Hepatitis B

Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). It's a major global health problem, affecting millions of people worldwide. While some people with hepatitis B experience acute illness and recover fully, others develop a chronic infection that can lead to serious liver damage, including cirrhosis and liver cancer. Fortunately, vaccination is highly effective in preventing hepatitis B infection.

Hepatitis B is a viral infection that specifically targets the liver. This vital organ performs many essential functions, including filtering toxins from the blood, producing bile for digestion, and storing energy. When the hepatitis B virus (HBV) attacks the liver, it causes inflammation and disrupts these crucial processes.   

The severity of hepatitis B can vary significantly. Some people experience a mild, acute illness that resolves within a few weeks. Others develop a chronic infection that persists for six months or longer. Chronic hepatitis B can lead to progressive liver damage, including scarring (cirrhosis), liver failure, and an increased risk of liver cancer.

Hepatitis B is a global health problem. Here are some prevalence statistics:

• Worldwide: An estimated 254 million people were living with chronic hepatitis B infection in 2022, with 1.2 million new infections occurring each year. 
• India: India has a high prevalence of hepatitis B, with an estimated 40 million people chronically infected. This accounts for roughly 15% of the global burden of chronic hepatitis B. 

There are two primary types of hepatitis B infection:

• Acute Hepatitis B: This is the initial infection with HBV. It typically lasts less than six months, and most people fully recover with their immune system successfully clearing the virus. However, in some cases, acute hepatitis B can progress to a chronic infection.   
• Chronic Hepatitis B: This occurs when the body's immune system is unable to eliminate the virus, and the infection persists for six months or longer. Chronic hepatitis B can be asymptomatic in the early stages, but over time, it can cause ongoing liver inflammation and damage, potentially leading to serious complications. 

Hepatitis B is caused by the hepatitis B virus (HBV), which is transmitted through contact with infected blood and body fluids. Here are the common ways HBV spreads:   

Blood-to-blood contact

This includes sharing needles or drug paraphernalia, receiving unscreened blood transfusions (though rare in many countries now), and accidental needlestick injuries in healthcare settings.   

Sexual contact

HBV can be transmitted through unprotected sexual intercourse with an infected person. The virus is present in semen, vaginal fluids, and to a lesser extent, saliva. 

The risk of transmission is higher with multiple sexual partners or having sex with someone who has acute or chronic hepatitis B. Using condoms consistently can significantly reduce the risk of HBV transmission during sex.

Mother-to-child transmission (perinatal transmission)

One of the hepatitis B causes is perinatal transmission. An infected mother can pass the virus to her baby during childbirth. This is a significant mode of transmission in regions with high HBV prevalence.   

Household contact

Sharing personal items that may have come into contact with infected blood, such as razors, toothbrushes, or nail clippers, can also spread the virus, though this is less common.   

It's important to note that HBV is not spread through casual contact like hugging, kissing, sharing food or drinks, coughing, or sneezing.

Many people with acute hepatitis B experience no symptoms. However, when symptoms do occur, they can include:

• Fatigue
• Loss of appetite
• Nausea and vomiting
• Abdominal pain
• Yellowing of the skin and eyes (jaundice)
• Dark urine
• Joint pain

Chronic hepatitis B often has no symptoms in the early stages. However, over time, it can lead to symptoms of liver damage, such as:

• Fatigue
• Jaundice
• Swelling in the legs and ankles
• Fluid buildup in the abdomen (ascites)
• Easy bruising or bleeding
• Confusion or drowsiness

Diagnosis involves blood tests for hepatitis that detect specific markers of HBV infection:   

• Hepatitis B surface antigen (HBsAg test): The presence of this antigen indicates a current hepatitis B infection, either acute or chronic.   
• Hepatitis B surface antibody (anti-HBs): This antibody indicates immunity to HBV, either from past infection or vaccination.   
• Hepatitis B core antibody (anti-HBc): This antibody appears during acute infection and persists for life, indicating past or current infection.   
• Hepatitis B e antigen (HBeAg): This antigen suggests high levels of HBV in the blood and a higher risk of transmitting the virus to others.   
• Liver function tests: These tests measure the levels of certain enzymes and proteins in the blood, helping to assess liver health and detect any signs of liver damage.   
• Viral DNA: In some cases, a test to measure the amount of HBV DNA in the blood may be done to assess the level of viral activity and guide treatment decisions.

