COMMON MISCONCEPTIONS ABOUT HEPATITIS B - ARE YOU LIVING WITH HEPATITIS B WITHOUT EVEN KNOWING IT?

Every month, CarePlus Clinic sees many patients with hepatitis B, ranging from individuals who are already under monitoring or treatment, those seeking specialist consultation, to people who are newly diagnosed with hepatitis B or C during routine health check-ups.

For many of these individuals, receiving a hepatitis B diagnosis for the first time can cause significant anxiety, both for themselves and their loved ones.

Through our consultations and clinical practice, we have found that there are still many common misconceptions about hepatitis B. Below are some of the most frequently encountered ones.

MISCONCEPTIONS THAT UNDERESTIMATE THE DISEASE
1. “I have no symptoms, so my liver must be healthy and there is nothing to worry about.”

Chronic hepatitis B can progress silently for many years without causing obvious symptoms, even when liver damage, cirrhosis, or early-stage liver cancer has already developed.

Key message:
No pain, no fatigue, and no symptoms do not necessarily mean that the liver is completely healthy or free from damage.

2. “I have hepatitis B, but I have regular health check-ups every year. My doctor says my liver enzymes are normal, so I don't need treatment or follow-up.”

Liver enzymes are only one of several factors used to assess chronic hepatitis B and determine whether treatment is indicated.

A person may still have a high HBV viral load even when liver enzymes are within the normal range.

In some cases, liver fibrosis may already be present before liver enzymes become elevated or obvious symptoms develop.

The risk of liver cancer also cannot be ruled out based solely on liver enzyme levels.

Key message: Chronic hepatitis B cannot be fully assessed based on liver enzyme levels alone.

3. “My HBV DNA is low or undetectable. Does that mean I am cured?”

For people receiving antiviral treatment, an undetectable HBV DNA level usually indicates that the virus is being effectively suppressed by treatment. However, this does not mean that HBV has been completely eliminated from the body.

Stopping medication without medical advice may allow the virus to reactivate and cause a hepatitis flare.

Key message: Viral suppression does not mean that the virus has been completely eliminated.

4. “I am an inactive hepatitis B carrier, so I don't need regular monitoring.”

The term “inactive carrier” can lead many patients to underestimate the importance of follow-up.

At CarePlus, we have seen patients who eventually presented with significant liver fibrosis or required evaluation for liver tumors after going years without monitoring their chronic hepatitis B.

Some people in the inactive phase of chronic hepatitis B may have a relatively low risk of disease progression. However, the phase of infection can change over time, and the risk of liver cancer is not zero.

Key message: Chronic hepatitis B is a dynamic condition that can change over time. Regular assessment and monitoring remain important.

5. “My liver ultrasound is normal, so there is nothing wrong with my liver.”

A conventional liver ultrasound is an important tool for evaluating the liver, but it cannot replace all the tests needed to assess chronic hepatitis B.

Ultrasound cannot measure the HBV viral load and has limitations in detecting early-stage liver fibrosis.

Depending on the individual case, a doctor may recommend a combination of tests, including:

• ALT/AST
• HBV DNA
• HBeAg/anti-HBe
• Liver fibrosis assessment
• Liver function tests
• Liver cancer surveillance

Key message: A liver ultrasound is only one piece of the overall picture.

6. “I'm young, so I don't need to worry about hepatitis B yet.”

Many people in Vietnam acquire hepatitis B through mother-to-child transmission or during early childhood. Therefore, by their 30s or 40s, some may have been living with the virus for several decades.

Being young does not necessarily mean that the duration of HBV infection is short.

In addition, chronic hepatitis B can increase the risk of liver cancer even before cirrhosis develops.

Key message:
With hepatitis B, your current age is not the only factor that matters. The duration of infection and the condition of your liver also play important roles.

7. “Several people in my family have hepatitis B and remain healthy, so I probably don't have much to worry about either.”

The course of chronic hepatitis B and the risk of complications can vary significantly from person to person, depending on multiple factors, including:

• Age and age at the time of infection
• Level of viral replication
• Degree of liver fibrosis
• Sex
• Family history of liver cancer
• Alcohol consumption
• Fatty liver disease and other metabolic conditions
• Coinfection with other hepatitis viruses

Key message:
Having hepatitis B does not mean that everyone will have the same disease course or the same level of risk.

8. “I am only at risk of liver cancer if I already have cirrhosis.”

Unlike many other chronic liver diseases, chronic hepatitis B can increase the risk of liver cancer even in the absence of cirrhosis.

Key message:
No cirrhosis does not mean zero risk of liver cancer.

9. “I am already receiving treatment for hepatitis B, so I no longer need liver cancer screening.”

Antiviral therapy can significantly reduce the risk of cirrhosis and liver cancer, but it does not reduce the risk to zero—particularly in people who already have cirrhosis or other high-risk factors.

Therefore, people receiving treatment and achieving good control of hepatitis B may still need regular liver cancer surveillance based on their individual risk.

Key message:
Effective treatment reduces the risk, but it does not completely eliminate the risk of liver cancer.

10. “I don't need regular check-ups. I'll see a doctor only if I feel very tired, develop jaundice, or have liver pain.”

When chronic hepatitis B causes obvious symptoms such as jaundice, ascites, gastrointestinal bleeding, or symptoms related to liver cancer, the disease may already be at an advanced stage.

The goal of chronic hepatitis B management is to detect changes before the patient develops symptoms.

Key message:
Regular monitoring is not about waiting for symptoms. It is about detecting changes early and preventing disease progression whenever possible.

