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| Hepatitis B |
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| HBV |
SYMPTOMS
Signs and symptoms of hepatitis B usually appear about three months after you've been infected and can range from mild to severe. Signs and symptoms of hepatitis B may include:
Abdominal pain Dark urine Fever Joint pain Loss of appetite Nausea and vomiting Weakness and fatigue Yellowing of your skin and the whites of your eyes (jaundice)
Most infants and children with hepatitis B never develop signs and symptoms. The same is true for some adults.
If you know you've been exposed to hepatitis B, contact your doctor immediately. A preventive treatment may reduce the risk that the virus will infect your body. But the treatment must be given within 24 hours of exposure to the hepatitis B virus.
CAUSES
Hepatitis B infection is caused by the hepatitis B virus (HBV). The virus is passed from person to person through blood, semen or other body fluids. When HBV enters your liver, it invades the liver cells and begins to multiply. This causes inflammation in the liver and leads to the signs and symptoms of hepatitis B infection.
Common ways HBV is transmitted include:
Sexual contact. You may become infected if you have unprotected sexual contact with an infected partner whose blood, saliva, semen or vaginal secretions enter your body. Sharing of needles. HBV is easily transmitted through needles and syringes contaminated with infected blood. Sharing intravenous (IV) drug paraphernalia puts you at high risk of hepatitis B. Accidental needle sticks. Hepatitis B is a concern for health care workers and anyone else who comes in contact with human blood. Mother to child. Pregnant women infected with HBV can pass the virus to their babies during childbirth.Acute vs. chronic hepatitis B
Hepatitis B infection may be either short-lived (acute hepatitis B) or long lasting (chronic hepatitis B).
Acute hepatitis B infection lasts less than six months. If the disease is acute, your immune system is usually able to clear the virus from your body, and you should recover completely within a few months. Most people who acquire hepatitis B as adults have an acute infection. Chronic hepatitis B infection lasts six months or longer. When your immune system can't fight off the virus, hepatitis B infection may become lifelong, possibly leading to serious illnesses such as cirrhosis and liver cancer. Most infants infected with HBV at birth and many children infected between 1 and 5 years of age become chronically infected. Chronic infection may go undetected for decades until a person becomes seriously ill from liver disease.
COMPLICATIONS
Having a chronic HBV infection can lead to serious complications, such as:
Scarring of the liver (cirrhosis). Hepatitis B infection may cause inflammation that leads to extensive scarring of the liver (cirrhosis). Scarring in the liver may impair the liver's ability to function. Liver cancer. People with chronic hepatitis B infection have an increased risk of liver cancer. Liver failure. Acute liver failure is a condition in which the vital functions of the liver shut down. When that occurs, a liver transplant is necessary to sustain life. Hepatitis D infection. Anyone chronically infected with HBV is also susceptible to infection with another strain of viral hepatitis — hepatitis D. You can't become infected with hepatitis D unless you're already infected with HBV. Having both hepatitis B and hepatitis D makes it more likely you'll develop complications of hepatitis. Kidney problems. Hepatitis B infection can cause kidney problems that may lead eventually to kidney failure. Children are more likely to recover from these kidney problems than are adults, who may experience kidney failure.
DIAGNOSIS
Doctors sometimes test certain healthy people for hepatitis B infection. This is recommended because hepatitis B infection often begins damaging the liver before it causes signs and symptoms. Testing for hepatitis B infection in people who have a high risk of coming in contact with the virus may help doctors begin treatment or recommend lifestyle changes that may slow liver damage.
People who may want to talk to their doctors about screening for hepatitis B infection include:
Anyone who lives with a person who has hepatitis B infection Anyone who has had sex with a person who has hepatitis B infection Anyone with an unexplained, abnormal liver enzyme test Anyone infected with HIV Immigrants, including internationally adopted children, from areas of the world where hepatitis B is more common, including Asia, the Pacific Islands, Africa and Eastern Europe People who inject drugs Inmates Men who have sex with men People who have one or both parents from an area of the world where hepatitis B is more common People who receive kidney dialysis People who take medications that suppress the immune system, such as anti-rejection medications used after an organ transplant Pregnant women
Blood tests to detect hepatitis B infection
Blood tests used to diagnose hepatitis B infection include:
A test to determine whether you can easily pass HBV to others. The hepatitis B surface antigen (HBsAg) test looks for hepatitis B surface antigen — part of the outer surface of the virus. Testing positive for this antigen means you have an active hepatitis B infection and can easily pass the virus to others. A negative test means you're probably not currently infected. A test to determine whether you're immune to HBV. The antibody to hepatitis B surface antigen (anti-HBs) test determines if you have antibodies to HBV. Having antibodies can be due to a prior HBV infection from which you've recovered. Or, it can mean you may already have been vaccinated. In either case, a positive anti-HBs test means you can't infect others or become infected yourself because you're protected by the vaccine or your own natural immunity. A test to determine whether you have had or currently have a hepatitis B infection. The antibody to hepatitis B core antigen (anti-HBc) test identifies people who have an HBV infection. If you test positive for hepatitis B core antibodies, you may have a chronic infection that you can transmit to others. A positive result may also mean you're recovering from an acute infection or have a slight immunity to HBV that can't otherwise be detected. How this test is interpreted often depends on the results of the other two tests.
Additional tests to gauge liver health and infection severity
If you receive a diagnosis of hepatitis B, your doctor may perform tests to check the severity of the HBV infection as well as the health of your liver. These tests include:
A test to determine how likely you are to spread HBV to others. The E antigen blood test looks for the presence of a protein secreted by HBV-infected cells. A positive result means you have high levels of the virus in your blood and can easily infect others. If the test is negative, you have lower blood levels of HBV and are less likely to spread the infection. A test to determine how much HBV DNA is in your blood. The hepatitis B DNA test detects parts of HBV DNA in your blood, indicating how much virus is present (viral load). Assessing your viral load can help monitor how well antiviral therapy is working. Tests to measure liver function. Liver function tests may gauge the amount of damage that has occurred in your liver cells.
Removing a sample of liver tissue for testing
During a liver biopsy, your doctor inserts a thin needle through your skin and into your liver. A small sample of liver tissue is removed for laboratory analysis. A biopsy may show the extent of any liver damage and may help determine the best treatment for you.
TREATMENT
If you know you've been exposed to the hepatitis B virus, call your doctor immediately. Receiving an injection of hepatitis B immune globulin within 24 hours of coming in contact with the virus may help protect you from developing hepatitis B.
Treatment for acute hepatitis B infection
If your doctor determines your hepatitis B infection is acute — meaning it is short-lived and will go away on its own — you may not need treatment. Instead, your doctor will work to reduce any signs and symptoms you experience while your body fights the infection. Your doctor may recommend follow-up blood tests to make sure the virus has left your body.
Treatment for chronic hepatitis B infection
If you've been diagnosed with chronic hepatitis B infection, your doctor may recommend:
Antiviral medications. Antiviral medications help fight the virus and slow its ability to damage your liver. Several medications are available. Your doctor can suggest which medications may be most appropriate for you. Liver transplant. If your liver has been severely damaged, a liver transplant may be an option. During a liver transplant, the surgeon removes your damaged liver and replaces it with a healthy liver. Most transplanted livers come from deceased donors, though a small number come from living donors.
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