Hepatitis B

What is Hepatitis B?

Hepatitis B is an inflammation of the liver caused by a viral infection. The liver is a large organ located under the rib cage in the right upper abdomen. It has many functions, such as making bile to digest fats, making factors to help blood clotting, and removing drugs and toxins from the body. There are several different viruses which can infect the liver, with Hepatitis A, B and C as the most common. Each is a different virus with distinct behavior and genetic makeup.

What causes Hepatitis B?

Hepatitis B is caused by a virus that is spread by contact with the blood of an infected person. In the United States, it is most commonly passed by needle sharing during injection drug use, having a tattoo or body piercing with dirty tools, sharing a toothbrush or razor from an infected person or unprotected sexual intercourse. In other parts of the world where Hepatitis B is common, the virus often passes from mother to baby at time of birth.

What are the symptoms of Hepatitis B?

The symptoms of Hepatitis B may be different during acute (new) vs. chronic (longstanding) hepatitis infection, and may vary from person-to-person. Many people experience no specific symptoms with this infection, or mild viral-like syndrome. Absence of symptoms does not mean the infection is controlled, however.

Symptoms of Hepatitis B may mimic the flu, and include feeling tired, nauseated, feverish, and also with right upper abdominal pain, poor appetite, cola-colored urine, pale looser stools, and yellowing of the eyes and skin (jaundice).

How is Hepatitis B diagnosed?

Your healthcare provider will order blood work to assess the presence and severity of liver damage. These lab tests may include:

  • Liver enzymes – elevation of these signals inflammation in the liver
  • Bilirubin – breakdown of hemoglobin in red blood cells is cleared by liver
  • Albumin – a protein made by the liver; low levels signify liver damage
  • Prothrombin time or INR – measurement of blood clotting function, affected by liver

Your healthcare provider will also ask you for a detailed medical history, asking about risk factors for Hepatitis B such as unprotected sex, injection drug use, blood transfusion, country of birth and any family history of Hepatitis B.

Other blood tests can determine presence of Hepatitis B, and whether the infection is acute or chronic. They measure antigens (pieces of Hepatitis B virus) and antibodies (proteins made by our immune system to control or limit virus). These tests include:

  • Hepatitis B surface antigen (HBsAg) – main marker of having the infection
  • Hepatitis B e-antigen (HBeAb) – 2nd tier test to look for circulating virus in carriers
  • Antibodies to hepatitis B core antigen (HBcAb), surface antigen (HBsAB), e-antigen (HBeAg) can assess timing of infection and immune response
  • Hepatitis B virus DNA – measures the amount of the actual virus in the blood

Your heath care provider may also order a liver biopsy, taking a tissue sample with a small needle. This can help further assess the causes of liver disease, and the severity of liver inflammation and scarring.

How is Hepatitis B treated?

In 95% of newly infected adults, our immune system can eliminate the virus within about six months, and then you are protected from future infection (much like with vaccination series). There are many medications which could be considered if acute Hepatitis B is unusually severe or prolonged.

Patients with chronic Hepatitis B (termed “carriers”) may be candidates for treatment if the virus is active, and this can halt the virus copying itself and further damaging the liver. Some of the available medications include tenofovir, adefovir, entecavir, telbivudine, lamivudine, and pegylated interferons, as well as off-label use of combination antivirals currently approved for HIV therapy. Regular monitoring is needed while on treatment to assess response, manage side effects, watch for drug resistance (sometimes a mutant form of the virus will take over), and watching for relapse (infection flare) after treatment is stopped.

General Measures:
All people with Hepatitis B should be vaccinated to protect against Hepatitis A infection, unless they are already immune to Hepatitis A. Regular screening for liver cancer is also recommended for some patients. For anyone with a chronic illness, an annual flu shot is advised, as well as a pneumococcal vaccine every five years.

How can I protect myself and others from Hepatitis B?

Hepatitis B is contagious. If you have Hepatitis B, take precautions to reduce the risk of infecting others.

  • Use a condom or other barrier protection when you have sex
  • Don’t share needles with anyone, dispose of them safely
  • Wear gloves if you have to touch anyone’s blood
  • Do not share a toothbrush, razor, or anything else that could have blood on it
  • Assure any tattoos or piercings are done with clean, sterilized tools
  • Hepatitis A and B vaccinations are recommended for those at risk of acquiring the infection.

Additional Resources for Hepatitis B:

American Liver Foundation
www.liverfoundation.org
1-800-GO-Liver

Hepatitis B Foundation
www.hepb.org
215-489-4900