Hepatitis B

What is hepatitis B?

Hepatitis B is a virus that infects the liver. Most adults who get hepatitis B have it for a short time and then get better. This is called acute hepatitis B.

You can have hepatitis B and not know it. You may not have symptoms. If you do, they can make you feel like you have the flu. But as long as you have the virus, you can spread it to others.

Sometimes the virus does not go away. This is called chronic hepatitis B. Over time, it can damage your liver. Babies and young children infected with the virus are more likely to get chronic hepatitis B.

What causes hepatitis B?

Hepatitis B is caused by the hepatitis B virus. It is spread through contact with the blood and body fluids of an infected person.

You can get hepatitis B if you:

• Have sex without using a condom.
• Share needles to inject drugs.
• Get a tattoo or piercing with tools that were not cleaned right.
• Share personal items like razors or toothbrushes.

A mother who has the virus can pass it to her baby during delivery. If you are pregnant and think you may have been exposed to hepatitis B, get tested. If you have the virus, your baby can get shots to help prevent the virus.

You cannot get hepatitis B from casual contact such as hugging, kissing, sneezing, coughing, or sharing food or drinks.

What are the symptoms?

Many people with hepatitis B do not know they have it, because they do not have symptoms. If you do have symptoms, you may just feel like you have the flu. Symptoms include:

• Feeling very tired.
• Mild fever.
• Headache.
• Not wanting to eat.
• Feeling sick to your stomach or vomiting.
• Belly pain.
• Diarrhea or constipation.
• Muscle aches and joint pain.
• Skin rash.
• Yellowish eyes and skin (jaundice). Jaundice usually appears only after other symptoms have started to go away.

Most people with chronic hepatitis B have no symptoms.

How is hepatitis B diagnosed?

A simple blood test can tell your doctor if you have the hepatitis B virus now or if you had it in the past. Your doctor will also be able to tell if you have had the vaccine to prevent the virus.

If your doctor thinks you may have liver damage from hepatitis B, he or she may use a needle to take a tiny sample of your liver for testing. This is called a liver biopsy.

How is it treated?

In most cases, hepatitis B goes away on its own. You can relieve your symptoms at home by resting, eating healthy foods, drinking plenty of water, and avoiding alcohol and drugs.

Treatment for chronic hepatitis B depends on whether the virus is getting worse and whether you have liver damage. Most people with chronic hepatitis B can live active, full lives by taking good care of themselves and getting regular checkups. There are medicines for chronic hepatitis B, but they may not be right for everyone. Work with your doctor to decide whether medicine is the right treatment for you.

 

Sometimes chronic hepatitis B can lead to severe liver damage. If this happens, you may need a liver transplant.

Can hepatitis B be prevented?

The hepatitis B vaccine is the best way to prevent infection. The vaccine is a series of three shots. Adults at risk and all babies, children, and teenagers should be vaccinated.

To avoid getting or spreading the virus to others:

• Use a condom when you have sex.
• Do not share needles.
• Wear latex or plastic gloves if you have to touch blood.
• Do not share toothbrushes or razors.

 

Cause

Hepatitis B is a liver disease caused by infection with the hepatitis B virus (HBV). Hepatitis B is one of the most easily spread (contagious) forms of viral hepatitis, which includes hepatitis A, B, C, D, and E. However, hepatitis has many other causes, including some medications, long-term alcohol use, fatty deposits in the liver, and exposure to certain industrial chemicals.

