Hepatitis B

Overview

Hepatitis (means: Inflammation of liver) can be caused by many reasons; at most occasions it is because of viral infection.  Other causes for e.g. poisoning, alcohol use, autoimmune diseases and some medicines may also cause liver inflammation.

Liver - medical-1503211_640The inflammation or swelling of the liver occurs due to the damage or injury in the liver tissues caused by the virus.  There are few different viruses, which can cause Hepatitis. Most common of them includes: Hepatitis A, Hepatitis B, Hepatitis C and Hepatitis E

This leaflet describes information relevant to Hepatitis B virus (HBV) infection.

HBV infection can cause inflammation in the liver.

Liver is the largest organ in our body. Liver performs several very important function for e.g. digesting food, storing food and getting rid of toxic substances

Worldwide 240 million people are infected with chronic HBV infection.

In Pakistan HBV infection is very common, as an estimate 2.5% of the total population in Pakistan are carriers of HBV.

HBV infection can be of two types

  • Acute (Short-term) infection – it causes the inflammation to liver tissues for a short period of time (few weeks to a couple of months). The patient’s body is able to fight the disease and as a result within six months the HBV is completely cleared from the body. In this type, the patient recovers complete healthy state with no long-term complications.

It mostly occurs when the virus enters the body in adult or older age.

  • Chronic (Long-term) infection – In this type, the patient’s body is not able to fully fight the disease. Patients are not able to clear the virus from the body and they become chronic HBV carriers. Chronic type of HBV infection usually depends on at what age the patient was infected with the virus.  In this type, usually the patient gets the virus at very early stage of life (less than 5 years old).   About 90% of infants who got the HBV from the HBV carrier mothers would develop chronic HBV infection.  Many patients do not experience jaundice or any symptom until their adult age. Most patients recover health after suffering with jaundice and stay healthy all their life, but the HBV remains in the body for the whole life.

However, about 5-10% of chronic infection patients can develop complications like serious damage to liver leading to cirrhosis and cancer. Chronic HBV patients are carriers of HBV that means they can infect others through body secretions, sexual relationship and blood transfusion.

HBV infection can be prevented with HBV vaccination. The HBV vaccine is very safe and effective and it is available worldwide. The vaccine protects the healthy people from getting the HBV infection. For complete protection, three shots of vaccine are required. The HBV vaccine is very affordable (not very expensive) and available in all major hospitals.

HBV vaccine does not provide protection to patients who are HBV carriers.

Signs and Symptoms

Most patients do not experience any symptoms.

Adult patients start to feel the symptoms after 3 – 4 months of getting the virus in the body. Large proportion of chronic HBV patients get the virus in their childhood, but do not experience any symptoms until they become adult.

Common symptoms include:

  • Not feeling like eating
  • Nausea and vomiting
  • Fatigue and tiredness
  • Jaundice (yellowing of skin and in the white portion of eyes)
  • Dark-colored urine
  • Upset digestion/ Diarrhea
  • Muscle ache
  • Fever in some patients
Causes and Risk Factors

Hepatitis is caused by Hepatitis B Virus.

HBV is present in the infected person’s blood and body secretions (reproductive secretions).  

Healthy persons who are not vaccinated can get the virus and become infected through one of the following mode of transmission:

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  • Children can get the virus during birth if they are born from HBV carrier mother
  • Transfusion of blood donated by HBV carrier patient
  • Having sexual relationship with infected person (exposed to reproductive secretions)
  • Health care professionals (Doctors, Nurses, Lab staff) not vaccinated with HBV vaccine can get the virus through the needle prick contaminated with blood from infected person
  • Drug addicts who share injection needles
  • Using personal items like razor, nail clipper, toothbrush of the infected person

HBV does not spread by:

  • Social contact, shaking hand, hugging, kissing
  • Sharing food with HBV carrier patient
  • HBV does not spread from contaminated water or food
  •         HBV does not spread with coughing and sneezing
Diagnosis and Testing

The doctor will diagnose the illness from the clinical condition and symptoms of the patient.

