January 13, 2023

Hepatitis B

What is Hepatitis B?

Hepatitis B is a viral infection that affects the liver. It is caused by the hepatitis B virus (HBV) and is transmitted through contact with the blood or other bodily fluids of an infected person. Symptoms of hepatitis B can include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, and jaundice. In some cases, the infection can lead to serious liver damage, including cirrhosis and liver cancer. A vaccine is available to prevent hepatitis B and antiviral medications can be used to treat the infection.

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The infection of Hepatitis B is short-term and goes away within a few weeks, but it can chronic, meaning that it lasts for more than six months. In case of being chronic, it can lead to serious liver conditions. Hepatitis mostly infects children and lasts for a longer period of time, but fades away in their adulthoods. Like ”Hepatitis A” it does not have any specific treatment. The only treatment is to manage the symptoms.

Symptoms of Hepatitis B

Sings and symptoms of hepatitis B, after being infected, appear in 2 to 4 months. In many cases, especially in children, the signs may appear within a few weeks and last for several months. The most common signs of acute Hepatitis B are as follows;

Fatigue
Jaundice (yellowing of the skin and eyes)
Loss of appetite
Nausea and vomiting
Abdominal pain
Dark urine and pale stools
Itchy skin
Joint pain and muscle aches
Fever
Rashes or hives
Swelling in the legs, ankles, or abdomen
Confusion or disorientation (in severe cases)
Chronic liver disease and cirrhosis (in chronic cases)

Causes and transmission of Hepatitis B infection

Hepatitis is a serious contagious infection, which can transmit from an infected individual to an uninfected one by means of sexual contact and blood transfusion. Hepatitis does not spread by breathing, sneezing, and other contacts. Intimate physical contact may allow the infection to spread. It can transmit in several ways;

Sexual contact: Hepatitis B can be spread through sexual contact. The virus is present in the blood, semen, and vaginal fluids, and can be transmitted through unprotected sexual contact, including vaginal, anal, and oral sex. It is important to practice safe sex and use condoms to prevent the spread of hepatitis B and other sexually transmitted infections. It is also recommended for those who are at high risk for hepatitis B to get vaccinated against the virus.
Sharing needles: Sharing a needle is a fast way to transmit Hepatitis B. This occurs because the virus is present in the blood of an infected person, and when the needle is shared, the virus is transferred to the person who uses the needle next. This is why it is important to always use clean and sterile needles, and to never share needles with others. Moreover, an accidental needle stick can also allow the transmission of the infection. Health workers are at high risk of having an infection as they are always in contact with infected persons, and needles.
Mother-to-child transmission: Mother-to-child transmission of hepatitis B can occur during pregnancy, childbirth, or breastfeeding. The virus can be passed from an infected mother to her baby through the placenta, during delivery, or through breast milk. The risk of transmission can be reduced through appropriate prenatal care and vaccination of the baby shortly after birth. It’s important for pregnant women to get tested for hepatitis B and receive appropriate care and treatment to reduce the risk of transmission to their babies.
Blood transfusions: Hepatitis B can be spread through blood transfusions, and the risk of transmission is very low due to the screening and testing of donated blood for hepatitis B. Additionally, blood banks use methods to inactivate the virus in donated blood, further reducing the risk of transmission. It is important to note that other precautions, such as using proper infection control procedures, can also help prevent the spread of hepatitis B in healthcare settings.
Household contact: Household contacts, such as family members living in the same home, can spread hepatitis B if they come into contact with the blood or other bodily fluids of an infected person. This can happen through sharing personal items, such as razor blades or toothbrushes, or through unprotected sexual contact. It is important for household contacts of a person with hepatitis B to get tested and vaccinated to prevent the spread of the virus.

Unlike Hepatitis A, it is not present in the faeces of the infected person. Therefore, it does not spread as fast HAV does.

It’s important to get vaccinated and practice safe sex, avoid sharing needles, and not share personal items with an infected person to prevent hepatitis B spread.

Types of Hepatitis B

Hepatitis B is of two types; Acute HBV lives for a short period of time, while Chronic HBV lives for a longer period of time, like more than 6 months.

Acute Hepatitis B

Acute hepatitis B is a viral infection that affects the liver. It is caused by the hepatitis B virus (HBV) and is characterized by the sudden onset of symptoms such as fatigue, nausea, vomiting, abdominal pain, jaundice (yellowing of the skin and eyes), and dark urine. The symptoms typically appear within 1-4 months after exposure to the virus and can range from mild to severe.

In most cases, acute hepatitis B is self-limiting and resolves on its own within a few weeks to months. However, in rare cases, it can lead to serious complications such as liver failure or death. Treatment for acute hepatitis B typically involves supportive care to manage symptoms and prevent complications. In some cases, antiviral medication may be prescribed to help speed up recovery.