How HBV is spread

HBV is spread when blood, semen, or vaginal fluids (including menstrual blood) from an infected person enter another person's body, usually in one of the following ways:

• Sexual contact. The hepatitis B virus can enter the body through a break in the lining of the rectum, vagina, urethra, or mouth. Sexual contact is the most important risk factor for the spread of HBV in North America.
• Sharing needles. People who share needles and other equipment (such as cotton, spoons, and water) used for injecting illegal drugs may inject HBV-infected blood into their veins.
• Work-related exposure. People who handle blood or instruments used to draw blood may become infected with the virus. Health care workers are at risk of becoming infected with the virus if they are accidentally stuck with a used needle or other sharp instrument infected with an infected person's blood, or if blood splashes onto an exposed surface, such as the eyes, mouth, or a cut in the skin.
• Childbirth. A newborn baby can get the virus from his or her mother during delivery when the baby comes in contact with the mother's body fluids in the birth canal (perinatal transmission). However, breast-feeding does not transmit the virus from a woman with HBV to her child.
• Body piercings and tattoos. HBV can be spread when needles used for body piercing or tattooing are not properly cleaned (sterilized) and HBV-infected blood enters a person's skin.
• Toiletries. Grooming items such as razors and toothbrushes can spread HBV if they carry blood from a person who is infected with the virus.

In the past, blood transfusions were a common means of spreading HBV. Today, all donated blood in the United States is screened for the virus, so it is extremely unlikely that you could become infected with the virus from a blood transfusion.

Contagious and incubation periods

Symptoms appear an average of 60 to 90 days (although they can appear 45 to 180 days) after you have contact with the hepatitis B virus (incubation period). Blood, semen, and vaginal fluids (including menstrual blood), whether fresh or dried, are highly contagious (HBV can be easily spread) during this period and for several weeks after the onset of symptoms.

• Blood contains the highest quantities of the hepatitis B virus.
• Blood and other body fluids that contain the virus can remain contagious for at least a week and possibly much longer, even if they are dried.

If you have a short-term HBV (acute) infection, you usually cannot spread the virus after antibodies against the surface antigen of HBV appear. This generally takes several weeks. If you have a long-term (chronic) HBV infection, you are able to spread the virus as long as the condition lasts.

 

Symptoms

Less than half of those with short-term (acute) hepatitis B infections have symptoms. Symptoms include:

• Jaundice (the skin and whites of the eyes appear yellow). Although jaundice is the defining sign of hepatitis B, it does not occur in most cases. Jaundice usually appears after other symptoms have started to go away.
• Extreme tiredness (fatigue).
• Mild fever.
• Headache.
• Loss of appetite.
• Nausea.
• Vomiting.
• Constant discomfort on the right side of the abdomen under the rib cage, where the liver is located. In most people, the discomfort is made worse when their bodies are jarred or if they overwork themselves.
• Diarrhea or constipation.
• Muscle aches.
• Joint pain.
• Skin rash.

Most people with chronic HBV have no symptoms.

If you were infected with acute HBV but had no symptoms, you may not find out that you once had hepatitis B, or that you currently have long-term (chronic) HBV infection, until you have a routine blood test or donate blood or until a family member or someone you live with is found to be infected. Some people never know they have hepatitis B until a health professional finds that they have cirrhosis or liver cancer (hepatocellular carcinoma). However, this is uncommon.

 

Cause

Hepatitis B is a liver disease caused by infection with the hepatitis B virus (HBV). Hepatitis B is one of the most easily spread (contagious) forms of viral hepatitis, which includes hepatitis A, B, C, D, and E. However, hepatitis has many other causes, including some medications, long-term alcohol use, fatty deposits in the liver, and exposure to certain industrial chemicals.

How HBV is spread

HBV is spread when blood, semen, or vaginal fluids (including menstrual blood) from an infected person enter another person's body, usually in one of the following ways:

• Sexual contact. The hepatitis B virus can enter the body through a break in the lining of the rectum, vagina, urethra, or mouth. Sexual contact is the most important risk factor for the spread of HBV in North America.
• Sharing needles. People who share needles and other equipment (such as cotton, spoons, and water) used for injecting illegal drugs may inject HBV-infected blood into their veins.
• Work-related exposure. People who handle blood or instruments used to draw blood may become infected with the virus. Health care workers are at risk of becoming infected with the virus if they are accidentally stuck with a used needle or other sharp instrument infected with an infected person's blood, or if blood splashes onto an exposed surface, such as the eyes, mouth, or a cut in the skin.
• Childbirth. A newborn baby can get the virus from his or her mother during delivery when the baby comes in contact with the mother's body fluids in the birth canal (perinatal transmission). However, breast-feeding does not transmit the virus from a woman with HBV to her child.
• Body piercings and tattoos. HBV can be spread when needles used for body piercing or tattooing are not properly cleaned (sterilized) and HBV-infected blood enters a person's skin.
• Toiletries. Grooming items such as razors and toothbrushes can spread HBV if they carry blood from a person who is infected with the virus.

