Tuesday, May 28, 2024

Chronic Hepatitis B Virus Infection

Who Are Hepatitis B Carriers

Hepatitis B: Treatment and care for a chronic condition

Hepatitis B carriers are people who have the hepatitis B virus in their blood, even though they dont feel sick. Between 6% and 10% of those people whove 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.

Hepatitis B And Pregnancy

If youâre pregnant, you might pass the virus to your baby at birth. Itâs less likely to happen during your pregnancy.

If your baby gets the virus and isnât treated, they could have long-term liver problems. All newborns with infected mothers should get hepatitis B immune globulin and the vaccine for hepatitis at birth and during their first year of life.

How Is It Transmitted

Hepatitis B is highly infectious, and is spread from one person to another through exposure to infected blood and body fluids . It can be spread through:

  • blood transfusions or organ transplantation in countries where blood or blood products have not been properly screened for hepatitis B and other viruses transmitted through blood
  • unprotected sex with an infected person
  • sharing needles or equipment for injecting drugs
  • unsterilized medical/dental equipment and shared/contaminated materials or equipment used for tattooing, body piercing or acupuncture
  • sharing toothbrushes or razors
  • childbirth
  • household contact between family members

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Study Population And Data Abstraction

This study was approved by the Institutional Review Board of the Burkina Faso National Ethics Committee for Health Research . Patients were recruited and tested for HBV viral load from October 1, 2014, through August 30, 2017, at Pietro Annigoni Biomedical Research Center in Ouagadougou, Burkina Faso, West Africa. CERBA provides free HBV viral load testing as well as affordable medical care for low-income patient populations. The protocol for referring patients for HBV viral load testing required that all patients be diagnosed with CHB, confirmed by at least two HBsAg tests at 6-month intervals. A total of 4,163 patients who were HBsAg+ were identified from the CERBA database. Excluded patients included 17 without viral load data and 202 who received treatment before the viral load assay. In total, 3,944 patients with CHB infection were included, comprising 3,885 patients without HCC and 59 with HCC .

FIG. 1

What Is Hepatitis B

Chronic hepatitis B virus infection

Hepatitis B is caused by a virus that infects the liver. It is one of the most common vaccine-preventable diseases affecting travellers and can cause either acute or chronic infection.

About 90 to 95 percent of adults with acute hepatitis B infection will clear the virus on their own within six months, and develop lifelong protection against it.

Some people are unable to clear the virus, and develop chronic hepatitis B. Untreated chronic hepatitis B can later develop into serious health problems. Children under four years old are at particular risk of chronic hepatitis B, because only up to 10% will clear the virus.

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Acute Vs Chronic Hepatitis B

A hepatitis B infection can result in either an acute infection or a chronic infection. When a person is first infected with the hepatitis B virus, it is called an “acute infection” . Most healthy adults that are infected do not have any symptoms and are able to get rid of the virus without any problems. Some adults are unable to get rid of the virus after six months and they are diagnosed as having a “chronic infection.” A simple blood test can diagnose an acute or chronic hepatitis B infection.

The risk of developing a chronic hepatitis B infection is directly related to the age at which a person is first exposed to the hepatitis B virus. The younger a person is when they are first infected, the greater the risk of developing a chronic hepatitis B infection:

  • More than 90% of infants that are infected will develop a chronic hepatitis B infection
  • Up to 50% of young children between 1 and 5 years who are infected will develop a chronic hepatitis B infection
  • 5-10% of healthy adults 19 years and older who are infected will develop a chronic hepatitis B infection

The recommendation for hepatitis B vaccination of babies and children is so important because they are at the greatest risk of developing a chronic infection if they are not protected against the hepatitis B virus as soon as possible.

Who Is More Likely To Get Hepatitis B

People are more likely to get hepatitis B if they are born to a mother who has hepatitis B. The virus can spread from mother to child during birth. For this reason, people are more likely to have hepatitis B if they

  • were born in a part of the world where 2 percent or more of the population has hepatitis B infection
  • were born in the United States, didnt receive the hepatitis B vaccine as an infant, and have parents who were born in an area where 8 percent or more of the population had hepatitis B infection

People are also more likely to have hepatitis B if they

  • are infected with HIV, because hepatitis B and HIV spread in similar ways
  • have lived with or had sex with someone who has hepatitis B
  • have had more than one sex partner in the last 6 months or have a history of sexually transmitted disease
  • are men who have sex with men
  • are injection drug users
  • work in a profession, such as health care, in which they have contact with blood, needles, or body fluids at work
  • live or work in a care facility for people with developmental disabilities
  • have been on kidney dialysis
  • live or work in a prison
  • had a blood transfusion or organ transplant before the mid-1980s

In the United States, hepatitis B spreads among adults mainly through contact with infected blood through the skin, such as during injection drug use, and through sexual contact.12

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Acute Vs Chronic Infection

If you have been diagnosed with hepatitis B, it is important to understand if your infection is acute or chronic.

When a person is first infected with the hepatitis B virus, it is called an “acute infection” . Many people are able to naturally get rid of an acute infection.

If the infection persists for more than 6 months, it is considered a chronic infection.

Acute infections have few, if any, lasting effects. People with chronic infections are at greater risk for developing serious liver diseases, including cirrhosis and liver cancer, and should take precautions to keep their liver healthy.