Prevention of acute hepatitis B includes getting vaccinated against the virus, practicing safe sex, avoiding sharing personal items such as razors or toothbrushes, and avoiding contact with the blood or other bodily fluids of infected individuals.

Chronic Hepatitis B

Chronic hepatitis B is a long-term infection caused by the hepatitis B virus (HBV) that can lead to serious health problems, including liver damage, cirrhosis, and liver cancer. It is usually characterized by the presence of the HBV surface antigen (HBsAg) in the blood for more than six months.

Symptoms of chronic hepatitis B may include fatigue, loss of appetite, nausea, vomiting, yellowing of the skin and eyes (jaundice), dark urine, and abdominal pain. However, many people with chronic hepatitis B may not have any symptoms at all.

Chronic hepatitis B can be diagnosed with a blood test that detects the presence of HBsAg and other HBV markers. Treatment options include antiviral medications, such as lamivudine, entecavir, and tenofovir, which can suppress the virus and slow the progression of liver damage.

It is important to be vaccinated against hepatitis B to prevent infection, to practice safe sex and avoid sharing needles to reduce the risk of transmission. People with chronic hepatitis B should also be monitored regularly by a healthcare provider to check for any signs of liver damage or complications.

Risk Factors of HBV infection

There are some key factors which increase the risk of having the infection. Avoid these factors, you may prevent yourself to a large extent.

Exposure to infected bodily fluids: People who come into contact with blood, semen, or other bodily fluids from an infected person have a higher risk of contracting hepatitis B.
Sexual contact: Having unprotected sex with multiple partners or having a sexually transmitted infection increases the risk of hepatitis B.
Sharing needles or other injection equipment: People who inject drugs or share needles or other injection equipment are at a higher risk of contracting hepatitis B.
Occupational exposure: Health care workers, first responders, and other individuals who may come into contact with blood or bodily fluids in their work are at a higher risk of hepatitis B.
Travel: People who travel to areas with a high prevalence of hepatitis B are at a higher risk of contracting the virus.
Household exposure: People living with someone who has hepatitis B are at a higher risk of contracting the virus.
Chronic liver disease: People with chronic liver disease or cirrhosis are at a higher risk of developing serious complications from hepatitis B.
Chronic kidney disease: People with chronic kidney disease are at a higher risk of contracting hepatitis B.
Immunocompromised: People who have a weakened immune system, such as those with HIV or cancer, are at a higher risk of contracting hepatitis B.
Newborns: Newborns of mothers who have hepatitis B are at a higher risk of contracting the virus.

Complications of HBV infection

Having a chronic HBV infection can lead to serious complications, such as:

Acute liver failure: In some cases, hepatitis B can cause severe damage to the liver, leading to acute liver failure. Symptoms include jaundice, abdominal pain, and confusion.
Chronic hepatitis B: When the infection persists for more than six months, it is considered chronic hepatitis B. Chronic hepatitis B can lead to cirrhosis, liver cancer, and liver failure.
Cirrhosis: Chronic hepatitis B can cause scarring of the liver, known as cirrhosis. This can lead to a loss of liver function and an increased risk of liver cancer.
Liver cancer: Chronic hepatitis B is a leading cause of liver cancer. Symptoms include abdominal pain, weight loss, and jaundice.
Autoimmune disorders: In some cases, hepatitis B can trigger autoimmune disorders, such as autoimmune hepatitis and lupus.
Kidney damage: Chronic hepatitis B can also cause damage to the kidneys, leading to kidney failure.
Neurological complications: In rare cases, hepatitis B can cause neurological complications, such as encephalitis, meningitis, and peripheral neuropathy.
Hepatic encephalopathy: Chronic hepatitis B can lead to a buildup of toxins in the bloodstream that can affect the brain and cause confusion, drowsiness, and even coma.
Increased risk of other infections: People with chronic hepatitis B are at an increased risk of developing other infections, such as pneumonia, tuberculosis, and sepsis.
Transmission to others: Individuals with chronic hepatitis B can transmit the virus to others through blood, semen, vaginal fluids, and breast milk.

How to prevent Hepatitis B infection

There are several medicated and lifestyle ways to prevent HBV infection, which are as follows;

Get Vaccinated:

Although HBV infection is not cured by any medicine, the good news about it is, it has a vaccine. The vaccine can prevent you from suffering the infection. The vaccine is given in the form of injections. There are different types of vaccines, each has its own different dose and schedule. Some are injected in two doses a month, while others are injected in 4 doses per six months.

The United States Advisory Committee on Immunization Practices advised vaccines for adults 19 to 59 years of age who do not have a contraindication to the vaccine.