In the past, blood transfusions were a common means of spreading HBV. Today, all donated blood in the United States is screened for the virus, so it is extremely unlikely that you could become infected with the virus from a blood transfusion.

Contagious and incubation periods

Symptoms appear an average of 60 to 90 days (although they can appear 45 to 180 days) after you have contact with the hepatitis B virus (incubation period). Blood, semen, and vaginal fluids (including menstrual blood), whether fresh or dried, are highly contagious (HBV can be easily spread) during this period and for several weeks after the onset of symptoms.

• Blood contains the highest quantities of the hepatitis B virus.
• Blood and other body fluids that contain the virus can remain contagious for at least a week and possibly much longer, even if they are dried.

If you have a short-term HBV (acute) infection, you usually cannot spread the virus after antibodies against the surface antigen of HBV appear. This generally takes several weeks. If you have a long-term (chronic) HBV infection, you are able to spread the virus as long as the condition lasts.

 

Exams and Tests

Your health professional will diagnose hepatitis B virus (HBV) infection based on a physical examination, your medical history, and blood tests. You will be asked questions about risk factors for hepatitis B (such as about your job or sexual activity) and about factors that could make the disease worse (such as your alcohol use or family history of liver cancer).

If your health professional thinks you have been exposed to or are infected with the virus, you will need tests to find out more about your condition.

Hepatitis blood tests include:

• Hepatitis B antigens and antibodies, which help determine whether you are or were once infected with HBV, whether you have been immunized, whether you have long-term (chronic) HBV infection, and whether you can pass the virus to others (contagious).
• Hepatitis B viral DNA (HBV DNA), which detects genetic material (DNA) from the hepatitis B virus. HBV DNA indicates that the virus is multiplying in your body (active) and that it is contagious.
• Tests that determine whether the hepatitis A, hepatitis C, or Epstein-Barr (which causes infectious mononucleosis, or "mono") viruses are causing your hepatitis if the results of your tests show that HBV is not multiplying in your body.
• Tests that determine the cause of liver inflammation if it is not a viral cause.
• Tests that determine whether you are infected with hepatitis D along with hepatitis B.

Should I be tested for hepatitis B and C?

Liver tests include:

• Bilirubin, albumin, and prothrombin time, which help determine how well your liver is functioning. Cholesterol testing also may be done.
• Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, and lactic dehydrogenase (LDH), which help determine whether your liver is damaged or inflamed. These tests measure enzymes. However, these tests alone are not a reliable way to confirm a diagnosis of hepatitis B. Additional tests usually are needed.

Tests may be done if you have chronic HBV infection and are considering antiviral treatment. These tests also may be used to determine whether treatment has been helpful in controlling liver damage caused by chronic HBV infection. They include:

• Diagnostic imaging.
  • Abdominal ultrasound
  • CT scan
  • MRI (may be used in rare cases)
• Removing a tissue sample from the liver (liver biopsy).

If you have chronic hepatitis B, the U.S. Centers for Disease Control and Prevention (CDC) recommends that you be vaccinated for hepatitis A if you have not been vaccinated or are not immune to this disease. For more information on Hepatitis A, see the topic Hepatitis A.

If you are at risk for liver cancer, an alpha-fetoprotein (AFP) test may be done. If the AFP level is elevated, it may indicate liver cancer.

 

If you have chronic HBV infection, you will need to visit your health professional regularly. He or she will do blood tests to monitor your liver function and the activity of the hepatitis B virus in your body. Some of the tests can tell your health professional whether HBV is actively multiplying in your liver, which increases your risk for chronic hepatitis. Chronic hepatitis can lead to cirrhosis or liver cancer (hepatocellular carcinoma).

