Hepatitis B: Symptoms, Treatments, Medications and Prevention

Hepatitis B is a serious viral infection that affects the liver and can lead to both acute and chronic disease. It is caused by the hepatitis B virus (HBV), which spreads through contact with infected blood or bodily fluids. Hepatitis B is a major global health concern, as it can lead to severe liver damage, cirrhosis, liver cancer, and even death if left untreated.

What is Hepatitis B?

Hepatitis B is a viral infection caused by the hepatitis B virus (HBV) that primarily targets the liver. The infection can manifest in two forms: acute and chronic.

Forms of Hepatitis B

1. Acute Hepatitis B: This is a short-term infection that occurs shortly after exposure to the virus. Most people with acute hepatitis B recover completely within a few months and develop immunity to the virus, meaning they cannot be infected again. However, in some cases, acute hepatitis B can lead to liver failure, which can be life-threatening.
2. Chronic Hepatitis B: When the infection lasts for more than six months, it is considered chronic. Chronic hepatitis B is more likely to occur in individuals infected at birth or during early childhood. Over time, chronic infection can cause serious liver damage, including cirrhosis (scarring of the liver), liver failure, and hepatocellular carcinoma (liver cancer). Chronic hepatitis B is a lifelong condition that requires ongoing monitoring and management.

Transmission of Hepatitis B

Hepatitis B is transmitted through exposure to infectious body fluids such as blood, semen, vaginal secretions, and, in some cases, saliva. The virus can enter the body through cuts, open sores, mucous membranes, or injection. Common modes of transmission include:

• Mother-to-child transmission: The most common route of HBV infection worldwide is from an infected mother to her child during childbirth.
• Unprotected sexual contact: HBV can be spread through sexual contact with an infected person.
• Needle sharing: People who inject drugs and share needles are at high risk of contracting HBV.
• Blood transfusions and medical procedures: In regions where blood is not screened properly, individuals can acquire HBV through transfusions or medical treatments.
• Close household contact: Although rare, hepatitis B can be transmitted through close personal contact with an infected person, such as sharing personal items (razors or toothbrushes) that may have traces of blood.

Who is at Risk of Hepatitis B?

Hepatitis B can affect anyone, but certain groups are at higher risk of contracting the virus due to specific behaviors, medical conditions, or geographic factors. Identifying high-risk populations is essential for implementing targeted prevention and treatment strategies.

High-Risk Populations for Hepatitis B

1. Newborns and Infants Born to Infected Mothers: One of the most common ways HBV is transmitted is from an infected mother to her child during childbirth. Babies born to mothers with chronic hepatitis B are at high risk of developing chronic infection if not properly treated at birth.
2. People with Multiple Sexual Partners: Engaging in unprotected sex with multiple partners increases the risk of exposure to hepatitis B, as the virus can be transmitted through sexual fluids.
3. People Who Inject Drugs: Sharing needles or other drug paraphernalia is a major risk factor for hepatitis B, as blood-to-blood contact can transmit the virus.
4. Healthcare Workers: Individuals working in healthcare settings are at risk of exposure to HBV through needlestick injuries, blood splashes, or contact with other infectious body fluids.
5. Men Who Have Sex with Men (MSM): This population is at increased risk due to the potential for sexual transmission of HBV during unprotected anal intercourse.
6. People with Chronic Kidney Disease: Individuals undergoing dialysis are at an increased risk of hepatitis B due to the potential for blood exposure during dialysis procedures.
7. People Living in or Traveling to High-Prevalence Areas: Certain regions, particularly in sub-Saharan Africa, East Asia, and the Pacific Islands, have higher rates of chronic hepatitis B infections. People living in or traveling to these regions are more likely to be exposed to HBV.
8. Household Contacts of Infected Individuals: Those living in close contact with someone who has hepatitis B may be at risk of infection, especially if they share personal items that could be contaminated with infected blood.

Symptoms of Hepatitis B

Hepatitis B symptoms vary depending on whether the infection is acute or chronic. Many people with acute hepatitis B have no symptoms or only mild symptoms, while chronic infection often remains asymptomatic for years until significant liver damage occurs.