In addition, blood test are carried out to determine the liver functioning and the presence of HBV in the blood. Most commonly Liver function test (LFT) is performed to monitor the level of liver enzymes before and during the treatment.

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Confirmation of HBV infection is determined by testing the blood of the patient for HBV Surface antigen.   People who are suspected for HBV infection are tested for HBV test.   Pregnant women are also required to test for HBV surface antigen before delivery.  

HBV has three main antigens.   HBV Surface antigen (HBsAg),  HBV Core antigen and HBV DNA

Doctor may also require to do ultrasound test or an X-ray and in severe cases liver biopsy to assess the extent of damage to the liver tissues.

Treatment

Acute type (short-term) of HBV infection does not require any specific treatment. The patient body is able to fight the infection.

Patient is required to use lots of fluid (water and Juices) and appropriate healthy nutrition with lots of rest. The patient starts to feel better in a couple of weeks. The doctor will continue monitoring the condition and in the few months (up to 6 months) the patient will clear the HBV from the body. Patients who recover from acute infection develop HBV antibodies that protect them from getting it again in life.

Chronic HBV

Chronic HBV patients should regularly consult their doctor or specialist (gastroenterologist) even if they do not experience any symptoms.

Usually doctor would require to get the blood test (liver enzyme test, alfa-fetoprotein) and ultrasound done two times in a year to continue monitor the functioning of the liver of the patient. HBV carrier patients should be seen by their doctor at least two times in a year.

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There are many antiviral treatment options available depending on severity of illness.

Doctor may prescribe a single drug or a combination of different drugs whichever is best suitable for the patient. The HBV medicines are used to slow down the multiplication of the virus and stops the damage to liver cells.

The main medications prescribed for chronic HBV patients include:

1. Interferon

2. Peginterferon

These drugs helps the body immune system to fight against HBV virus. They are given as injections and usually required for several months up to a year.

Additional antiviral drugs may be required depending on disease severity.

Liver Transplant

In case of liver failure due to complications caused by HBV, patient may require liver transplant. The liver transplant is a major surgery in which diseased liver is replaced with portion of a liver from a healthy donor.

Complications

Chronic HBV can cause complications.

It can result in liver cirrhosis, which occurs when the liver cells die leaving fatty scar in place. It is important that patient should take care of him/herself.

Prevention

HBV infection can be prevented with HBV vaccination (see vaccination schedule).  The HBV vaccine is very safe and effective and it is available worldwide. The vaccine protects the healthy people from getting the HBV infection. For complete protection, three shots of vaccine are required. The HBV vaccine is very affordable (not very expensive) and available in all major hospitals.

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  • Take precautions to prevent HBV spread by not sharing razors, tooth brushes and nail clippers
  • Stay limited with your partner. Avoid unprotected sex with anyone who have HBV infection
Living with HBV Infection

It is important for chronic HBV patient to take care of him/herself.

– Pregnant women who are carrier of HBV should inform their doctor to protect the baby from HBV infection. Babies born from HBV carrier mothers are given the HBV antibodies and HBV vaccine within 12 hours of birth.

-Consume healthy diet, eat vegetables, fruits and healthy proteins. Avoid consuming too much fatty food for e.g. ice creams, cream cakes and all other fatty food.

-Do not drink alcohol

-Do not share personal items, such as razors, nail clippers and tooth brush with anyone

-It is recommended that all family members of HBV patient should get HBV vaccine.

-Be cautious and informed about intimate relationship. Partner of HBV carrier patient should be vaccinated with HBV vaccine

-HBV carrier should inform their doctor or dentist that they are HBV carrier patient to ensure that they provide treatment that would have least impact on liver and also to protect other patients

-HBV carrier patients should not use any medicines even vitamins and herbal medicines without checking with their specialist doctor

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