Early Detection

The CDC recommends that all pregnant women have the hepatitis B surface antigen test. This test also may be repeated later in the pregnancy if a woman is at high risk for infection. For more information on risk factors, see the What Increases Your Risk section of this topic.

People who were once exposed to the hepatitis B virus, especially people who moved to the United States from a country where the virus is common, often develop lifelong protection (immunity) against HBV and do not need to be vaccinated. However, people from countries where HBV infection is common may carry the virus and should be screened for the virus.

You can be screened for hepatitis B before getting vaccinated. However, keep in mind that:

• Hepatitis B vaccination (What is a PDF document?) may cost less than screening. Screening costs include the cost of a health professional visit and laboratory tests. If antibodies against HBV are not found, you will have to pay for the full vaccination series (three shots given at different times), including the cost of additional office visits.
• You can receive the hepatitis B vaccine even if you already have antibodies against HBV in your bloodstream, and no harm will result.

 

Treatment Overview

Treatment of hepatitis B viral (HBV) infection depends on how active the virus is and whether you are at risk for liver damage such as cirrhosis. Short-term (acute) hepatitis B usually goes away on its own; home treatment is used to relieve symptoms and help prevent spread of the virus. In long-term (chronic) HBV infection, treatment includes monitoring the condition and using antiviral medications to prevent liver damage. If hepatitis B has severely damaged your liver, a liver transplant may be considered.

The American Association for the Study of Liver Disease has made recommendations on who should receive antiviral treatment for chronic hepatitis B based on the presence of hepatitis B antigens in your blood, the level of HBV DNA in your blood, and the levels of your liver enzymes.⁴

Initial treatment

Your initial treatment for hepatitis B (HBV) infection depends on whether you are seeing your health professional because you believe you may have recently been infected with the hepatitis B virus (HBV), you have the symptoms of acute HBV infection, or you have chronic HBV infection.

If you believe you have recently been exposed to HBV, you should receive a shot of hepatitis B immune globulin (HBIG) and the first of three immunization shots of hepatitis B vaccine(What is a PDF document?). It is important to receive this treatment within 7 days after a needle stick and within 2 weeks after sexual contact that may have exposed you to the virus. The sooner you receive treatment after exposure, the more effective treatment is.

If you have the symptoms of acute hepatitis B, treatment with medication is usually not needed. Home treatment usually will relieve your symptoms and help prevent the spread of the virus. To help relieve symptoms and prevent the spread of the infection:

• Slow down to reduce fatigue. Reduce your activity level to match your energy level. Don't go to work or school unless your workload can be reduced to match your energy level. Avoid strenuous exercise. As you start to feel better, go back to your regular activities gradually.
• Eat right. Even though food may not appeal to you, it is important to get adequate nutrition. For most people, nausea and loss of appetite become worse as the day goes on. Try eating a substantial (but not heavy) meal in the morning and lighter meals later in the day.
• Drink plenty of liquids to avoid dehydration. It is important that you keep your body well-hydrated when you have hepatitis B, especially if you have been vomiting. Drink plenty of water and, if you can tolerate them, drink fruit juices and broth to obtain additional calories. Rehydration drinks help replenish electrolytes.
• Avoid alcohol and drugs. Hepatitis B makes it difficult for your liver to process drugs and alcohol. If you take drugs (prescription or illegal) or drink alcohol when you have hepatitis, their effects may be more powerful and may last longer. In addition, alcohol and some drugs can worsen liver damage. You should avoid alcohol until your health professional feels that your liver is completely healed, which may take as long as 3 to 4 months. Ask your health professional about using prescription medications.
• Try to control itching. People with hepatitis B sometimes develop itchy skin. You can use nonprescription medications, such as Benadryl or Chlor-Trimeton, to control itching. Talk to your health professional before taking nonprescription medications.
• Prevent the spread of HBV by informing people you live with or sleep with about the illness, not sharing personal toiletries (such as razors and toothbrushes), and using a condom or abstaining from sex.

