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Hepatitis B

Overview

The hepatitis B virus (HBV) causes a potentially life-threatening liver infection called hepatitis B.   It is a major global health issue. In some people, hepatitis B infection can become chronic, lasting more than six months. Infants and children are more likely to have chronic (long-term) hepatitis B infection. Even if the signs and symptoms are severe, most people with hepatitis B recover completely. Hepatitis B can be prevented using a vaccine that is both safe and effective. It is best to avoid hepatitis B infection because it can progress to chronic disease and liver cancer. If you've been infected, you can prevent the virus from spreading to others by taking certain precautions.

Types

Hepatitis B infection can be short-term (acute) or long-term (chronic).

Acute Hepatitis B infection: The duration of an acute hepatitis B infection is less than six months. In a few months, your immune system should be able to remove acute hepatitis B from your system, and you should be completely recovered. Most individuals with hepatitis B develop an acute illness, although it can progress to a chronic infection.

Chronic Hepatitis B infection: Hepatitis B infection is chronic when it lasts six months or more. It persists because your immune system is unable to fight the infection. Chronic hepatitis B infection can last a lifetime and cause serious health issues such as cirrhosis and liver cancer.

Causes

The hepatitis B virus (HBV) causes hepatitis B infection. The virus is transmitted from one person to the other by blood, semen, and other bodily fluids and is not spread through coughing or sneezing. 

HBV can be transmitted in a variety of ways, including:

Sexual Contact: You may get Hepatitis B by having unprotected sex with an infected individual and if the person's blood, saliva, semen, or vaginal fluids penetrate your body.

Sharing needles: HBV is easily transmitted by infected blood-contaminated needles and syringes. 

Needle Pricks: Hepatitis B is a risk for health care professionals and anyone else who comes into contact with human blood by accident.

From the mother to the child: HBV-infected pregnant mothers can spread the virus to their babies during childbirth. However, the newborn can be immunized to prevent infection in almost all cases. You should consult your healthcare provider about getting tested for Hepatitis B if you are pregnant or planning to become pregnant. 

Signs And Symptoms

Hepatitis B symptoms and signs range from mild to severe. They usually appear one to four months after you've been infected, though they might appear as early as two weeks after you've been infected. Some people, especially young children, may not show any signs or symptoms.

  • Symptoms and signs of hepatitis B include:
  • Yellow color of skin and eyes ( Jaundice)
  • Abdominal discomfort or pain
  • Nausea and vomiting
  • Fatigue or weakness
  • Loss of appetite
  • Dark-colored urine
  • Joint Pain
  • Fever 

Risk Factors

Hepatitis B is transmitted through contact with an infected individual's blood, semen, or other body fluids. You are more likely to contract hepatitis B if you:

  • Have unprotected intercourse with multiple sex partners or with an HBV-infected partner.
  • Share needles.
  • Are a man who has sexual intercourse with other men.
  • Are the child of an infected mother.
  • Have a job that requires you to come into contact with human blood.
  • Travel to places like Asia, the Pacific Islands, Africa, and Eastern Europe, where HBV infection rates are high.

Diagnosis

 Your doctor will check for signs of liver disease like yellowing skin or abdominal pain. The tests listed below can help diagnose hepatitis B or its complications:

Blood tests: They can detect signs of the hepatitis B virus in your body and help diagnose acute or chronic hepatitis. A simple blood test can also tell you whether or not you're immune to the disease. Your healthcare provider may normally order the following tests: 

  • HBsAg, Anti-HBs, Anti-HBs core, HBsAg, HBeAg, Anti-HBe
  • Quantitative Hepatitis B viral DNA.
  • HBV Genotype 
  • Complete Blood Count 
  • Liver Function Test ( Including ALT, AST, Alkaline Phosphatase (ALP), Bilirubin etc)
  • Autoantibody screening
  • Lipid Profile
  • Clotting factors 
  • Ferritin

Ultrasound:  It can be used to figure out how much damage has been done to the liver.

Liver biopsy: A small portion of your liver may be removed for examination (liver biopsy) to check for liver damage.

Treatment

You should consult your doctor if you've been exposed to the hepatitis B virus and aren't sure if you've been vaccinated. Immunoglobulin (an antibody) injections given within 12 hours after virus exposure may help protect you from getting hepatitis B. Because this treatment only offers short-term protection, you should also acquire the hepatitis B vaccine if you haven't already.

Acute: If your hepatitis B infection is acute, you may not require specific treatment. Instead, your doctor may prescribe rest, adequate nutrition, and plenty of fluids while your body fights the infection. In severe cases, antiviral drugs or a hospital stay may be required to prevent complications.

Chronic: The majority of people diagnosed with chronic hepatitis B infection often require lifelong treatment. Treatment lowers your chances of developing liver disease and prevents you from spreading the virus to others. Chronic hepatitis B treatment includes:

Medications: Antiviral drugs, such as entecavir (Baraclude), tenofovir (Viread), lamivudine (Epivir), adefovir (Hepsera), and telbivudine (Tyzeka), can help fight the virus and decrease its ability to cause liver damage. These drugs are to be taken by mouth. To find out which medicine is best for you, consult your healthcare provider.

Injections of interferon: Interferon alfa-2b (Intron A) is a synthetic version of an infection-fighting substance produced by the body. It's primarily used by young people with hepatitis B who wish to avoid long-term therapy or women who want to get pregnant after completing a short treatment course. However, during pregnancy, interferon should not be taken. Nausea, vomiting, difficulty breathing, and depression are possible side effects.

Liver Transplant: A liver transplant may be a viable option if your liver has been severely damaged. During a liver transplant, the surgeon removes your damaged liver and replaces it with a healthy liver.

Complications

Chronic HBV infection can cause serious complications, including:

  • Liver Cirrhosis ( Scarring)
  • Fulminant liver failure
  • Prolonged cholestasis.
  • Acute Liver Failure
  • Liver Cancer
  • Kidney disease such as glomerulonephritis
  • Cryoglobulinemia 

Prevention

Hepatitis B vaccine is usually given in three or four doses over a six-month period. The hepatitis B vaccine is advised for:

  • Newborns.
  • Children and adolescents who were not immunized at birth.
  • People who have more than one sexual partner.
  • Those who share a home with a hepatitis B infected person.
  • Anyone who is infected with a sexually transmitted infection, such as HIV.
  • Males who engage in intercourse with other men.
  • People who share needles and syringes or inject illegal drugs.
  • Health-care personnel, emergency workers, and others who come into contact with blood.
  • Sexual partners of a hepatitis B patient.
  • People who suffer from chronic liver disease.
  • End-stage renal disease patients.
  • Travelers who intend to visit an area where the prevalence of hepatitis B is high.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 20, 2023. 

References

Hepatitis B (who.int)

https://www.who.int/news-room/fact-sheets/detail/hepatitis-b

Hepatitis B - FAQs, Statistics, Data, & Guidelines | CDC

https://www.cdc.gov/hepatitis/hbv/index.htm

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