Facts You Need to Know about Hepatitis B
by Beth G. Hodges, MD

Hepatitis B is infection of the liver by the Hepatitis B virus. Worldwide, 350 million people are chronic carriers of Hepatitis B. Of these, 250,000 die of chronic end stage liver disease each year.

Hepatitis B can cause both an acute and a chronic illness. The illness is considered chronic if it is present in the body for longer than six months.

Only 10% of those infected with the Hepatitis B virus go on to develop a chronic infection. Of that 10%, 2/3rds of those become carriers of the disease, meaning they can pass it on but are no longer themselves affected by it. Only 1/3 have chronic Hepatitis B.

Of those who are unfortunate enough to develop chronic Hepatitis B, 25% will die of liver disease, usually cirrhosis (chronic liver damage that is irreversible.) The rest have an increased risk for hepatocellular carcinoma, a type of liver cancer.

The Hepatitis B infection is passed to others through semen, saliva, or blood or from a mother to a baby during the birthing process. That last type of transmission is called vertical transmission.

Symptoms

Symptoms of infection typically occur within a window of 30-180 days after exposure. The symptoms are nonspecific and flu-like, consisting of a decrease in appetite, fatigue, nausea, vomiting, a yellowing of the skin called jaundice, a darkening of the urine, and a whitish appearance to the stool. Occasionally, a fulminant hepatitis infection can develop, which is life-threatening.

Diagnosis and Treatment

Hepatitis B infection is diagnosed through history (verbal information given from the patient to the doctor), physical exam, and blood tests. Often, an ultrasound or CT scan of the liver will need to be done, as well as a liver biopsy, which involves surgically inserting a needle into the liver and withdrawing a core of tissue for evaluation. A liver biopsy is the only way to diagnose and classify cirrhosis.

There are several medications that can be given for Hepatitis B chronic infection, but they are not tolerated very well by the patient in most cases. Interferon, also used to treat chronic Hepatitis C infection, can stop the infection in up to 40% of people. Epivir (lamivudine) slows replication of the virus, but only for as long as the medication is taken, as does Hepsera (adefovir dipivoxil.) Hepsera can also lead to kidney damage and must be monitored carefully. Some chronic Hepatitis B patients go on to require liver transplant.

How to Prevent Hepatitis B

Prevention of Hepatitis B occurs through vaccination, originally done only in healthcare workers, but now given to all children in the United States and most developed countries. If known exposure to Hepatitis B occurs, as through vertical transmission to a baby born to a mother with Hepatitis B, then Hepatitis B immunoglobulin given along with the first dose of vaccine within hours of exposure is usually effective at prevention of transmission. The rest of the vaccination schedule should be followed as normal.

The consistent use of condoms can prevent transmission of the virus through sexual contact. Another common source of transmission is through homemade tattoos or body piercing, which should be avoided.

Published - February, 2010