Hepatitis B treatment varies depending on the type and severity of the infection:

Acute Hepatitis B

Most people with acute hepatitis B recover fully without specific treatment. Supportive care focuses on rest, adequate hydration, and managing symptoms like nausea or fatigue.   

Chronic Hepatitis B

The goals of chronic hepatitis B treatment are to suppress HBV replication, reduce liver inflammation, prevent disease progression, and lower the risk of complications. Treatment options include: 

• Antiviral medications: These oral medications, such as tenofovir or entecavir, help to reduce the amount of HBV in the blood and suppress viral replication. They are often taken long-term to control the infection.   
• Interferon injections: Pegylated interferon is an injectable medication that can stimulate the immune system to fight HBV. It can be effective in some people but may have more side effects than oral antivirals.   
• Liver transplant: In cases of severe liver damage or liver failure, a liver transplant may be necessary.   

It's crucial to consult with a healthcare professional specializing in liver disease (hepatologist) to determine the most appropriate treatment plan for your specific situation.

Certain factors increase the risk of hepatitis B infection:

• Being born to a mother with hepatitis B
• Living with someone who has chronic hepatitis B
• Having multiple sexual partners
• Injecting drugs
• Working in healthcare
• Travelling to areas with high rates of hepatitis B
• Having a weakened immune system

Chronic hepatitis B can lead to serious liver complications, including:

• Cirrhosis: Scarring of the liver that can lead to liver failure.
• Liver cancer: Chronic hepatitis B infection is a major risk factor for liver cancer.
• Liver failure: The liver loses its ability to function properly.
• Death: Hepatitis B can be fatal, especially in cases of chronic infection and liver complications.

If you have chronic hepatitis B, it's important to practice hepatitis B self care:

1. Get regular medical checkups as it helps monitor your liver health and detect any complications early.

2. Follow your doctor's treatment recommendations, stick to your prescribed medications, and attend all appointments.

3. Maintain a healthy lifestyle by eating a balanced diet, exercising regularly, and avoiding alcohol and other substances that can damage the liver.

4. Get vaccinated against hepatitis A. This can help to prevent further liver damage.

5. Talk to your doctor about your risk of liver cancer. You may need regular screening if there is a possibility of liver cancer.

Hepatitis B is always a sexually transmitted infection.

While sexual contact is one way HBV can spread, it can also be transmitted through other means, such as mother-to-child transmission and sharing needles.

Hepatitis B is always a chronic condition.

Some people with hepatitis B experience acute infection and recover fully.

There is no treatment for hepatitis B.

While there is no cure for chronic hepatitis B, effective treatments are available to manage the virus and prevent liver damage.

See your doctor if you experience any symptoms of hepatitis B, such as fatigue, loss of appetite, abdominal pain, jaundice, or dark urine.

• What type of hepatitis B do I have?
• What are my treatment options?
• What are the potential complications of hepatitis B?
• How often do I need to be monitored for liver damage?
• What can I do to prevent the spread of hepatitis B to others?

If someone you know has hepatitis B, you can offer support by:

• Educating yourself about the condition: This will help you understand what they are going through.
• Offering emotional support: Listen, offer encouragement, and be patient.
• Helping with practical tasks: Offer to help with errands, cooking, or childcare.
• Encouraging them to seek medical care: Help them find a doctor or specialist if needed.
• Connecting them with support groups: There are support groups available for people with hepatitis B.

Hepatitis B is a serious liver infection that can have significant health consequences. However, with vaccination and effective treatments, it is possible to prevent infection and manage the condition to minimize liver damage. If you have any concerns about hepatitis B, talk to your doctor.