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Gastroenterology and Hepatology

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Hepatitis B

What is hepatitis?
What is hepatitis B infection?
What are the signs of hepatitis B?
How does a person get hepatitis B infection?
How does my doctor tell if I have hepatitis B?
How is hepatitis B treated?
Why is hepatitis B treated?
How is hepatitis B prevented?

What is hepatitis?

The word "hepatitis" comprises two elements:

  • “-itis” at the end of the word indicates inflammation

  • the first part comes from the organ called hepar, which means liver

Hepatitis therefore means inflammation of the liver, like appendicitis means inflammation of the appendix and colitis means inflammation of the colon.

Inflammation is the local reaction in the body to fight a damaging agent. There are multiple causes of inflammation and in the case of liver disease they include viruses (hepatitis A, B, C, etc.), alcohol and a variety of other diseases. Any disease that becomes chronic can lead to a scarred liver (cirrhosis).

What is hepatitis B infection?

Hepatitis B is infection of the liver caused by the hepatitis B virus.

Hepatitis B is one of five different kinds of hepatitis viruses (A-E). Only hepatitis B, C and D can become chronic conditions, and possibly cause cirrhosis.

This infection may cause minimal disease, even after years. It can also cause major scar formation, cirrhosis, and liver cancer (hepatocellular carcinoma).

What are the signs of hepatitis B?

As with the other hepatitis viruses, a person infected with hepatitis B may not have any symptoms.

Others may have symptoms such as:

  • Fatigue (feeling tired)

  • Nausea (feeling sick)

  • Loss of appetite and weight loss

  • Fever

  • Pain in the joints

  • Jaundice: yellowing of the skin and whites of the eyes

  • Dark urine

  • Pain in the liver area (middle of the back, on the right side)

How does a person get hepatitis B infection?

Hepatitis B is a blood-borne virus, which means that it is transmitted by contact with the blood of a person who already has the virus. People with a higher risk of getting hepatitis B include:

  • Those who have had sex with a person who has hepatitis B, especially sex with multiple partners. Hepatitis B is much more contagious compared to hepatitis C.

  • Those who share intravenous needles (as in injecting illegal drugs) with an infected person

  • Those who have a job that brings them into contact with blood

  • Babies born to a mother with hepatitis B

  • Those who travel to areas where hepatitis B is common

If you are in one of the above categories, ask your doctor about testing and vaccination for hepatitis B.

The blood and bodily fluids of a person with hepatitis B are infectious long before he or she feels any symptoms (one to six months). In fact, many people with chronic hepatitis B may have no symptoms, and do not know that they are carriers of the disease.

How does my doctor tell if I have hepatitis B?

Blood tests to check for antibodies to the virus will tell for certain if you have, or have been exposed to, hepatitis B. These show up in the blood after infection.

  • HBsAg: indicates that you have active virus in the blood

  • Anti-HBs: you are immune for the virus (you will develop this also if successfully immunized)

  • HBe: a further marker of active virus

  • Anti-HBe often associated with low level replication of the virus. Sometimes associated with a different strain ('mutant').

  • HBVDNA: proves the presence of virus in the blood. The higher, the more active the virus

How is hepatitis B treated?

Medications have become increasingly effective at treating hepatitis B.

They include interferons and so-called nucleoside analogues such as lamuvidine (Epivir), adefovir (Hepsera) or entecavir (Baraclude).

They work by a combination of killing the virus and stimulating the immune system to attack infected liver cells.

Why is hepatitis B treated?

  • To eradicate the source of infection

  • To halt progression of disease

  • To reverse some of the damage done by the disease

  • To prevent development of hepatocellular carcinoma (liver cancer)

Most patients with acute hepatitis B do not need specific medications, but they will need to be monitored to make sure that they are adequately hydrated and are eating well. The sickest may require hospital admission.

About 95% of those infected will clear the virus spontaneously.

Once hepatitis B becomes chronic, those with active disease (blood tests, liver biopsy) will respond best to therapy. Those patients with very advanced disease may need liver transplantation, although this is rarely necessary.

How is hepatitis B prevented?

You can protect yourself from getting hepatitis B infection with a vaccine. The Centers for Disease Control and Prevention (CDC) recommends hepatitis B vaccine for the following groups of people:

  • All newborns, infants and children, especially sexually active teenagers

  • Health care and emergency personnel

  • Hemodialysis patients

  • Patients with chronic liver disease

  • Military personnel

  • Morticians and embalmers

  • Patients and staff at institutions for the mentally challenged

  • Prison inmates

  • People with multiple sexual partners

  • Injection drug users

  • Sexual partners and household members of people with chronic hepatitis B

  • International travelers

  • Members of ethnic or racial groups with a high rate of hepatitis B infection (including African Americans, Latino Americans, Native Americans, Alaskan Natives, and Asian and Pacific Islanders)

The World Health Organization is a major advocate of universal vaccination for all to prevent disease.

Disclaimer

Information on the Dartmouth-Hitchcock Medical Center (DHMC) website:

  • is not provided as medical advice
  • does not establish a doctor-patient or other relationship
  • is not intended nor should be assumed to guarantee a specific result

Our goals are to provide people with meaningful information to make informed decisions about their health and health care.

DHMC and its affiliated component organizations aspire to deliver consistent high quality medical care to all patients and to continually improve its quality of care as evolving technology and medical knowledge permits.

Please call 911 in the case of any medical emergency.