Hepatitis B

Overview

What is hepatitis B?

Hepatitis B is a serious liver infection that causes inflammation (swelling and reddening) that can lead to liver damage. Hepatitis B, also called HBV and Hep B, can cause cirrhosis (hardening or scarring), liver cancer and even death.

What are the types of hepatitis B?

There are two types of hepatitis B infection: acute and chronic.

Acute

An acute infection happens at the beginning, when you first get infected with hepatitis B. Many people are able to clear it from their bodies and recover. In fact, this is true of about 4 in 5 adults who are infected.

Chronic

If you are not able to clear the infection within six months or longer, you have chronic hepatitis B. (Chronic means long-lasting.) It is chronic hepatitis B that leads to inflammation and the serious, and possibly fatal, illnesses of cirrhosis of the liver and liver cancer. Treatment can slow disease progress, reduce the chance of liver cancer and increase your chances of surviving.

How common is hepatitis B?

Hepatitis B is fairly common in Africa and the western Pacific region. Throughout the world, there are about 292 million people who are infected with chronic hepatitis B. In the U.S., the figure exceeds 2 million people.

The number of infections had been falling in the U.S., but fewer vaccinations among adults combined with the onset of the opioid crisis and injected drug usage has resulted in the numbers rising again. Infected women can pass the infection on to their babies. Children who are infected before age 5 are more likely to have chronic infection than those infected later in life.

Symptoms and Causes

What are the symptoms of hepatitis B?

Some people who are infected never feel sick. Others who are newly infected have symptoms that last for several weeks. Symptoms may be minor or intense and may include:

  • Achy muscles or joints.
  • Stomach pain.
  • Loss of appetite.
  • Mild fever.
  • Loose stool (diarrhea).
  • Lack of energy.
  • Constipation.
  • Having yellow skin or eyes (jaundice).
  • Being sick to your stomach.
  • Brown urine.

More than 90% of people who get hepatitis B as adults ultimately recover from their symptoms.

How is hepatitis B spread?

You can become infected with hepatitis B through exposure to blood, semen and other bodily fluids of an infected person. You can get the infection by:

  • Having unprotected sex.
  • Sharing or using dirty needles for drug use, tattoos or piercing.
  • Sharing everyday items that may contain body fluids, including razors, toothbrushes, jewelry for piercings and nail clippers.
  • Being treated medically by someone who does not use sterile instruments.
  • Being bitten by someone with the infection.
  • Being born to a pregnant woman with the infection.

Hepatitis B is not spread by:

  • Kissing on the cheek or lips.
  • Coughing or sneezing.
  • Hugging, shaking hands or holding hands.
  • Eating food that someone with the infection has prepared.
  • Breastfeeding.

What are the risk factors for getting hepatitis B?

Due to the way that hepatitis B spreads, people most at risk for getting infected include:

  • Children whose mothers have been infected with hepatitis B.
  • Children who have been adopted from countries with high rates of hepatitis B infection.
  • People who have unprotected sex and/or have been diagnosed with a sexually transmitted infection.
  • People who live with or work in an institutional setting, such as prisons or group homes.
  • Healthcare providers and first responders.
  • People who share needles or syringes.
  • People who live in close quarters with a person with chronic hepatitis B infection.
  • People who are on dialysis.

Who are hepatitis B carriers?

Hepatitis B carriers are people who have the hepatitis B virus in their blood, even though they don’t feel sick. Between 6% and 10% of those people who’ve been infected with the virus will become carriers and can infect others without knowing it. There are over 250 million people in the world who are carriers of HBV, with about 10% to 15% of the total located in India. Children are at the highest risk of becoming carriers. About 9 in 10 babies infected at birth become HBV carriers, and about half of children who are infected between birth and age 5 carry the virus. A blood test can tell you if you are a hepatitis B carrier.

Diagnosis and Tests

How is hepatitis B diagnosed?

There are three main ways to diagnose HBV infection. They include:

  • Blood tests: Tests of the blood serum (or plasma) shows how your body’s immune system is responding to the virus. A blood test can also tell you if you are immune to HBV.
  • Abdominal ultrasound: An ultrasound uses sound waves to show the size and shape of your liver and how well the blood flows through it.
  • Liver biopsy: A small sample of your liver tissue is removed though a tiny incision and sent to a lab for analysis.

The blood test that is used to diagnose hepatitis B is not a test that you get routinely during a medical visit. Often, people who’ve become infected first learn they have hepatitis B when they go to donate blood. Blood donations are routinely scanned for the infection.

The virus can be detected within 30 to 60 days of infection. About 70% of adults with hepatitis B develop symptoms, which tend to appear an average of 90 days after initial exposure to the virus.