MISCONCEPTIONS THAT OVERESTIMATE THE DISEASE
11. “If I have hepatitis B, I will definitely develop cirrhosis or liver cancer.”

In 2024, approximately 240 million people were living with chronic hepatitis B worldwide, and hepatitis B was associated with an estimated 1.1 million deaths, primarily from cirrhosis and liver cancer.

This means that hepatitis B is a serious condition that requires appropriate long-term management. However, it is incorrect to assume that “HBV infection = inevitable cirrhosis, liver cancer, or death.”

Antiviral treatment can slow disease progression, reduce the risk of cirrhosis and liver cancer, and improve long-term outcomes.

Key message:
Hepatitis B is a serious disease, but infection does not mean that cirrhosis or liver cancer is inevitable.

12. “If I have hepatitis B, I must start medication immediately.”

The latest treatment guidelines have expanded the criteria for antiviral treatment, and approximately half of people with chronic hepatitis B may now meet treatment eligibility criteria under the WHO 2024 guidelines.

However, not everyone with chronic hepatitis B requires immediate treatment.

The decision to start treatment depends on the individual's clinical context and factors such as:

• HBV DNA level
• ALT levels
• Degree of liver fibrosis
• Presence of cirrhosis
• Age and other risk factors
• Family history of liver cancer
• Other clinical considerations

Key message:
More than 50% may be eligible for treatment ≠ 100% need immediate treatment.

13. “The higher my HBV DNA level, the more severe my liver damage must be.”

HBV DNA reflects the level of viral replication. However, the severity of liver disease must be assessed using multiple factors, including ALT levels, the degree of liver fibrosis, and other clinical parameters.

Key message:
HBV DNA tells us how actively the virus is replicating—not how much damage has already occurred in the liver.

14. “If I have hepatitis B, I should not have children because my baby will get hepatitis B.”

Without preventive interventions, the risk of mother-to-child transmission can be approximately 70–90% among mothers with a high HBV viral load.

However, effective prevention can dramatically reduce this risk.

WHO recommends that all newborns receive the first dose of hepatitis B vaccine as soon as possible after birth, preferably within 24 hours.

For infants born to mothers with hepatitis B, hepatitis B immune globulin (HBIG) and maternal antiviral prophylaxis may provide additional protection when clinically indicated.

Key message:
Having hepatitis B does not mean you cannot have children. With appropriate medical care and preventive measures, mother-to-child transmission can be greatly reduced.

15. “If someone in my family has hepatitis B, we need to use separate bowls, chopsticks, and utensils.”

According to the CDC, hepatitis B is not spread through food or water, hugging, coughing, sneezing, or sharing eating utensils.

Rather than isolating or stigmatizing people with hepatitis B, the most important steps are to test household members and vaccinate those who are not immune.

Key message:
Hepatitis B does not require social isolation. Testing and vaccination are the best ways to protect family members.

16. “If my husband or wife has hepatitis B, we cannot have a normal sex life.”

Hepatitis B can be transmitted through sexual contact. Therefore, sexual partners of people with hepatitis B should be tested and vaccinated if they are not already immune.

A complete hepatitis B vaccine series provides very high protection against infection.

Once the partner has completed vaccination and has confirmed immunity when indicated, couples can discuss their sexual health and prevention measures with their healthcare provider.

Key message:
Hepatitis B does not mean the end of a normal relationship or sex life. Testing, vaccination, and appropriate prevention can provide effective protection.

17. “Once I start taking medication for hepatitis B, I will have to take it for the rest of my life.”

International treatment guidelines generally recognize that many people who start antiviral therapy for chronic hepatitis B will require long-term treatment, often for many years or potentially lifelong.

However, “many” does not mean “everyone.”

For selected patients without cirrhosis, treatment discontinuation may sometimes be considered if specific criteria are met and close medical monitoring is possible.

Key message:
Treatment for chronic hepatitis B is often long-term, but the duration of treatment is not the same for every patient.

18. “Having hepatitis B means my body is weak and I have to follow a very restrictive diet and lifestyle.”

WHO recommends that people living with hepatitis B maintain a healthy, balanced diet and an active lifestyle.

There is no general recommendation that people with hepatitis B must avoid meat or eggs.

Regular physical activity is generally encouraged, unless there are specific medical reasons to limit it.

People with chronic hepatitis B should also avoid or limit alcohol because of its potential to further harm the liver.

Key message:
Living with hepatitis B does not mean living a restricted life. A healthy diet, regular physical activity, and appropriate medical follow-up are important.

As the points above show, hepatitis B is not a condition to be taken lightly, but neither is a hepatitis B diagnosis synonymous with cirrhosis or liver cancer.

What matters is understanding the disease correctly and avoiding the mistake of judging liver health based solely on the presence or absence of symptoms, a single liver enzyme result, or one ultrasound examination.

Chronic hepatitis B should be assessed and monitored comprehensively and regularly, according to each individual's clinical condition and risk factors.

If you have chronic hepatitis B, do not stop your medication on your own, and do not wait until symptoms appear before seeing a doctor.

Talk to a gastroenterology or hepatology specialist to assess your risk, determine whether treatment is indicated, and establish an appropriate monitoring plan.

If you have never been tested for hepatitis B—especially if you have a family member with hepatitis B—consider getting tested and receiving the hepatitis B vaccine if you are not already immune.

Understand the disease.
Monitor it appropriately.
Detect changes early.
Treat it correctly to reduce the risk of complications.

If you are interested in Gastroenterology and Hepatology, follow more insights from Dinh Thi Ngoc Minh, MSc, Specialist Level II – Gastroenterology & Hepatology, for practical, easy-to-understand, and clinically relevant medical information.

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