For more information on treating the symptoms of acute HBV infection, see the Home Treatment section of this topic.

If you have chronic HBV infection, treatment depends on how active the virus is in your body and the potential for liver damage. The goal of treatment is to stop liver damage by preventing the virus from multiplying.

Antiviral medication is used if the virus is active and you are at risk for liver damage. Medication slows the ability of the virus to multiply. Antiviral medicine for hepatitis B includes:

• Interferons such as interferon alfa-2b and pegylated interferon alfa-2a.
• Nucleoside reverse transcriptase inhibitors (NRTIs) such as adefovir, lamivudine, and entecavir.

Should I use antiviral therapy for chronic hepatitis B?

Whether or not you are taking medication, you will need to visit your health professional regularly. He or she will do blood tests to monitor your liver function and the activity of the hepatitis B virus (HBV) in your body. Some of the tests can determine whether HBV is actively multiplying in your liver, which increases your risk for chronic hepatitis. Chronic hepatitis can lead to liver damage and disease such as cirrhosis or liver cancer (hepatocellular carcinoma).

Ongoing treatment

Ongoing treatment for chronic hepatitis B (HBV) infection consists of using antiviral medication (if necessary) and seeing your health professional on a regular basis to monitor the virus and check for liver damage.

Antiviral medication for hepatitis B includes:

• Interferons such as interferon alfa-2b and pegylated interferon alfa-2a.
• Nucleoside reverse transcriptase inhibitors (NRTIs) such as adefovir, lamivudine, and entecavir.

Should I use antiviral therapy for chronic hepatitis B?

Whether or not you are taking medication, you will need to visit your health professional regularly. He or she will do blood tests to monitor your liver function and the activity of the hepatitis B virus (HBV) in your body. Some of the tests can determine whether HBV is actively multiplying in your liver, which increases your risk for chronic hepatitis. Chronic hepatitis can lead to liver damage and disease such as cirrhosis or liver cancer (hepatocellular carcinoma).

Treatment if the condition gets worse

Hepatitis B (HBV) infection can lead to liver damage and diseases such as cirrhosis or liver cancer (hepatocellular carcinoma). If you develop significant liver damage because of hepatitis and your condition becomes life-threatening, you may need a liver transplant.

Home Treatment

Home treatment is important for relieving symptoms and preventing the spread of hepatitis B virus (HBV).

While there is no specific medical treatment for short-term (acute) hepatitis B, there are some things you can do that may help you feel better while the illness is running its course.

Slow down

• Reduce your activity level to match your energy level. You don't have to stay in bed, but listen to your body and slow down when you become tired.
• Don't go to work or school unless your workload can be reduced to match your energy level.
• Avoid strenuous exercise.
• As you start to feel better, go back to your regular activities gradually. If you try to meet your regular pace too soon, you may get sick again.

Eat right

• Even though food may not appeal to you, it is important to get adequate nutrition. For most people, nausea and loss of appetite become worse as the day goes on. Try eating a substantial (but not heavy) meal in the morning and lighter meals later in the day.
• Health professionals used to recommend a high-calorie, protein-rich diet to people who have hepatitis. This is no longer believed to be of any benefit, and such foods can be hard to eat when you feel nauseated. Try to maintain a balanced diet while eating foods that appeal to you.

Avoid dehydration

It is important that you keep your body well-hydrated when you have hepatitis B, especially if you have been vomiting.

• Drink plenty of water.
• If you can tolerate them, fruit juices and broth are other good choices because they provide additional calories.
• Many of the "sports drinks" available in grocery stores can help replace essential minerals (electrolytes) that are lost during vomiting. You can also make your own rehydration drink.

Avoid alcohol and drugs

Hepatitis impairs your liver's ability to process drugs and alcohol. If you take drugs (prescription or illegal) or drink alcohol when you have hepatitis, their effects may be more powerful and may last longer. In addition, alcohol and some drugs can worsen liver damage.

