek urgent medical care
Jaundice (yellow skin/eyes) with confusion
Acute liver failure — emergency.
Vomiting blood or black stools
Variceal bleeding from cirrhosis — emergency.
Pregnancy with hepatitis B
Need urgent specialist care to prevent transmission to baby.
How is it diagnosed?
Blood tests: HBsAg (current infection), anti-HBs (immunity from vaccine or past infection), anti-HBc (past or current exposure), HBV DNA (virus levels). Liver function tests (ALT, AST). FibroScan to assess for scarring. Ultrasound and AFP every 6 months for cirrhosis or high-risk patients to screen for liver cancer.
What the latest science says
Several "functional cure" research programs are testing combinations of antivirals plus immune therapy to clear the virus completely. None approved yet, but exciting progress. Universal screening in pregnancy + birth dose vaccine + tenofovir for high-viral-load mothers can virtually eliminate mother-to-child transmission.
Outlook — what to expect
With daily antiviral medication, hepatitis B is well controlled and cirrhosis can usually be prevented. Treatment is often lifelong. Liver cancer remains a risk even on treatment — surveillance every 6 months is essential.
Treatment
Habits & Lifestyle
Lifestyle protects the liver and prevents transmission.
- Take antiviral medication EVERY DAY without missing — resistance develops with poor adherence.
- Avoid alcohol entirely — accelerates liver damage.
- Get hepatitis A vaccine.
- Don't share toothbrushes, razors, or nail clippers.
- Inform sexual partners and household members — they need vaccination.
- Inform any healthcare or dental provider before procedures.
Diet
Standard healthy diet for liver health.
- Mediterranean diet pattern — fruits, vegetables, whole grains, olive oil, fish.
- Avoid raw shellfish — risk of additional liver-damaging infections.
- Avoid herbal remedies marketed for liver — many are toxic.
- Coffee 3-4 cups daily (unsweetened) protects against fibrosis progression.
Medications
Daily antiviral pills are the cornerstone — highly effective and well tolerated.
- Tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF) — first-line in most patients.
- Entecavir — alternative first-line for treatment-naive patients.
- NEVER stop without doctor supervision — sudden withdrawal can cause severe flares.
- Pregnancy: tenofovir is safe; high viral load mothers receive it from week 28 to prevent transmission.
- Treatment is usually lifelong; some patients with HBeAg seroconversion can discontinue under careful monitoring.
Procedures & Surgery
Procedures address complications.
- Liver ultrasound + AFP every 6 months — surveillance for liver cancer.
- FibroScan every 1-2 years to assess scarring.
- Endoscopy in cirrhosis to screen for varices.
- Liver transplant for advanced cirrhosis or liver cancer meeting criteria.
In the Saudi context
Hepatitis B remains one of the most common chronic infectious diseases in Saudi Arabia among adults born before 1989. The MOH provides free testing and treatment. Universal infant vaccination has dramatically reduced rates in those born after 1989. All pregnant women are screened. Family members of infected patients should be tested and vaccinated if not immune.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- What's my viral load and ALT — am I a candidate for treatment?
- Should my family members be tested and vaccinated?
- How often will I need ultrasound and AFP?
- Is my hepatitis A vaccination up to date?
Medically reviewed by: SGA Hepatology Panel · Last reviewed 24/04/2026