General Characteristics Of The Study Population
A total of 65,175 outpatients and 12,649 inpatients were retrieved from the Guangzhou Eighth Peoples Hospital database for the study period between January 1, 2008 and December 31, 2015 . General characteristics of the outpatients and the inpatients by disease stages were detailed in Table . Approximate 90% outpatient visits and 57% inpatients admissions were due to CHB, 9% and 27% were due to cirrhosis, and 1% and 16% were due to HCC. About 75% of these patients were male and the proportion of patients aged 40 to 60 accounted for approximately 50%. Self-payment and medical insurance were the main payment modes. Table also shows the proportions of patients received prescriptions for antiviral drugs, hepatoprotective drugs, traditional Chinese medicine and anti-fibrotic medicine for outpatients and inpatients.
Fig. 1
Parenteral Routes: Transmission Of Hepatitis B Hepatitis D And Hepatitis C
Hepatitis B, C, and D viruses are all transmitted by what is known as the parenteral route. Parenteral simply means that these viruses can be introduced by all routes except through the intestinal tract, which leaves the door wide open in terms of possible exposure. Lets look at the possible transmission routes for each of these types of hepatitis virus more closely.
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How Do You Get Hepatitis C
You can get hepatitis C when you have contact with the blood of a person with the virus. This through sharing needles, syringes, or other injection drug equipment.
Other less common routes of transmission are:
- having a needlestick injury
- being born to a birthing parent with hepatitis C
- having sex with someone with hepatitis C without a barrier method
- receiving a tattoo or piercing with nonsterile equipment
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Treatment For Acute Hepatitis B Infection
If your provider determines your hepatitis B infection is acute meaning it is short lived and will go away on its own you may not need treatment. Instead, your provider might recommend rest, proper nutrition, plenty of fluids and close monitoring while your body fights the infection. In severe cases, antiviral drugs or a hospital stay is needed to prevent complications.
Hiv And Hbv Coinfection
About 2% of people with HIV in the United States are coinfected with HBV both infections have similar routes of transmission. People with HIV are at greater risk for complications and death from HBV infection. All people with HIV are recommended to be tested for HBV, and if susceptible, are further recommended to receive the hepatitis B vaccination or, if chronically infected, evaluated for treatment to prevent liver disease and liver cancer. For more information about HIV and HBV coinfection, visit HIV.govâs pages about hepatitis B and HIV coinfection.
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Viral Hepatitis Updates To Inform Syndemic Approaches
Recent viral hepatitis news may be of interest to readers engaged in efforts to respond to the syndemic of viral hepatitis and HIV, a focus of concern in both the National HIV/AIDS Strategy and the Viral Hepatitis National Strategic Plan.
A syndemic is the clustering and interaction of two or more diseases, as a result of social and structural determinants of health , that leads to excess burden of disease in a population. Both national strategies seek to advance a more holistic approach to the syndemic of viral hepatitis, HIV, STIs, mental health, and substance use disorders.
To support our colleagues in the HIV community pursuing these more holistic and integrated approaches, we want to share information about several recent viral hepatitis developments and resources.
Transmission Symptoms And Treatment
How is HBV transmitted?
HBV is transmitted through activities that involve percutaneous or mucosal contact with infectious blood or body fluids , including
- sex with a partner who has HBV infection
- injection drug use that involves sharing needles, syringes, or drug-preparation equipment
- birth to a person who has HBV infection
- contact with blood from or open sores on a person who has HBV infection
- exposures to needle sticks or sharp instruments and
- sharing certain items with a person who has HBV infection that can break the skin or mucous membranes , potentially resulting in exposure to blood.
How long does HBV survive outside the body?
HBV can survive outside the body and remains infectious for at least 7 days .
What should be used to clean environmental surfaces potentially contaminated with HBV?
Any blood spills should be disinfected using a 1:10 dilution of one part household bleach to 9 parts water. Gloves should be worn when cleaning up any blood spills.
Who is at risk for HBV infection?
The following populations are at increased risk for becoming infected with HBV:
- Infants born to people with HBV infection
- Sex partners of people with HBV infection
- Men who have sex with men
- People who inject drugs
- Household contacts or sexual partners of known people with chronic HBV infection
- Health care and public safety workers at risk for occupational exposure to blood or blood-contaminated body fluids
- Patients on hemodialysis
Who should be screened for HBV?
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Carefully Review Criteria Before Initiating Antiviral Treatment For Hbv
In general, patients with active HBV should be considered for HBV antiviral treatment.
Patients with inactive HBV may need HBV treatment in certain situations such as if they are immunosuppressed or on treatment for chronic HCV.
Always carefully review thecriteria for starting HBV medications and/or consult an expert before initiating HBV treatment.