• If you are taking prescription medications, your health professional may instruct you to stop using them until your liver has had time to heal. Do not stop taking prescription medications unless your health professional has told you to do so.
• Check with your health professional before taking any new medications or continuing the use of nonprescription medications, including herbal products and acetaminophen (such as Tylenol). Acetaminophen can worsen liver disease, especially if you continue to drink alcohol.
• You should avoid alcohol until your health professional feels that your liver is completely healed. This may take as long as 3 to 4 months.

Try to control itching

People with hepatitis sometimes develop itchy skin. You can control itching by keeping cool and out of the sun, wearing cotton clothing, or using nonprescription medications, such as Benadryl or Chlor-Trimeton. Talk to your health professional if you want to take nonprescription medications.

 

Be sure to follow the instructions for use that are provided with the product, and stop using the product if you have any side effects.

See your health professional regularly if you have chronic HBV infection

If you have been diagnosed with long-term (chronic) HBV infection, your health professional will recommend that you be vaccinated for hepatitis A if you have not been vaccinated or are not immune to this disease. For more information on hepatitis A, see the topic Hepatitis A. You also will need to visit your health professional regularly. He or she will do blood tests to monitor your liver function and the activity of the hepatitis B virus (HBV) in your body. Some of the tests can tell your doctor whether HBV is actively multiplying in your liver, which increases your risk for chronic hepatitis. Chronic hepatitis can lead to liver disease such as cirrhosis or liver cancer (hepatocellular carcinoma).

 

Medications

For people with short-term (acute) hepatitis B infection (HBV), treatment with medication is not recommended. Antiviral medication may be used for long-term (chronic) HBV infection if the virus is multiplying or liver damage exists or may develop.

However, antiviral therapy is not recommended for everyone who has chronic hepatitis B viral infection. It is an option for people who have or appear likely to develop liver damage such as cirrhosis. Antiviral therapy does not help if you already have severe liver damage.

The American Association for the Study of Liver Disease has made recommendations on who should receive antiviral treatment for long-term (chronic) hepatitis B based on the presence of hepatitis B antigens in your blood, the level of hepatitis B virus DNA (HBV DNA) in your blood, and the levels of your liver enzymes.⁴

Medication Choices

• Interferons such as interferon alfa-2b and pegylated interferon alfa-2a.
• Nucleoside reverse transcriptase inhibitors (NRTIs) such as adefovir, lamivudine, and entecavir.

Should I use antiviral therapy for chronic hepatitis B?

What To Think About

• It is important to weigh the benefits of treatment against the risks. Treatment for chronic hepatitis B works in about 40% of people who receive it.²
• Interferons are given as shots. Adefovir, lamivudine, and entecavir are pills.
• Interferons have common side effects, including fever, headaches, and hair loss. They may also cause or aggravate mental problems. Adefovir, lamivudine, and entecavir have few side effects but generally need to be taken for a longer period of time.
• After you have taken lamivudine for 1 year or longer, you can become resistant to the drug. Drug resistance means the medicine no longer works very well. If you develop resistance to lamivudine, you can take adefovir.
• If you have cirrhosis, you cannot use interferons. But you can use lamivudine.
• After any kind of treatment for hepatitis B, the virus may return (relapse).
• Adefovir was approved in 2002 and entecavir was approved in 2005, so the long-term effects of these two medicines are not yet known.

 

Surgery

Hepatitis B is a viral infection that affects the liver. There is no surgical treatment for hepatitis B.

If you develop significant liver damage because of hepatitis and your condition becomes life-threatening, you may need a liver transplant.

In rare cases, short-term (acute) hepatitis B progresses rapidly to liver failure, a life-threatening condition called fulminant hepatitis. For some people, liver transplantation offers the only hope for survival.

 

WebMD Medical Reference from Healthwise

Last Updated: November 04, 2005

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Reference Link:

http://www.webmd.com/hepatitis/hepb-guide