Hepatitis B

What Is Hepatitis B?

Hepatitis B is a viral infection caused by the hepatitis B virus (HBV). The condition can become chronic and recurring for many patients, which greatly increases the risk of developing liver cancer, liver failure, or cirrhosis, which is the scarring of the liver. Cirrhosis also often leads to liver failure if the patient is unable to receive a liver transplant. However, most people do recover from hepatitis B, provided it is treated. There is a vaccine for hepatitis B, so it is not as common as it once was, but those who are unvaccinated are at more risk of contracting the virus. Hepatitis B is passed from person to person via contact with contaminated body fluids, blood, or semen. 

What Are the Symptoms of Hepatitis B?

You may not notice symptoms of hepatitis B until one to four months after you are infected. However, it is possible to feel symptoms as early as two weeks post-infection. Children may not develop noticeable symptoms if infected. In adults and some children, the most common symptoms of hepatitis B include:

• Unexplained fatigue or weakness
• Dark urine
• Abdominal pain 
• Yellowing of the skin and eyes (jaundice)
• Loss of appetite
• Nausea and vomiting
• Joint pain
• Fever

If you have a known exposure to hepatitis B, let your physician know immediately, even if you are vaccinated. Being treated for hepatitis B within 24 hours of exposure greatly reduces the risk of infection. If you have any symptoms of hepatitis B, you should consult your gastroenterologist or provider.

What Causes Hepatitis B?

Hepatitis B is caused by the Hepatitis B virus (HBV). It can only be spread through person-to-person contact, via blood, semen, or other bodily fluids. You cannot contract hepatitis B if a person coughs or sneezes near you, as the disease is not spread that way. The reasons patients develop hepatitis B include:

• Sexual contact. This is the most common way to get hepatitis B. The virus can be spread through person-to-person contact with semen, vaginal secretions, saliva, or blood. 
• Accidents with needles. Healthcare workers have a greater risk of developing hepatitis B through accidental contact with infected needles.
• Sharing of needles. Intravenous drug users have a higher chance of developing the virus if they share used needles. 
• Mother to infant. If you have hepatitis B and are pregnant, it will be passed along to the fetus. However, you can have your child vaccinated shortly after birth to minimize the chances of infection later in life.

What Are the Different Hepatitis B Types?

There are two types of hepatitis B: acute and chronic. An acute case of hepatitis B is short-lasting (around six months). Most adults with acute hepatitis B recover completely with treatment. However, some cases of acute hepatitis B can become chronic, which is more serious. 

A chronic case of hepatitis B lasts for more than six months, primarily because the body’s immune system is too weak to fight off the infection. Chronic hepatitis B is often a lifelong disease, but goes undetected until the patient begins to show symptoms of liver disease. Having chronic hepatitis B greatly increases the risk of more serious liver disease, such as cirrhosis and liver failure. 

Am I at Risk for Hepatitis B?

Certain risk factors can greatly increase the risk of developing hepatitis B:

• Those who share intravenous needles
• Those with multiple (unprotected) sexual partners
• Having sexual intercourse with someone infected with hepatitis B
• Men who have intercourse with other men
• Having a job that comes into contact with biohazard materials 
• Those who travel to areas with high HBV infection rates, such as Eastern Europe, Asia, Africa, and the Pacific Islands

You can greatly reduce the risk of hepatitis B by using protection with sexual partners, not sharing used needles, taking extreme caution if you must handle biohazard materials, and only getting body piercings and tattoos from a business that is focused on client safety. 

Who Should Get the Hepatitis B Vaccine?

In modern times, newborns are typically vaccinated against hepatitis B at birth. However, not everyone is vaccinated at birth for multiple reasons. Those who are unvaccinated should consider the hepatitis B vaccine if they fall into the following categories:

• Anyone with an STD, including HIV
• Those with multiple sexual partners
• Men who have intercourse with men
• Those with chronic liver disease or end-stage kidney disease
• Healthcare and emergency workers
• Those who inject drugs or use illegal drugs
• Those who share IV needles
• Travelers planning to visit a region with high HBV infection rates
• Those who work in a clinic setting for the developmentally disabled
• Someone who lives with a person infected with HBV
• Children and adolescents not vaccinated at birth

There is a much higher chance of hepatitis B being chronic later in life if you are infected as an infant, young child, or adolescent. Therefore, the vaccine is recommended at birth. 

How Is Hepatitis B Diagnosed?

If hepatitis B is suspected, your physician will first give you a physical exam, taking care to note any yellowing of the eyes or skin. The first thing your gastroenterologist will do is order blood tests. The bloodwork results can let your physician know if you have hepatitis B, whether it’s acute or chronic, and if you’re immune to it. 

Your provider may also use a liver ultrasound to see the amount of liver damage caused after a hepatitis B infection is confirmed, or they may take a biopsy (tissue sample) to send to the laboratory. 

Your physician may also screen you for hepatitis B even if you are healthy and are experiencing no symptoms. This criteria is highly based on a patient’s risk factors. If you are at high risk, your provider may order blood tests.

How Is Hepatitis B Treated?

Treatment for hepatitis B depends on:

• Whether the disease is acute or chronic
• If the person was exposed to HBV within 24 hours 

If you know you’ve been directly exposed to hepatitis B, your doctor can inject you with immunoglobulin (antibodies). The patient must receive this treatment between 12 ans 24 hours after exposure. Immunoglobulin, however, is only a short-term solution. If you are not vaccinated against hepatitis B, your doctor will recommend the vaccine along with the immunoglobulin injection. 

If your hepatitis B is acute, you may not need treatment. Many acute cases of hepatitis B resolve on their own within six months. However, your doctor may recommend antiviral medications. The best thing to do to fight a hepatitis B infection is to get plenty of rest, drink plenty of fluids, and follow good nutrition guidelines. While acute hepatitis B infections respond to treatment, the virus can recur and become chronic, which is much more serious. 

Chronic hepatitis B infection requires lifetime treatment to fight the virus. Untreated chronic hepatitis B increases your risk of developing liver cancer, cirrhosis, and liver failure. Treatment also ensures you don’t spread HBV. Antiviral medications are first-line treatment for chronic hepatitis B, but your doctor may also recommend interferon injections. These contain a man-made substance that fights the infection, similarly to immunoglobulin. These injections are optimal for women who want to become pregnant and those who would like to avoid long-term treatment. The injection does carry some side effects, however, namely nausea and vomiting, depression,and difficulty breathing. 

The last course of action is a liver transplant. If your liver has been badly scarred by hepatitis B and there is significant damage, you may be a candidate for liver transplant. This replaces your diseased liver with a healthy one. However, the waiting list for a liver transplant can be lengthy.