Symptoms of Acute Hepatitis B

Acute hepatitis B usually develops within 1 to 4 months after exposure to the virus. Symptoms can range from mild to severe and may include:

1. Fever: A low-grade fever is common in the early stages of infection.
2. Fatigue: A general feeling of tiredness and malaise is common in people with acute hepatitis B.
3. Loss of Appetite: People with hepatitis B may experience a decreased desire to eat, leading to unintentional weight loss.
4. Nausea and Vomiting: Digestive symptoms such as nausea, vomiting, and stomach discomfort may be present.
5. Abdominal Pain: Pain or discomfort in the upper right part of the abdomen (where the liver is located) can occur.
6. Dark Urine and Pale Stools: Urine may become dark (tea-colored), while stools may appear pale or clay-colored due to liver dysfunction.
7. Jaundice: Yellowing of the skin and the whites of the eyes (jaundice) occurs as the liver becomes unable to process bilirubin, a waste product produced by the breakdown of red blood cells.

Symptoms of Chronic Hepatitis B

Chronic hepatitis B is often asymptomatic for many years, which means individuals can carry the virus and spread it without knowing. When symptoms do occur, they are usually related to liver damage and include:

1. Persistent Fatigue: Chronic fatigue and weakness may persist over time.
2. Joint Pain: Some people with chronic hepatitis B may experience joint pain or arthritis-like symptoms.
3. Swelling in the Legs and Abdomen: In advanced cases, fluid buildup in the legs (edema) and abdomen (ascites) may occur due to liver damage.
4. Jaundice: Jaundice may reappear in individuals with chronic hepatitis B as liver function deteriorates.
5. Liver Failure: In severe cases, chronic hepatitis B can lead to cirrhosis or liver failure, characterized by severe symptoms such as confusion, bleeding, and coma.

Diagnosis of Hepatitis B

The diagnosis of hepatitis B involves a combination of medical history, physical examination, and laboratory tests that detect HBV infection, assess liver function, and determine the phase of the disease.

Medical History and Physical Examination

Doctors will ask about the patient’s symptoms, potential exposure to HBV, travel history, sexual practices, and drug use. They will also assess for signs of liver damage, such as jaundice or abdominal tenderness. A physical exam may reveal an enlarged liver or signs of fluid buildup.

Diagnostic Laboratory Tests

1. HBsAg (Hepatitis B Surface Antigen): The presence of HBsAg in the blood indicates an active HBV infection, either acute or chronic. This is one of the first markers to appear after infection.
2. Anti-HBs (Hepatitis B Surface Antibody): This test detects antibodies produced in response to HBV infection or vaccination. A positive result indicates immunity to the virus.
3. HBcAb (Hepatitis B Core Antibody): The core antibody can indicate a past or current infection. Two types of antibodies are tested:
   • IgM HBcAb: Indicates a recent or acute infection.
   • IgG HBcAb: Suggests a past or chronic infection.
4. HBV DNA (Hepatitis B Viral DNA Test): This test detects the genetic material of HBV in the blood and measures the amount of virus present. It is used to assess viral load, which helps determine the severity of the infection and monitor the effectiveness of treatment.
5. Liver Function Tests: These tests measure levels of liver enzymes such as ALT (alanine aminotransferase) and AST (aspartate aminotransferase). Elevated levels of these enzymes suggest liver inflammation and damage.
6. Liver Biopsy: In some cases, a liver biopsy may be performed to assess the extent of liver damage, particularly if cirrhosis or liver cancer is suspected.
7. FibroScan: This non-invasive test uses ultrasound to measure liver stiffness, which can indicate the degree of fibrosis (scarring) in the liver caused by chronic hepatitis B.

Treatments of Hepatitis B

There is no cure for hepatitis B, but treatment is available to manage the infection and reduce the risk of liver damage. The choice of treatment depends on whether the infection is acute or chronic, the patient’s age, liver function, and the stage of the disease.