Antiviral Medication For Hepatitis B
Doctors may recommend antiviral medication for people with chronic hepatitis B, which occurs when the virus stays in your body for more than six months.
Antiviral medication prevents the virus from replicating, or creating copies of itself, and may prevent progressive liver damage. Currently available medications can treat hepatitis B with a low risk of serious side effects.
NYU Langone hepatologists and infectious disease specialists prescribe medication when they have determined that without treatment, the hepatitis B virus is very likely to damage the liver over time. People with chronic hepatitis B may need to take antiviral medication for the rest of their lives to prevent liver damage.
There are many different types of antiviral medications available, and your doctor recommends the right type for you based on your symptoms, your overall health, and the results of diagnostic tests. A doctor may take a wait-and-see approach with a person who has a healthy liver and whose blood tests indicate a low viral load, the number of copies of the hepatitis B virus in your bloodstream.
Someone with HIV infection or AIDS may have a weakened immune system and is therefore more likely to develop liver damage. The U.S. Centers for Disease Control and Prevention strongly recommends that people with HIV infection who are diagnosed with hepatitis B immediately begin treatment with antiviral medication.
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Closing In On A Cure For Hepatitis B
For Thomas Tu, eliminating hepatitis B is a deeply personal goal.
Tu, a molecular virologist at the Westmead Institute for Medical Research in Sydney, Australia, learnt he had chronic hepatitis B as a teenager. A blood test revealed telltale signs of the infectious liver disease, which Tu had probably acquired at birth.
In his late 20s, Tu started taking a medication to limit the viruss replication and prevent collateral damage to his liver cells. Now 36, he has been on that daily treatment a pill known as a nucleoside analogue ever since.
Yet, even with a therapy that keeps his infection well under control, Tu remains at heightened risk for liver disease. He must juggle visits to specialist doctors and bear prescription-drug costs. And he knows that many others racked by the financial instability, emotional toil and stigma that the lifelong infection can bring have it much worse.
Part of Nature Outlook: Hepatitis B
Im in this quite privileged space to be able to be on therapy and not have any side effects or feel any burden from taking daily medicines, Tu says. Thats not the same for the majority of people living with hepatitis B.
We are using all our weapons to tackle every single step of the virus, says Man Fung Yuen, a hepatologist at the University of Hong Kong.
Approved Drugs For Adults
There are currently 7 approved drugs in the United States for adults living with chronic hepatitis B infection. These include 5 types of antiviral drugs that are taken as a pill once a day for 1 year or longer. And there are 2 types of immune modulator drugs called interferon that are given as an injection for 6 months to 1 year.
It is important to know that not everyone needs to be treated. A liver specialist should evaluate your health through a physical exam, blood tests, and an imaging study of your liver . Then you can discuss together whether you are a good candidate for treatment since the approved drugs are most effective when there are signs of active liver disease. In addition, talk to your provider about HBV Clinical Trials since there are several new drugs being tested that are available for infected adults.
All adults, however, should be seen regularly by a liver specialist whether they are on treatment or not.
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How Is Hepatitis B Spread
- 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.
American Association For The Study Of Liver Diseases Recommendations
The 2016 AASLD guidelines for the treatment of chronic hepatitis B as well as select recommendations from the 2018 AASLD guidance update on the prevention, diagnosis, and treatment of chronic hepatitis B are outlined below and in the Guidelines section.
The AASLD does not recommend antiviral therapy in individuals with all of the following, regardless of HBeAg status or age :
- No clinical evidence of cirrhosis
- Persistently normal ALT levels
- Low levels of HBV DNA replication . ]
Adults with immune-active chronic hepatitis B infection
Administer antiviral therapy to lower the risk of morbidity and mortality associated with chronic hepatitis B infection.
The recommended initial agent for adults is PEG-IFN, entecavir, or tenofovir.
Adults with immune-tolerant chronic hepatitis B infection
Antiviral therapy is not recommended.
The AASLD suggests obtaining ALT levels at least every 6 months to monitor for potential transition to immune-active or -inactive chronic hepatitis B.
For select patients older than 40 years, the AASLD suggests antiviral therapy in the setting of normal ALT levels, elevated HBV DNA , and significant necroinflammation or fibrosis on liver biopsy specimens.
Adults with HBeAg-positive immune-active chronic hepatitis B who seroconvert to anti-HBe on nucleoside analog therapy
Adults with HBeAg-negative immune-active chronic HBV infection
Children with chronic hepatitis B infection
Individuals with HBV and HCV coinfection
Individuals with HBV and HIV coinfection
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Complications Of Hepatitis B
Most people do not have any lasting problems after having a hepatitis B infection.
If left untreated, chronic hepatitis B can cause liver damage and increase your risk of getting liver cancer.