Management and Treatment

How is hepatitis B treated?

Your healthcare provider will treat you based on what type of hepatitis B you have, acute or chronic.

Acute hepatitis B infections

If you develop an acute (short-lived) form of the condition, you probably won’t need medical treatment. Instead, your doctor will likely suggest that you get plenty of rest, drink lots of fluids and maintain a healthy diet to support your body as it fights off the infection.

Chronic hepatitis B infections

If you have chronic hepatitis B, you might be a candidate for drug therapy. Usually, drug therapy is used only if you have active liver disease. There are seven drugs that are approved by the U.S. Food and Drug Administration to treat hepatitis B. Two are injectable forms of interferon, while the five other antivirals are tablets.

You will need to take these medications every day. They help by slowing the virus’s ability to multiply in your system. This helps reduce swelling and liver damage. You’ll need to be regularly monitored for early signs of liver damage and liver cancer. Your healthcare provider will want to see you once or twice a year.

What are the long-term effects of hepatitis B?

The long-term complications of hepatitis B may include:

  • Becoming a hepatitis B carrier.
  • Chronic hepatitis B infection.
  • Cirrhosis (scarring of the liver).
  • Liver cancer.
  • Liver failure.
  • Death.

Is there a cure for chronic hepatitis B?

Currently, there is no complete cure for hepatitis B. But when managed properly, those living with the virus can expect to live a normal life. Maintaining a healthy diet and avoiding alcoholic beverages and tobacco products are crucial components in managing the disease.

You should also visit a doctor familiar with hepatitis B at least annually—though twice a year might be best — to monitor your liver through blood tests and medical imaging. As with most diseases, detecting it early leads to a better outcome. If you’re exposed to the virus, you should get an antibody injection within 12 hours of exposure.

What treatments are available for chronic hepatitis B if medications don’t work?

If you have advanced hepatitis B, you might also become a candidate for a liver transplant. This path does not always result in a cure because the virus continues in your bloodstream after a transplant. To prevent being infected again after your transplant, you may be prescribed hepatitis B immunoglobulin with an antiviral agent.

What is involved in a liver transplant?

A liver transplant is considered necessary when the liver is damaged and cannot function or in some cases of liver cancer. Your liver is very important. It is responsible for many functions related to making sure that your body stays healthy and is able to digest foods.

You may be eligible for a transplant if you have chronic hepatitis B infection or some of the diseases that may result from it, including liver cancer and cirrhosis. You will have to complete testing and be evaluated before being approved for a transplant. It is likely that you will be placed on a waiting list while an appropriate organ is found.

Donated livers come from two types of donors: living and deceased. Because the liver can regenerate, it is possible to use part of a liver for transplant. The remaining sections in both the donor and the receiver will grow into livers of adequate size.

People who get liver transplants must take anti-rejection drugs for the rest of their lives. These drugs make you more susceptible to infection. However, liver transplants have become more successful over time and continue to improve.

Prevention

Can hepatitis B be prevented?

The hepatitis B vaccine is one of the best ways to control the disease. It is safe, effective and widely available. More than one billion doses of the vaccine have been administered globally since 1982. The World Health Organization (WHO) says the vaccine is 98-100% effective in guarding against the virus. Newborns should be vaccinated.

The disease has also been more widely prevented thanks to:

  • Widespread global adoption of safe blood-handling practices. WHO says 97% of the blood donated around the world is now screened for HBV and other diseases.
  • Safer blood injection practices, using clean needles.
  • Safe-sex practices.

You can help prevent hepatitis B infections by:

  • Practicing safe sex (using latex or polyurethane condoms for any sex act).
  • Never sharing personal care items like toothbrushes or razors.
  • Getting tattoos or piercings only at shops that employ safe hygiene practices.
  • Not sharing needles to use drugs.
  • Asking your healthcare provider for blood tests to determine if you have HBV or if you are immune.

Does the hepatitis B vaccine have any side effects?

In most cases, there are no side effects to the vaccine. It is not recommended for patients who are allergic to yeast. In the United States, the Centers for Disease Control and the Food & Drug Administration routinely monitor all federally approved vaccines for quality control.

Who should be vaccinated for hepatitis B?

All newborns should be vaccinated. Also, people who are under 18 who were not vaccinated at birth should also get the vaccine. Other groups who should be sure to be vaccinated are those in certain high-risk categories, such as:

  • Persons with other chronic liver diseases, end-stage renal (kidney) disease or with HIV/AIDs.
  • Travelers to and from areas of the world that have high rates of HBV infection.
  • People who inject drugs.
  • People who have more than one sexual partner.
  • Men who have sex with men.
  • Adults with diabetes.
  • Sexual partners of infected people and people who share households with infected individuals.
  • People who are exposed to blood and other bodily fluids, including healthcare and public safety professionals, and people who work in jails and other places taking care of people who can’t take care of themselves.