Treatment for Acute Hepatitis B

Most people with acute hepatitis B recover without specific antiviral treatment. The focus of treatment is on supportive care, which includes:

1. Rest: Adequate rest helps the body fight the infection and recover.
2. Hydration and Nutrition: Maintaining good hydration and nutrition is essential to support liver function and overall health.
3. Medications for Symptom Relief: Over-the-counter medications such as acetaminophen may be used to relieve fever, pain, and discomfort. However, these should be used with caution as they can be hard on the liver.
4. Hospitalization for Severe Cases: In rare cases where acute hepatitis B leads to liver failure, hospitalization may be necessary. These individuals may require close monitoring, intravenous fluids, and medications to support liver function. In extreme cases, a liver transplant may be required.

Treatment for Chronic Hepatitis B

The goal of treating chronic hepatitis B is to reduce the viral load in the body, prevent liver damage, and reduce the risk of complications such as cirrhosis and liver cancer. Long-term antiviral therapy is often necessary to suppress the virus and manage the disease.

1. Antiviral Medications: These drugs work by reducing the amount of HBV in the body and limiting the damage to the liver. Common antiviral medications include:
   • Tenofovir disoproxil fumarate (TDF): A first-line antiviral drug that effectively suppresses HBV replication.
   • Entecavir: Another potent antiviral medication used to treat chronic hepatitis B.
   • Tenofovir alafenamide (TAF): A newer version of tenofovir with fewer side effects, especially on kidney function.
2. Interferon Therapy: Interferon-alpha is an immune-modulating drug that helps the body fight HBV. It is typically used in younger patients or those who wish to avoid long-term antiviral therapy. Interferon therapy can have significant side effects, including flu-like symptoms, fatigue, and depression.
3. Regular Monitoring: People with chronic hepatitis B require regular monitoring of liver function, viral load, and liver fibrosis. This helps determine the effectiveness of treatment and assess the risk of progression to cirrhosis or liver cancer.
4. Liver Transplantation: In cases where chronic hepatitis B has led to irreversible liver damage (cirrhosis or liver failure), a liver transplant may be the only option. A liver transplant can save a patient’s life, but it requires long-term immune-suppressing medications to prevent organ rejection.

Most Common Medications for Hepatitis B

Medications for hepatitis B focus on antiviral therapy to reduce viral replication and protect the liver from further damage. While these medications cannot cure the infection, they help control the disease and prevent complications.

Antiviral Medications for Chronic Hepatitis B

1. Tenofovir Disoproxil Fumarate (TDF): TDF is one of the most widely used antiviral medications for treating chronic hepatitis B. It effectively reduces HBV DNA levels and can prevent liver damage. It is typically taken once daily and has a good safety profile. However, it can cause bone and kidney toxicity in some patients.
2. Entecavir (Baraclude): Entecavir is another first-line antiviral medication that works by blocking the replication of HBV. It is highly effective at lowering viral load and is often prescribed to patients who cannot tolerate tenofovir. It is generally well-tolerated and taken once daily.
3. Tenofovir Alafenamide (TAF): TAF is a newer formulation of tenofovir that is as effective as TDF but has fewer side effects, particularly in terms of kidney function and bone density. TAF is becoming a preferred option for patients who need long-term antiviral therapy.
4. Lamivudine (Epivir): While lamivudine was one of the first antiviral drugs used to treat hepatitis B, it is now less commonly prescribed due to the development of drug resistance. However, it may still be used in some cases where other options are not available.

Immune-Modulating Medications

1. Pegylated Interferon-alpha (Pegasys): Pegylated interferon is used to boost the immune system’s ability to fight the virus. It is administered as weekly injections for a fixed duration (typically 6 to 12 months). Interferon therapy can result in a sustained virological response, meaning the virus remains suppressed even after treatment ends. However, it has significant side effects, including flu-like symptoms, fatigue, and mood changes.

