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Hepatitis B

Definition

Hepatitis B is irritation and swelling (inflammation) of the liver due to infection with the hepatitis B virus (HBV).

Other types of viral hepatitis include:

• Hepatitis A
• Hepatitis C
• Hepatitis D

See also:

• Autoimmune hepatitis
• Chronic persistent hepatitis
• Drug-induced hepatitis

Causes, incidence, and risk factors

Hepatitis B infection can be spread through having contact with the blood, semen, vaginal fluids, and other body fluids of someone who already has a hepatitis B infection.

Infection can be spread through:

• Blood transfusions (not common in the United States)
• Direct contact with blood in health care settings
• Sexual contact with an infected person
• Tattoo or acupuncture with unclean needles or instruments
• Shared needles during drug use
• Shared personal items (such as toothbrushes, razors, and nail clippers) with an infected person

The hepatitis B virus can be passed to an infant during childbirth if the mother is infected.

Risk factors for hepatitis B infection include:

• Being born, or having parents who were born in regions with high infection rates (including Asia, Africa, and the Caribbean)
• Being infected with HIV
• Being on hemodialysis
• Having multiple sex partners
• Men having sex with men

Most of the damage from the hepatitis B virus occurs because of the way the body responds to the infection. When the body's immune system detects the infection, it sends out special cells to fight it off. However, these disease-fighting cells can lead to liver inflammation.

Symptoms

After you first become infected with the hepatitis B virus:

• You may have no symptoms
• You may feel sick for a period of days or weeks
• You may become very ill (called fulminant hepatitis)

If your body is able to fight off the hepatitis B infection, any symptoms that you had should go away over a period of weeks to months.

Some people's bodies are not able to completely get rid of the hepatitis B infection. This is called chronic hepatitis B.

Many people who have chronic hepatitis B have few or no symptoms. They may not even look sick. As a result, they may not know they are infected. However, they can still spread the virus to other people.

Symptoms may not appear for up to 6 months after the time of infection. Early symptoms may include:

• Appetite loss
• Fatigue
• Fever, low-grade
• Muscle and joint aches
• Nausea and vomiting
• Yellow skin and dark urine due to jaundice

People with chronic hepatitis may have no symptoms, even though gradual liver damage may be occurring. Over time, some people may develop symptoms of chronic liver damage and cirrhosis of the liver.

Signs and tests

The following tests are done to identify and monitor liver damage from hepatitis B:

• Albumin level
• Liver function tests
• Prothrombin time

The following tests are done to help diagnose and monitor people with hepatitis B:

• Antibody to HBsAg (Anti-HBs) -- a positive result means you have either had hepatitis B in the past, or have received a hepatitis B vaccine
• Antibody to hepatitis B core antigen (Anti-HBc) -- a positive result means you had a recent infection or an infection in the past
• Hepatitis B surface antigen (HBsAg) -- a positive result means you have an active infection
• Hepatitis E surface antigen (HBeAg) -- a positive result means you have a hepatitis B infection and are more likely to spread the infection to others through sexual contact or sharing needles

Patients with chronic hepatitis will need ongoing blood tests to monitor their status.

Treatment

Acute hepatitis needs no treatment other than careful monitoring of liver and other body functions with blood tests. You should get plenty of bed rest, drink plenty of fluids, and eat healthy foods.

In the rare case that you develop liver failure, you may need a liver transplant. A liver transplant is the only cure in some cases of liver failure.

Some patients with chronic hepatitis may be treated with antiviral medications or a medication called peginterferon. These medications can decrease or remove hepatitis B from the blood and reduce the risk of cirrhosis and liver cancer.

Liver transplantation is used to treat severe, chronic hepatitis B liver disease.

Patients with chronic hepatitis should avoid alcohol and should always check with their doctor or nurse before taking any over-the-counter medications or herbal supplements. This even includes medications such as acetaminophen, aspirin, or ibuprofen.

See: Cirrhosis for information about treating more severe liver damage caused by hepatitis B.

Support Groups

See: Liver disease support group

Expectations (prognosis)

The acute illness usually goes away after 2 - 3 weeks. The liver usually returns to normal within 4 - 6 months in almost all patients who are infected.

Some people develop chronic hepatitis.

• Almost all newborns and about 50% of children who become infected with hepatitis B develop chronic hepatitis. Less than 5% of adults who are infected with the hepatitis B virus develop the chronic condition.
• Chronic hepatitis B infection increases the risk for liver damage, including cirrhosis and liver cancer.
• People who have chronic hepatitis B can transmit the infection. They are considered carriers of the disease, even if they do not have any symptoms.

Hepatitis B is fatal in about 1% of cases.

Complications

There is a much higher rate of hepatocellular carcinoma in people who have chronic hepatitis B than in the general population.

Other complications may include:

• Chronic persistent hepatitis
• Cirrhosis
• Fulminant hepatitis, which can lead to liver failure and possibly death

Calling your health care provider

Call your health care provider if:

• You develop symptoms of hepatitis B
• Hepatitis B symptoms do not go away in 2 or 3 weeks, or new symptoms develop
• You belong to a high-risk group for hepatitis B and have not yet received the HBV vaccine.

Prevention

All children should receive their first dose of the hepatitis B vaccine at birth, and complete the series of three shots by age 6 months. Children younger than age 19 who have not been vaccinated should receive "catch-up" doses.

People who are at high risk, including health care workers and those who live with someone who has hepatitis B should get the hepatitis B vaccine.

Infants born to mothers who either currently have acute hepatitis B, or who have had the infection should receive a special vaccination that includes hepatitis B immune globulin and a hepatitis B immunization within 12 hours of birth.

Screening of all donated blood has reduced the chance of getting hepatitis B from a blood transfusion. Mandatory reporting of the disease allows state health care workers to track people who have been exposed to the virus. The vaccine is given to those who have not yet developed the disease.

The hepatitis B vaccine or a hepatitis B immune globulin (HBIG) shot may help prevent hepatitis B infection if it is given within 24 hours of exposure.

Lifestyle measures for preventing transmission of hepatitis B:

• Avoid sexual contact with a person who has acute or chronic hepatitis B.
• Use a condom and practice safe sex.
• Avoid sharing personal items, such as razors or toothbrushes.
• Do not share drug needles or other drug equipment (such as straws for snorting drugs).
• Clean blood spills with a solution containing 1 part household bleach to 10 parts water.

Hepatitis B (and hepatitis C) viruses cannot be spread by casual contact, such as holding hands, sharing eating utensils or drinking glasses, breast-feeding, kissing, hugging, coughing, or sneezing.

References

Dienstag JL. Hepatitis B virus infection. N Engl J Med. 2008;359:1486-1500.

Perrillo R. Hepatitis B and D. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier;2010:chap 78.

Sorrell MF, Belongia EA, Costa J, Gareen IF, Grem JL, Inadomi JM, et al. National Institutes of Health Consensus Development Conference Statement: Management of hepatitis B. Ann Intern Med. 2009;150:104-10.