Does the hepatitis B vaccine last for a lifetime?

Studies suggest the vaccine remains effective for up to 20 years. It’s possible that the vaccine lasts your entire life, but that has not been confirmed. A booster hepatitis B vaccine is offered if the initial vaccine looses effectiveness.

Outlook / Prognosis

What is the outlook for people with hepatitis B?

The outlook for people with HBV is better now than ever before. You are certainly able to live a full life and help yourself stay healthy. You should make sure to have regular check-ups with a healthcare provider who is qualified to treat hepatitis B, possibly a liver doctor.

Make sure you are vaccinated against hepatitis A. Check with your healthcare provider or pharmacist before taking other medications or over-the-counter products, including supplements and natural products. These could interfere with your medication or damage your liver. For instance, taking acetaminophen (Tylenol®) in large doses may harm your liver.

Follow the usual guidelines for living a healthy life:

  • Eat nutritious foods, choosing from a variety of vegetables, fruits and healthy proteins. It is said that cruciferous vegetables (like cabbage, broccoli, cauliflower and Brussels sprouts) are especially good at protecting the liver.
  • Exercise regularly.
  • Don’t smoke and don’t drink. Both tobacco and alcohol are bad for your liver.
  • Do things that help you cope with stress, like journaling, talking with others, meditating and doing yoga.
  • Avoid inhaling toxic fumes.

Living With

What should you know about pregnancy and hepatitis B?

A pregnant woman who has hepatitis B can pass the infection to her baby at delivery. This is true for both vaginal and cesarean deliveries.

You should ask your healthcare provider to test you for hepatitis B when you find out you are pregnant. However, while it is important for you and your healthcare provider to know if you do have hepatitis B, the condition should not affect the way that your pregnancy progresses.

If you do test positive, your provider may suggest that you contact another healthcare provider, a liver doctor, who is skilled in managing people with hepatitis B infections. You may have a high viral load and may need treatment during the last 3 months of your pregnancy. A viral load is the term for how much of the infection you have inside of you.

You can prevent your infant from getting hepatitis B infection by making sure that your baby gets the hepatitis B vaccine in the hours after they are born along with the hepatitis B immunoglobulin. These two shots are given in two different locations on the baby. They are the first shots needed.

Depending on the type of vaccine used, two or three more doses must be given, usually when the baby is 1 month old and then 6 months old, with the last (if there is a third) by the time the baby is 1 year old. It is critical that all newborns get the hepatitis B vaccination, but even more important if you have hepatitis B yourself.

Can you get more than one form of hepatitis?

Yes. You can get different forms of hepatitis at different times. For example, if you’ve had hepatitis A or hepatitis C, you can still get hepatitis B.

What should you know about hepatitis B before you travel?

Hepatitis B is quite common in China and other Asian countries, where as many as 1 in 12 people have the virus, though many don’t know it. Before traveling to those places, you should make sure you’ve been vaccinated against the virus.

In addition to getting the vaccine, you can take these additional precautions to reduce your risk of contracting the virus:

  • Refrain from taking illegal drugs.
  • Always use latex or polyurethane condoms during sex.
  • Make sure new, sterile needles are used during all piercings, tattoos and acupuncture sessions.
  • Avoid direct contact with blood and bodily fluids.
  • Know the HBV status of all your sexual partners.
  • Ask your doctor about possible vaccination before you travel to a place where hepatitis B is common.

A note from Cleveland Clinic

Hepatitis B is a liver disease that can cause serious damage to your health. One reason that is dangerous is that it can easily go undetected for years while damaging your liver. Talk with your healthcare provider about being tested for hepatitis B if you have any reason to believe that you were not vaccinated or if you have engaged in risky behavior. If you do test positive, follow the directions from your healthcare provider so that you can live a longer, healthier and happier life.

Last reviewed by a Cleveland Clinic medical professional on 07/09/2020.

References

  • Hepatitis B Foundation. What Is Hepatitis B? (https://www.hepb.org/what-is-hepatitis-b/what-is-hepb/) Accessed 7/9/2020.
  • Centers for Disease Control and Prevention. Hepatitis B. (https://www.cdc.gov/hepatitis/hbv/) Accessed 7/9/2020.
  • World Health Organization. Hepatitis B. (https://www.who.int/news-room/fact-sheets/detail/hepatitis-b) Accessed 7/9/2020.
  • American Liver Foundation. Liver Transplant. (https://liverfoundation.org/for-patients/about-the-liver/the-progression-of-liver-disease/liver-transplant/#facts-at-a-glance) Accessed 7/9/2020.

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