It is important to take any medicine you have been prescribed and go for regular check-ups to make sure your liver is working properly.
Page last reviewed: 01 July 2022 Next review due: 01 July 2025
Injections: Interferon And Pegylated Interferon
Pegylated interferon is given as an injection once per week. It can be used alone or with an oral hepatitis B medication. Patients with both chronic hepatitis B and hepatitis D infection may need pegylated interferon alone or combined with an oral hepatitis B pill.
- Pegylated interferon therapy is usually given for 48 weeks.
- Pegylated interferon may cause many side effects, such as flu-like symptoms, rashes, irritability, and depression.
- Side effects to interferon require close monitoring with routine blood tests.
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What Do I Need To Know About Having Hepatitis B
If you have chronic hepatitis B, getting the right medical care can help you stay healthy. Taking good care of your liver is important. Talk with your doctor before you take any prescription medication, over-the-counter drugs, vitamins, or nutritional supplements to make sure they wont hurt your liver. You should also stay away from alcohol, because drinking can damage your liver.
Update On Prevention Diagnosis And Treatment Of Chronic Hepatitis B: Aasld 2018 Hepatitis B Guidance
This AASLD 2018 Hepatitis B Guidance is intended to complement the AASLD 2016 Practice Guidelines for Treatment of Chronic Hepatitis B1 and update the previous hepatitis B virus guidelines from 2009. The 2018 updated guidance on chronic hepatitis B includes updates on treatment since the 2016 HBV guidelines and guidance on screening, counseling, and prevention specialized virological and serological tests monitoring of untreated patients and treatment of hepatitis B in special populations, including persons with viral coinfections, acute hepatitis B, recipients of immunosuppressive therapy, and transplant recipients.
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The Hepatitis B Vaccine
Getting the hepatitis B vaccine is one of the most effective ways to prevent hepatitis B. Its usually administered in two, three, or four doses. In many countries, infants receive their first dose of the vaccine at birth.
The Centers for Disease Control and Prevention recommends that infants receive their first dose of the vaccine at birth and finish all doses at 6 to 18 months old.
The CDC also recommends all children under the age of 19 years old be vaccinated if they havent already received the vaccination.
Adults can also get the hepatitis B vaccine. The vaccine is generally recommended if you have an increased risk of contracting the virus. Some of these risk factors include:
- traveling to or living in a region where hepatitis B is common
- being sexually active with more than one partner or with a partner who has hepatitis B
- working in a medical setting or other workplaces where youre exposed to bodily fluids
- using intravenous drugs and sharing drug equipment
- having chronic liver disease, a human immunodeficiency virus infection, a hepatitis C infection, diabetes, or kidney disease on dialysis
If youve been exposed to the hepatitis B virus and havent been vaccinated, try to see a doctor right away. They can administer the first dose of the vaccine, though youll need to follow up to receive the remaining doses over the next few months.
They may also prescribe a medication called
What Treatments Are Available For Chronic Hepatitis B If Medications Dont 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.
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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.
Prevention Tips For Hepatitis B
Hepatitis B Prevention Measures
Hepatitis B is a vaccine-preventable disease. More than 1 billion doses of the hepatitis B vaccine have been given worldwide, and it is considered to be a very safe and effective vaccine to protect infants, children and adults from hepatitis B. Learn more.
All sexual partners, family and close household members living with a chronically infected person should be tested and vaccinated. It is important to remember that hepatitis B is not spread casually! It is not spread by coughing, sneezing, hugging, cooking and sharing food. It is spread through direct contact with infected blood and bodily fluids.
Additional Prevention Measures
In addition to vaccination, there are other simple ways to help stop the spread of hepatitis B:
- Wash your hands thoroughly with soap and water after any potential exposure to blood
- Use condoms with sexual partners
- Avoid direct contact with blood and bodily fluids
- Clean up blood spills with a fresh diluted bleach solution
- Cover all cuts carefully
- Avoid sharing sharp items such as razors, nail clippers, toothbrushes, and earrings or body rings
- Discard sanitary napkins and tampons into plastic bags
- Avoid illegal street drugs
- Make sure new, sterile needles are used for ear or body piercing, tattoos, and acupuncture
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New Cdc Resource On Insurance Coverage For Viral Hepatitis Services
Last fall, CDCâs Division of Viral Hepatitis released an FAQ document that summarizes insurance coverage and patient cost-sharing by plan type for viral hepatitis prevention and treatment services. The document discusses coverage by private insurance, Medicare, and Medicaid for:
- Hepatitis A and B vaccination
- Hepatitis B and C screening and testing
- Hepatitis B and C treatment
Read Frequently Asked Questions: Insurance Coverage for Viral Hepatitis Treatment and Prevention ServicesExit Disclaimer .