Hepatitis B

Introduction

Hepatitis B is an infection that affects the normal functioning of your liver. It is caused by the hepatitis B virus (HBV). This infection can be acute or chronic, depending on the duration of this condition. If you develop chronic hepatitis, it can lead to severe complications, including liver failure. Majority of the cases of hepatitis B recover completely, but some with chronic hepatitis may suffer from impaired liver functioning. This infection can be prevented by the administration of the Hepatitis B vaccine. If you've been infected, taking specific precautions can help prevent the virus from spreading to others.

 

Types

Hepatitis B has two types: Acute and chronic hepatitis.

Acute hepatitis B infection develops in the initial period after you get infected with the Hep B virus. This infection lasts for less than six months. Most adults recover well from acute hepatitis on their own within a few months.

Chronic hepatitis B infection develops if hepatitis persists for more than six months. An important cause of this condition is a weakened immune system that is unable to fight off the virus. Chronic hepatitis can lead to future complications, including cirrhosis, liver cancer, or liver failure.

 

Causes

Hepatitis B is caused by the hepatitis B virus (HBV). This virus transmits through blood, semen, or other body fluids from one infected person to another and is not spread through coughing or sneezing. Unlike hepatitis A virus, it does not spread through contaminated food and drinks. One of the most common modes of transmission of the hepatitis B virus is sexual contact. If you have unprotected sex with an infected person, the virus can enter your body through semen or other secretions. Another frequent way this virus spreads is by sharing contaminated needles. The use of injection needles for drug abuse and sharing the same with other people increases the risk of this infection. Even if a doctor or healthcare worker accidentally gets a needle prick injury after being contaminated with blood, they may contract the virus.

Hepatitis B virus can also spread through vertical transmission, i.e., from a pregnant mother to her child. This virus can be passed on to the baby during childbirth. The risk of transferring this virus to her baby is about 20% if the mother is positive for Hep B surface antigen. In rare cases, hepatitis B can also spread among members of the same family by coming in direct contact with the blood, saliva, or mucous membrane of an infected person.

 

Risk Factors and Epidemiology

Hepatitis B virus can infect anyone at any age, but children are at a higher risk of developing chronic hepatitis. Adults have a higher risk of contracting this virus if they have unprotected sex with an infected person. A man having sexual intercourse with other men or with multiple partners increases the risk. Sharing contaminated needles or blades, especially among drug abusers, is another risk factor. Doctors, nurses, and other healthcare workers who have to work with needles and blood are at high risk of contracting this virus through needle stick injury. Birth from an infected mother can also infect the child. Traveling to regions with an increased number of active cases may also increase your risk of contracting the Hep B virus.

According to research studies, Pakistan is one of the countries that carries the highest burden of hepatitis B. The incidence of liver cancer and liver failure is also high due to an increased number of cases of chronic hepatitis. It has been estimated that around 4.55 million people live with Hep B infection in Pakistan.

 

Signs and Symptoms

The signs and symptoms of hepatitis B develop after one to four months of contracting this virus. These symptoms can range from mild to severe. Young children may not develop any symptoms at all. In teens and adults, the infection can present with fever, abdominal discomfort or pain, jaundice, dark urine, loose stool, pain in joints, nausea/ vomiting, loss of appetite, fatigue, and generalized weakness. Some people may also develop skin rash and itching.

 

Diagnosis

Your doctor may require a brief history to identify the possible cause and its route of contamination. Physical examination can be done, including looking for signs of jaundice and abdominal pain. The conformational diagnosis of hepatitis B can be made by running a blood test for the presence of this virus. The blood test can also indicate whether you have acute or chronic hepatitis. (HBsAg, Anti-HBs, Anti-HBs core, HBsAg, HBeAg, Anti-HBe, Quantitative Hepatitis B viral DNA, HBV Genotype etc).  Your doctor may perform other tests to check the condition and functioning of your liver, such as LFTs (Liver function tests), liver ultrasound, etc. If liver cancer is suspected, a liver biopsy is performed by taking a small sample of liver tissue.

 

Treatment

Treatment for the hepatitis B virus depends on the duration and severity of your condition. If you think you have been exposed to the virus by coming in contact with contaminated blood or semen, call your doctor immediately. An immunoglobulin injection in the first 12 hours can prevent you from developing this infection. If you develop acute hepatitis, your doctor will only recommend rest, plenty of fluids, and a proper diet in case you have mild symptoms. In severe cases, you may get hospitalized for a certain duration. In chronic cases of hepatitis B, lifetime treatment is necessary to prevent the risk of liver complications. Antiviral drugs are prescribed, which help in fighting against the virus. If the liver has been compromised severely due to chronic hepatitis, the doctor may recommend a liver transplant.

 

Medication

Antiviral drugs can include entecavir, adefovir, tenofovir, lamivudine or telbivudine etc. These drugs are prescribed in specific dosages to be taken by mouth. No drugs should be taken without consultation with your doctor as they may damage your liver further.

Complications

Chronic HBV infection may cause severe complications, including:

• Cirrhosis

• Fulminant liver failure

• Acute liver failure

• Prolonged cholestasis.

• Liver Cancer

 

Prognosis

Majority of the people with acute hepatitis recover well on their own in less than six months. Those with chronic hepatitis can also lead a normal life if treatment options are utilized. Lack of treatment and care can increase the risk of liver complications.

 

Prevention

Hepatitis B vaccine is the best way to prevent hepatitis B. The vaccine is given in three to four shots over a span of six months. It is suggested for all those at a high risk of contracting the Hep B virus. Apart from vaccines, you should also practice safe sex measures and avoid drug abuse. Healthcare workers should also ask for the history of hepatitis from a patient before beginning an examination.