Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV). It can be acute and resolve without treatment. However, some forms can be chronic, and these could lead to cirrhosis and liver cancer.
In this article, learn more about HBV, including transmission, early symptoms, and treatment.
What Is Hepatitis B?
Hepatitis B is a liver infection caused by the hepatitis B virus (HBV). HBV is one of five types of viral hepatitis. The others are hepatitis A, C, D, and E. Each is a different type of virus, and types B and C are most likely to become chronic.
Symptoms
Many HBV infections occur during infancy or childhood. This is because a mother can pass HBV to her child during childbirth. However, doctors rarely diagnose HBV in childhood, as it causes few obvious symptoms.
Symptoms of a new HBV infection may not be apparent in children under 5 years of age or in adults with a suppressed immune system. Among those aged 5 years and over, around 30–50% will show initial signs and symptoms.
Acute symptoms appear around 60–150 days after exposure to the virus, and they can last from several weeks to 6 months.
A person with a chronic HBV infection may have ongoing episodes of abdominal pain, persistent fatigue, and aching joints.
Early Symptoms
If HBV does cause symptoms early on, they may include:
• fever
• joint pain
• fatigue
• nausea
• vomiting
• loss of appetite
• abdominal pain
• dark urine
• clay colored stools
• jaundice, or yellowing of the skin and whites of the eyes
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. It does not spread by sneezing or coughing.
Common ways that HBV can spread are:
1. Sexual contact
You may get hepatitis B if you have unprotected sex with someone who is infected. The virus can pass to you if the person's blood, saliva, semen or vaginal secretions enter your body.
2. Sharing of needles
HBV easily spreads through needles and syringes contaminated with infected blood. Sharing IV drug paraphernalia puts you at high risk of hepatitis B.
3. Accidental needle sticks
Hepatitis B is a concern for health care workers and anyone else who comes in contact with human blood.
4. Mother to child
Pregnant women infected with HBV can pass the virus to their babies during childbirth. However, the newborn can be vaccinated to avoid getting infected in almost all cases. Talk to your doctor about being tested for hepatitis B if you are pregnant or want to become pregnant.
Acute Vs. Chronic Hepatitis B
Hepatitis B infection may be either short-lived (acute) or long-lasting (chronic).
Acute hepatitis B infection lasts less than six months. Your immune system likely can clear acute hepatitis B from your body, and you should recover completely within a few months. Most people who get hepatitis B as adults have an acute infection, but lasts six months or longer.
Chronic hepatitis B infection lasts six months or longer. It lingers because your immune system can't fight off the infection. Chronic hepatitis B infection may last a lifetime, possibly leading to serious illnesses such as cirrhosis and liver cancer.
The younger you are when you get hepatitis B — particularly newborns or children younger than 5 — the higher your risk of the infection becoming chronic. Chronic infection may go undetected for decades until a person becomes seriously ill from liver disease.
Who is at risk for hepatitis B?
Hepatitis B spreads through contact with blood, semen or other body fluids from an infected person.
Certain groups are at particularly high risk of HBV infection. These include:
• healthcare workers
• men who have sex with other men
• people who use IV drugs
• people with multiple sex partners
• people with chronic liver disease
• people with kidney disease
• people over the age of 60 with diabetes
• those traveling to countries with a high incidence of HBV infection
HBV cannot spread through:
• food or water
• shared eating utensils
• breastfeeding
• hugging
• kissing
• holding hands
• coughing
• sneezing
• insect bites
Complications
Having a chronic HBV infection can lead to serious complications, such as:
1. Scarring of the liver (cirrhosis)
The inflammation associated with a hepatitis B infection can lead to extensive liver scarring (cirrhosis), which may impair the liver's ability to function.
2. Liver cancer
People with chronic hepatitis B infection have an increased risk of liver cancer.
3. 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.
Other conditions
People with chronic hepatitis B may develop kidney disease or inflammation of blood vessels.
Hepatitis B Diagnosis
Doctors can usually diagnose hepatitis B with blood tests. Screening for hepatitis B may be recommended for individuals who:
• have come in contact with someone with hepatitis B
• have traveled to a country where hepatitis B is common
• have been in jail
• use IV drugs
• receive kidney dialysis
• are pregnant
• are men who have sex with men
• have HIV
To screen for hepatitis B, your doctor will perform a series of blood tests.
1. Hepatitis B surface antigen test
A hepatitis B surface antigen test shows if you’re contagious. A positive result means you have hepatitis B and can spread the virus. A negative result means you don’t currently have hepatitis B. This test doesn’t distinguish between chronic and acute infection. This test is used together with other hepatitis B tests to determine the state of a hepatitis B infection.
