Hepatitis B

By Stephen Holt, MD, PhD, FACP

• What is Hepatitis B?
• How is it Transmitted?
• Who Is At Risk?
• Symptoms
• How is it Diagnosed?
• Treatment
• Residual Effects
• Suggested Articles

What is Hepatitis B?

Hepatitis B is inflammation of the liver due to a virus called the Hepatitis B virus (HBV), belonging to the family hepadnaviridae. Originally known as serum hepatitis, HBV was the first hepatitis virus to be identified. It is preventable with safe and effective vaccines that have been available since 1982. According to the World Health Organization, an estimated 257 million people are living with HBV infection. Approximately 1.2 million of those infected with the Hepatitis B virus live in the United States. Chronically infected persons are at high risk of cirrhosis and liver cancer, diseases that kill about 1 million people worldwide each year.

The Centers for Disease Control attribute the Hepatitis B vaccine to the decline of new infections per year in the United States, from an estimated 260,000 in the 1980s to about 73,000 in 2003. The greatest decline has happened among children and adolescents due to routine Hepatitis B vaccination. Of the 1.2 million chronically infected Americans, 20 to 30 percent acquired their infection in childhood.

How is it Transmitted?

HBV is a hardy virus and has been detected in blood, sweat, tears, saliva, semen, vaginal secretions, menstrual blood and breast milk. Hepatitis B is 50 to 100 times more infectious than HIV. Hepatitis B infection is transmitted from person to person in three primary ways:

• Through blood or blood products
• Through sexual contact
• From mother to child during pregnancy and childbirth

Who Is At Risk?

The following people are at increased risk:

• People who received blood or a blood-product transfusion prior to 1975
• Hospital or other healthcare facility workers
• Live-in family members and roommates of an infected person
• Current or former intravenous drug users
• People who have acquired a tattoo or had a body piercing with an infected needle
• Sex partners of infected people
• Travelers to countries where HBV is epidemic
• People who were born to a mother infected with HBV and were not vaccinated
• Organ transplant recipients who received an infected organ

Symptoms

Hepatitis B can be either acute, lasting no longer than six months, or chronic, lasting six months or more. Chronic HBV can potentially lead to liver damage, cirrhosis and liver cancer. Symptoms of acute and chronic Hepatitis B are similar to those of acute hepatitis due to any viral cause, and are often mistaken for a bad cold or the flu. Those symptoms may include a rash, muscle and joint aches, fever, dark urine, decreased appetite, nausea, vomiting and abdominal discomfort.

Approximately 20 percent of people with acute Hepatitis B may suffer from severe joint stiffness and pain. These individuals may seek treatment from a rheumatologist or a massage therapist to alleviate these symptoms.

Most adults have a strong enough immune system to battle acute viral Hepatitis B and completely eliminate it from the body. When this occurs, symptoms will resolve and protective antibodies will be formed against the virus, creating immunity to this virus. This immunity, however, will not protect a person against other hepatitis viruses such as Hepatitis A virus or Hepatitis C virus.

The immune system is the most important factor in determining whether a person can rid his/her body of the virus rather than develop a persistent infection. If an adult is infected, the probability of developing chronic hepatitis is very low, approximately 1 to 5 percent.

How is it Diagnosed?

The Hepatitis B serology is necessary to obtain an accurate diagnosis of acute and chronic Hepatitis B. As with all liver diseases, even if a person feels fine, that is no guarantee that his/her liver is doing fine. In addition to a battery of blood tests and at least one imaging study (usually a sonogram), revealing the level of liver fibrosis will determine if treatment is necessary.

Treatment

The goals for treating acute Hepatitis B include:

• Assuring adequate nutrition and hydration
• Preventing further damage to the liver (eliminate alcohol consumption)
• Avoiding transmission of the virus to others
• Bed rest, if necessary

There are no medications to treat acute Hepatitis B and most cases of HBV are mild and do not require hospitalization. Only people who are at high risk for complications, such as pregnant women, the elderly, people with serious underlying medical conditions or those who become significantly dehydrated from excessive nausea and vomiting need to be hospitalized.

The goals for treating chronic Hepatitis B include:

• Preserving liver function and preventing liver damage (eliminate alcohol consumption)
• Boosting the immune system to help fend off damage from the virus

Conventional medicines are used in the treatment of chronic HBV. The first medication found to be effective for chronic Hepatitis B and approved by the FDA in 1992 was interferon. Interferon is not without its side effects. At times, the side effects may be so severe that discontinuation of the drug becomes a necessity. Treatment with interferon, however, has been shown to decrease the incidence of long-term complications of Hepatitis B, such as liver failure and the need for liver transplantation.

Residual Effects

Other than for people who are at high risk for complications such as pregnant women, the elderly, or people with existing serious medical conditions, since most cases of acute Hepatitis B are mild, there should be no long term after-effects once the virus has cleared the body.

Those people infected with chronic HBV carry the virus for life and are at high risk of developing kidney problems, liver damage, cirrhosis and liver cancer. Therefore, preserving liver function by living a healthy lifestyle (eating healthy foods and eliminating alcohol consumption), and boosting the immune system is imperative along with medical treatment.

This information is intended for educational purposes only and should not be used in any other manner. This information is not intended to substitute for informed medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified health care provider.

Suggested Articles

• Seven Ways to Ease Acute Hepatitis B Symptoms
• 10 Facts Impacting Chronic Hepatitis B Treatment
• Hepatitis B Drug Resistance
• Outlook Brightens for Chronic Hepatitis B
• Why Occult Hepatitis B Can Be Hazardous

About the Author

Stephen Holt, MD, PhD, FACP

Stephen Holt, M.D. is a Distinguished Professor of Medicine NYCPM (Emerite) and a medical practitioner in New York State. He has published many peer-review papers in medicine and he is a best-selling author with more than twenty books in national and international distribution. He has received many awards for teaching and research. Dr. Holt is a frequent lecturer at scientific meetings and healthcare facilities throughout the world. He is a best selling author and the founder of the Holt Institute of Medicine.