The hepatitis B vaccine is also strongly advised for:

Newborn babies, especially whose mothers are infected
Those who work or live in a center for people who are developmentally disabled
Children and adolescents not vaccinated at birth
Healthcare workers, emergency workers and other people who come into contact with blood
Men who have sex with men
Sexual partners of someone who has hepatitis B
Travellers planning to go to an area of the world with a high hepatitis B infection rate
People who have multiple sexual partners
People who live with someone who has hepatitis B
Anyone who has a sexually transmitted infection, including HIV
Men who have sex with men
People who have multiple sexual partners
Sexual partners of someone who has hepatitis B
People who inject illegal drugs or share needles and syringes
People with chronic liver disease
People with end-stage kidney disease

Precautionary Measures

Apart from getting vaccinated, there are some general preventive measures to be adopted for avoiding the risk of HBV infection.

Practice safe sex: Use a barrier method of contraception, such as condoms, to reduce the risk of transmission through sexual contact. Never engage in unprotected sex unless you’re absolutely certain your partner isn’t infected with HBV or any other sexually transmitted infection.
Avoid sharing needles or other injectable equipment: This is a major risk factor for hepatitis B transmission, as the virus can survive for up to a week outside of the body.
Be cautious with body piercing and tattooing: Make sure the equipment used is sterile and that the practitioner follows proper hygiene and sterilization procedures.
Avoid sharing personal items: Avoid sharing items such as razors, toothbrushes, or nail clippers with others, as the virus can survive on surfaces for up to 7 days.
Practice good hygiene: Wash your hands regularly with soap and water, especially after coming into contact with blood or other bodily fluids.
Use caution when travelling: If you are travelling to a country where the incidence of hepatitis B is high, take extra precautions to protect yourself.
Avoid alcohol and drugs: Alcohol and drugs can damage the liver, making it more susceptible to infection.
Get tested: If you think you may have been exposed to the virus, get tested to confirm whether or not you have been infected. If you are infected, it is important to get treatment as soon as possible.

When to see a doctor?

It is important to see a doctor if you experience any symptoms of hepatitis B, such as; Fatigue, Jaundice (yellowing of the skin and eyes), Dark urine, Loss of appetite, Nausea and vomiting, Abdominal pain, and Joint pain.

Additionally, if you have been exposed to hepatitis B or are at a higher risk of infection (such as through unprotected sexual contact or sharing needles), it is important to get tested and discuss potential treatment options with a doctor. Regular check-ups and monitoring are also important for those who have been diagnosed with chronic hepatitis B to ensure proper management of the disease.

Diagnosis of Hepatitis B infection

Your health care provider can diagnose hepatitis b infection simply by signs and symptoms with a general physical examination. You can even detect the infection before the appearance of the symptoms by means of tests, as the symptoms generally appear after a few weeks of getting infected. A suspected HBV case can be confirmed by the following diagnostic tests;

Blood Tests:

Hepatitis B blood tests are used to diagnose and monitor the progression of the hepatitis B virus (HBV) infection. There are several types of blood tests that can be used to detect HBV, including:

Hepatitis B surface antigen (HBsAg) test: This test is used to detect the presence of the HBsAg protein, which is a marker of an active HBV infection.
Hepatitis B surface antibody (HBsAb) test: This test is used to detect the presence of antibodies against the HBsAg protein, which indicates a past or resolved HBV infection.
Hepatitis B core antigen (HBcAg) test: This test is used to detect the presence of the HBcAg protein, which is a marker of a chronic HBV infection.
Hepatitis B e antigen (HBeAg) test: This test is used to detect the presence of the HBeAg protein, which is a marker of a high viral load and increased risk of transmitting the virus to others.
Hepatitis B e antibody (HBeAb) test: This test is used to detect the presence of antibodies against the HBeAg protein, which indicates a lower viral load and reduced risk of transmitting the virus to others.
Hepatitis B viral load test: This test measures the amount of HBV DNA in the blood, which can be used to monitor the progression of the infection and the effectiveness of treatment.

Ultrasound Tests

A liver ultrasound is a non-invasive imaging test that uses sound waves to create pictures of the liver. It can be used to detect hepatitis B, a viral infection that causes inflammation of the liver. During the test, the patient will lie on their back and a gel will be applied to the skin on the right side of the abdomen. A small handheld device called a transducer will be moved over the gel, emitting sound waves and creating images of the liver on a monitor. The images will be analyzed by a radiologist to look for signs of hepatitis B, such as an enlarged liver or abnormal blood flow. If hepatitis B is detected, further tests may be needed to confirm the diagnosis and determine the severity of the infection.