2. Hepatitis B core antigen test
The hepatitis B core antigen test shows whether you’re currently infected with HBV. Positive results usually mean you have acute or chronic hepatitis B. It may also mean you’re recovering from acute hepatitis B.
3. Hepatitis B surface antibody test
A hepatitis B surface antibody test is used to check for immunity to HBV. A positive test means you are immune to hepatitis B. There are two possible reasons for a positive test. You may have been vaccinated, or you may have recovered from an acute HBV infection and are no longer contagious.
4. Liver function tests
Liver function tests are important in individuals with hepatitis B or any liver disease. Liver function tests check your blood for the amount of enzymes made by your liver. High levels of liver enzymes indicate a damaged or inflamed liver. These results can also help determine which part of your liver may be functioning abnormally.
If these tests are positive, you might require testing for hepatitis B, C, or other liver infections. Hepatitis B and C viruses are a major cause of liver damage throughout the world. You will likely also require an ultrasound of the liver or other imaging tests.
Treatment
1. Treatment to prevent hepatitis B infection after exposure
If you know you've been exposed to the hepatitis B virus and aren't sure if you've been vaccinated, call your doctor immediately. An injection of immunoglobulin (an antibody) given within 12 hours of exposure to the virus may help protect you from getting sick with hepatitis B. Because this treatment only provides short-term protection, you also should get the hepatitis B vaccine at the same time, if you never received it.
2. 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 might recommend rest, proper nutrition and plenty of fluids while your body fights the infection. In severe cases, antiviral drugs or a hospital stay is needed to prevent complications.
3. Treatment for chronic hepatitis B infection
Most people diagnosed with chronic hepatitis B infection need treatment for the rest of their lives. Treatment helps reduce the risk of liver disease and prevents you from passing the infection to others.
Treatment for chronic hepatitis B may include:
Antiviral medications
Several antiviral medications — including entecavir (Baraclude), tenofovir (Viread), lamivudine (Epivir), adefovir (Hepsera) and telbivudine (Tyzeka) — can help fight the virus and slow its ability to damage your liver. These drugs are taken by mouth. Talk to your doctor about which medication might be right for you.
Interferon injections
Interferon alfa-2b (Intron A) is a man-made version of a substance produced by the body to fight infection. It's used mainly for young people with hepatitis B who wish to avoid long-term treatment or women who might want to get pregnant within a few years, after completing a finite course of therapy. Interferon should not be used during pregnancy. Side effects may include nausea, vomiting, difficulty breathing and depression.
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 who donate a portion of their livers.
Prevention
The hepatitis B vaccine is typically given as three or four injections over six months. You can't get hepatitis B from the vaccine.
The hepatitis B vaccine is recommended for:
• Newborns
• Children and adolescents not vaccinated at birth
• Those who work or live in a center for people who are developmentally disabled
• People who live with someone who has hepatitis B
• Health care workers, emergency workers and other people who come into contact with blood
• Anyone who has a sexually transmitted infection, including HIV
• Men who have sex with men
• People who have multiple sexual partners
• Sexual partners of someone who has hepatitis B
• People who inject illegal drugs or share needles and syringes
• People with chronic liver disease
• People with end-stage kidney disease
• Travelers planning to go to an area of the world with a high hepatitis B infection rate
Take precautions to avoid HBV
Other ways to reduce your risk of HBV include:
• Know the HBV status of any sexual partner. Don't engage in unprotected sex unless you're absolutely certain your partner isn't infected with HBV or any other sexually transmitted infection.
• Use a new latex or polyurethane condom every time you have sex if you don't know the health status of your partner. Remember that although condoms can reduce your risk of contracting HBV, they don't eliminate the risk.
• Don't use illegal drugs. If you use illicit drugs, get help to stop. If you can't stop, use a sterile needle each time you inject illicit drugs. Never share needles.
• Be cautious about body piercing and tattooing. If you get a piercing or tattoo, look for a reputable shop. Ask about how the equipment is cleaned. Make sure the employees use sterile needles. If you can't get answers, look for another shop.
• Ask about the hepatitis B vaccine before you travel. If you're traveling to a region where hepatitis B is common, ask your doctor about the hepatitis B vaccine in advance. It's usually given in a series of three injections over a six-month period.
Conclusion
Hepatitis B is an infection of your liver. It’s caused by a virus. It's spread when people come in contact with the blood, open sores, or body fluids of someone who has the hepatitis B virus.
Although HBV is a significant health concern around the world, for most people, there is a vaccine that offers effective protection against the virus.
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