Symptom Management

1. Analgesics and Antipyretics: Medications such as acetaminophen (Tylenol) may be used to relieve pain and fever associated with acute hepatitis B. However, acetaminophen should be used cautiously in patients with liver disease, as high doses can worsen liver damage.
2. Hepatoprotective Agents: Some medications and supplements may help protect the liver from damage and support liver function. However, these should only be used under the guidance of a healthcare provider, as some supplements can have harmful effects on the liver.

Where is Hepatitis B Most Prevalent?

Hepatitis B is a global health problem, but its prevalence varies widely across different regions. Understanding where hepatitis B is most common is crucial for implementing targeted public health strategies and vaccination campaigns.

High-Prevalence Regions

1. Sub-Saharan Africa: Hepatitis B is highly endemic in many sub-Saharan African countries, with chronic infection rates ranging from 5% to 15% of the population. Most infections in this region are acquired at birth or in early childhood.
2. East Asia and the Pacific Islands: Countries in East Asia, including China, Taiwan, South Korea, and the Philippines, have high rates of chronic hepatitis B infection. Vertical transmission (mother-to-child) is a significant mode of transmission in these regions.
3. Eastern Europe and Central Asia: Hepatitis B rates are also elevated in certain parts of Eastern Europe and Central Asia, particularly among people who inject drugs or engage in unprotected sex.
4. Middle East and North Africa: The prevalence of chronic hepatitis B is moderate to high in the Middle East and North Africa, with a significant burden of disease in rural areas where vaccination coverage may be lower.

Moderate and Low-Prevalence Regions

1. Western Europe and North America: In most high-income countries, hepatitis B prevalence is relatively low, thanks to widespread vaccination programs. However, certain high-risk populations, such as immigrants from high-prevalence countries, people who inject drugs, and men who have sex with men (MSM), continue to have higher rates of infection.
2. Latin America: While hepatitis B prevalence in Latin America is lower compared to Africa and Asia, certain regions, particularly in the Amazon Basin, still have high rates of chronic infection.

Prevention of Hepatitis B

Preventing hepatitis B involves a combination of vaccination, safe practices, and public health measures. The hepatitis B vaccine is the most effective way to prevent infection and is included in national immunization programs in many countries.

Vaccination

1. Hepatitis B Vaccine: The hepatitis B vaccine is safe and highly effective at preventing both acute and chronic hepatitis B. The vaccine is usually administered as a series of three or four doses over six months. It is recommended for:
   • All infants at birth (to prevent mother-to-child transmission)
   • Unvaccinated children and adolescents
   • Adults at high risk of infection, such as healthcare workers, people who inject drugs, and individuals with multiple sexual partners
2. Birth Dose for Newborns: Administering the first dose of the hepatitis B vaccine within 24 hours of birth is crucial in preventing mother-to-child transmission. This is especially important in high-prevalence regions where vertical transmission is common.
3. Vaccination for High-Risk Groups: In addition to universal infant vaccination, targeted vaccination programs for high-risk adults (e.g., healthcare workers, MSM, people who inject drugs) are essential to reduce the spread of HBV.

Safe Practices

1. Safe Injection Practices: People who inject drugs should use sterile needles and never share injection equipment. Needle exchange programs can help reduce the transmission of hepatitis B and other blood-borne infections.
2. Safe Sex: Using condoms during sexual activity reduces the risk of transmitting hepatitis B through sexual fluids. People with multiple sexual partners or those in high-risk groups should be regularly tested for HBV.
3. Avoid Sharing Personal Items: Sharing personal items such as razors, toothbrushes, or nail clippers can lead to the transmission of HBV if they come into contact with blood.

Public Health Measures

1. Blood Screening: Ensuring that all donated blood is screened for hepatitis B can prevent transmission through blood transfusions.
2. Education and Awareness: Public health campaigns aimed at increasing awareness about hepatitis B, its transmission, and prevention can help reduce the spread of the virus.
3. Universal Precautions in Healthcare Settings: Healthcare workers should follow standard precautions to prevent exposure to blood and body fluids. This includes using personal protective equipment (PPE), such as gloves and masks, and safely handling needles and other sharp instruments.