Hepatitis B is the most common liver infection in the world and is caused by the hepatitis B virus. The hepatitis B virus enters the body and travels through the blood to the liver. In the liver, it attaches to the liver cells and multiplies. Although the patient may not have any problems at this phase, multiplication of the virus triggers a response from the body’s immune system.
Hepatitis B infection can lead to cirrhosis (scarring of the liver), liver failure or even liver cancer unless diagnosed and managed early.
There are probably 350 - 400 million people with chronic (lifelong) hepatitis B infection worldwide.
Hepatitis B infection is considered to be ’acute‘ in the first 6 months after infection. If hepatitis B virus tests (HBsAg) are positive after 6 months, this is now a ‘chronic’ (long term) hepatitis B infection, which may last a lifetime.
Symptoms of acute hepatitis B
Symptoms resulting from acute hepatitis B infection are common, with jaundice occurring approximately 12 weeks after initial infection.
The symptoms of acute hepatitis B include:
Loss of appetite
Nausea and vomiting
Muscle and joint pain
Many people with acute hepatitis B have no symptoms and never realize they had the infection. A small number of those with acute hepatitis B become very sick in a short period of time. This happens if there is massive damage to the liver and it stops working. This is called acute liver failure.
Symptoms of chronic hepatitis B
Most people with chronic hepatitis B do not have any symptoms of infection so that they feel healthy and may not be aware they are infected. However, other s may experience symptoms, which are similar to those experienced with other forms of viral hepatitis. These can include:
Tiredness, depression and irritability
Pain in the liver (upper, right side of abdomen)
Nausea and vomiting
Loss of appetite
Joint aches and pains.People with chronic hepatitis B have a significantly increased risk of developing liver cancer.
Those who have immunity and normal LFTs do not need treatment. People who are chronically infected but do not have any liver damage also do not need treatment but need close monitoring. However, if a person has liver damage they should consider having treatment for hepatitis B. The decision on when to start treatment is complex and should be made in consultation with a gastroenterologist / hepatologist.
The most common are anti-viral medications taken as tablets each day for a year or longer:
Lamivudine: There are almost no side effects to Lamivudine, however a significant concern is the possible development of hepatitis B virus mutations and antiviral drug resistance after long-term use.
Adefovir: There are almost no side effects except for the possibility of developing virus mutations and antiviral drug resistance.
Entecavir (Baraclude): Entevavir has potent activity against chronic hepatitis B. There are almost no side effects except for the possibility of developing virus mutations and antiviral drug resistance.
Tenofovir (Viread): Tenofovir has potent activity against chronic hepatitis B. It is particularly useful in patients who have developed drug resistance to other medications.
Treatment aims are to stop the hepatitis B virus from multiplying, or to reduce the rate of multiplication as much as possible. This decreases the risk of serious liver disease developing later in life and makes it possible for the liver to repair some of the damage and to work better. However, it is very rare that any of these medications will cure hepatitis B infection.
The main side effect of the antiviral tablets is sometimes the hepatitis B virus mutates (changes) during the course of treatment, which means the antiviral tablets are not as effective against the new form of the virus. This is called antiviral resistance.
During treatment, the patient’s blood tests are monitored very carefully to look for signs of antiviral resistance. If there are signs of resistance such as elevated liver enzymes and high levels of hepatitis B virus in the blood, the antivirals may be changed.
Consider being vaccinated
Practice safe sex (use a condom)
Wash hands after touching blood or body fluids
Wear disposable gloves if giving someone first aid, or cleaning up blood or body fluids
Avoid sharing toothbrushes, razors, needles, syringes, personal hygiene items or any object that may come into contact with blood or body fluids
Use new and sterile needles / syringes for each injection
Cover all cuts and open sores with a band aid or bandage
Wipe up any blood spills and then clean the area with bleaching powder
Throw away personal items such as tissues, menstrual pads, and bandages in a sealed plastic bag.
Limit or avoid alcohol
Do not smoke
Eat a healthy, well-balanced diet
Those who have been exposed to the hepatitis B virus and who have not been vaccinated should receive hepatitis B immunoglobulin (HBIG) within 72 hours of exposure, and a dose of hepatitis B vaccine as soon as possible or within 7 days.