Liver Biopsy

A liver biopsy is a procedure in which a small sample of liver tissue is removed and examined under a microscope. This can help detect the presence of hepatitis B, as well as determine the severity of liver damage caused by the virus. The procedure is typically done using a thin, hollow needle that is inserted through the skin and into the liver. The procedure is usually done under local anaesthesia, and the sample of liver tissue is sent to a laboratory for analysis. The results of the biopsy can help guide treatment decisions and monitor the progression of the disease.

Screening Healthy people for HBV infection

Screening healthy people for hepatitis B is not generally recommended as it is a rare infection and most individuals who are infected do not show symptoms. However, there are certain populations who may be at a higher risk for hepatitis B and may benefit from screening. These include:

Individuals from countries with a high prevalence of hepatitis B.
Individuals who have had close contact with someone with hepatitis B.
Individuals who have engaged in high-risk behaviours such as injecting drugs or having unprotected sex with multiple partners.
Individuals who work in healthcare or other settings where may be at risk of exposure to hepatitis B.
Pregnant women, as they can spread the virus to newborns.
People living with someone who has hepatitis B
People have many sexual partners
People having sex with someone who has hepatitis B
Men who have sex with men
Individuals having a history of a sexually transmitted illness
Individuals having HIV or hepatitis C
Those who have a liver enzyme test with unexplained abnormal results
Those who receive kidney dialysis
Those who are taking medications that suppress the immune system, such as those used to prevent rejection after an organ transplant
Those who use illegally injected drugs
Those who stayed in prison
Individuals born in a country where hepatitis B is common, including Asia, the Pacific Islands, Africa and Eastern Europe
Those who have parents or adopted children from places where hepatitis B is common, including Asia, the Pacific Islands, Africa and Eastern Europe

If a person falls into one of these categories, they should speak with their healthcare provider to discuss whether screening for hepatitis B is appropriate for them.

Treatment of Hepatitis B

After a diagnosis of the infection, you must consult your doctor. Once the infection is fully diagnosed, the doctor will decide what type of treatment is suitable for you, because, the infection is of two types. Each type has its own separate treatment.

Treatment of Acute HBV

Once your healthcare provider detects the infection is acute. In an acute case, you do not need any medical treatment, as it is short termed and goes away on its own. The patient only needs rest, proper nutrition, and plenty of fluid. Generally, an acute infection shows mild symptoms, however, if the case is severe hepatitis B is typically treated with antiviral medications such as entecavir or tenofovir or HB Immunoglobulin injection to prevent further complications like Chronic HBV. These medications work by inhibiting the replication of the hepatitis B virus, which can help to reduce the severity of symptoms and prevent the progression to chronic hepatitis B. Other treatment options may include supportive care, such as rest and a healthy diet, as well as monitoring for complications such as liver failure or cirrhosis. In some cases, a liver transplant may be necessary if hepatitis B causes significant damage to the liver. It’s important to consult with a healthcare provider for proper diagnosis and treatment.

Treatment of Chronic HBV

A chronic HBV has milder to more severe symptoms, but it lasts for a longer period of time, even for the rest of your life. A chronic HBV may have many complications like inflammation and scarring of the liver, hepatitis C, and HIV infection. The treatment depends on the severity and complications of the condition. HBV treatment may include;

Chronic hepatitis B virus (HBV) infection is typically treated with antiviral medications, such as:

Nucleoside/nucleotide analogues: These medications work by blocking the replication of the virus in the liver. Examples include lamivudine (Epivir), entecavir (Baraclude), and tenofovir disoproxil fumarate (Viread).
Interferon alfa: This is a type of immune system-based treatment that can help reduce the viral load in the liver and improve liver function.
Pegylated interferon: This is a long-acting form of interferon that is given once a week and can help reduce the viral load and improve liver function.
Direct-acting antiviral (DAA) agents: These medications work by targeting specific viral proteins and are effective in treating chronic HBV infection in a majority of patients. Examples include paritaprevir-ritonavir-ombitasvir (Viekira Pak), glecaprevir-pibrentasvir (Mavyret), and sofosbuvir-velpatasvir (Epclusa)

It is important to note that treatment for chronic HBV infection should be individualized and tailored to the patient’s specific needs and circumstances. A combination of antiviral medications, along with regular monitoring of viral load and liver function tests, is typically recommended to achieve the best possible outcome.

Liver Transplant

The need for a liver transplant happens when your liver is completely damaged due to HBV. It is a surgical procedure in which a damaged or diseased liver is replaced with a healthy one from a deceased or living donor. In the case of a patient with hepatitis B virus (HBV), a liver transplant may be necessary if the liver damage caused by the virus is severe and other treatments are not effective. However, HBV can also be reactivated after a transplant, so it is important for patients to receive careful monitoring and management of the virus before and after the transplant. This may include taking antiviral medications to prevent or control the reactivation of the virus.