Why do some people naturally get rid of the virus while others develop chronic infections? The risk of developing a chronic hepatitis B infection is directly related to the age at which a person is first exposed to the hepatitis B virus. The younger a person is when they are first infected, the greater the risk of developing a chronic hepatitis B infection.

How Do Doctors Treat The Complications Of Hepatitis B

Hepatitis B Virus: Serology

If chronic hepatitis B leads to cirrhosis, you should see a doctor who specializes in liver diseases. Doctors can treat the health problems related to cirrhosis with medicines, minor medical procedures, and surgery. If you have cirrhosis, you have an increased chance of liver cancer. Your doctor may order blood tests and an ultrasound or another type of imaging test to check for liver cancer.

If chronic hepatitis B leads to liver failure or liver cancer, you may need a liver transplant.

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Who Should Get The Hepatitis B Vaccine

All newborn babies should get vaccinated. You should also get the shot if you:

  • Come in contact with infected blood or body fluids of friends or family members
  • Use needles to take recreational drugs
  • Have sex with more than one person
  • Are a health care worker
  • Work in a day-care center, school, or jail

How Is Hepatitis B Prevented

Testing & Vaccination

  • The hepatitis B vaccine offers excellent protection against HBV. The vaccine is safe and highly effective. Vaccination consists of 3 doses of vaccine over the course of 6 months. Protection lasts for 20 years to life.
  • The American Academy of Pediatrics recommends that all children should receive hepatitis B vaccine starting at birth. .
  • The CDC recommends hepatitis B vaccine for persons traveling to countries where HBV is common .
  • If you have one or more risk factors for hepatitis B infection, you should get a simple HBV blood test. The blood test will determine whether you are:
  • immune to hepatitis B or
  • susceptible to hepatitis B and need vaccination or
  • infected with hepatitis B and need further evaluation by a physician
  • The basic test for acute HBV infection is called the Hepatitis B Core IgM Antibody test. People who have acute hepatitis B show positive IgM antibodies on this test.
  • Perinatal Hepatitis

    • California law requires testing of all pregnant women for hepatitis B infection
    • If the mother is HBV-infected, she will pass the infection to the baby during the birth process, unless the baby gets immunized within hours of birth
    • Giving the infant HBIG and HBV vaccine right away will reliably prevent infection of the infant
    • Other family members should best tested for hepatitis B too, and given vaccine if they are not already infected or immune

    Healthy Habits

    After Exposure to Hepatitis B

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    How Hbv Infection Is Transmitted

    Transmission of HBV in travelers is through percutaneous or mucosal exposure to HBV-infected blood or bodily fluids including saliva or semen . There are reports of transmission via sexual contact, contaminated blood and its products, and contaminated medical equipment and through sharing of infected needles and injecting apparatus .

    In SSA, the viral infection, is often disseminated through perinatal and horizontal route, while in the developed regions, most infections occur in adults of younger ages through injecting drug use or high-risk sexual behavior . HBV infection is known to be transmitted from the mother to child and it is a thing of worry . Every year, about 25,000 infants are born to HBV-diagnosed mothers in the United States, and approximately 1000 mothers transmit HBV to their infants. This means that about 90% of HBV-infected newborns will eventually develop to chronic infection, and up to 25% of those infected at birth will eventually die prematurely due to HBV-related complications. Therefore, the standard care for pregnant women includes an HBV testing during each pregnancy, to prevent HBV-positive pregnant women from transmitting the viral agent to her unborn child .

    Treatment For Suspected Exposure

    Colorectal Liver Metastasis Linked to Chronic Hepatitis B ...

    Anyone who has had potential exposure to HBV can undergo a postexposure prophylaxis protocol.

    This consists of HBV vaccination and hepatitis B immunoglobin . Healthcare workers give the prophylaxis after the exposure and before an acute infection develops.

    This protocol will not cure an infection that has already developed. However, it decreases the rate of acute infection.

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    Hepatitis B During Pregnancy

    If a woman with HBV becomes pregnant, they may transmit the virus to their baby. Women should inform the doctor who delivers their baby that they have HBV.

    The infant should receive an HBV vaccine and HBIG with 1224 hours of birth. This significantly reduces the risk that they will develop HBV.

    The HBV vaccine is safe to receive while pregnant.

    People with a high risk of HBV include:

    • the infants of mothers with HBV
    • the sexual partners of people with HBV
    • people who engage in sexual intercourse without contraception and those who have multiple sexual partners
    • men who have sex with men
    • people who inject illicit drugs
    • those who share a household with a person who has a chronic HBV infection
    • healthcare and public safety workers who are at risk of occupational exposure to blood or contaminated bodily fluids
    • people receiving hemodialysis, which is a type of kidney treatment
    • people taking medications that suppress the immune system, such as chemotherapy for cancer
    • those who come from a region with a high incidence of HBV
    • all women during pregnancy

    People can prevent HBV infection by:

    • wearing appropriate protective equipment when working in healthcare settings or dealing with medical emergencies
    • not sharing needles
    • following safe sexual practices
    • cleaning any blood spills or dried blood with gloved hands using a 1:10 dilution of one part household bleach to 10 parts water

    A vaccine against HBV has been available since 1982.

    People who should receive this vaccine include:

    Obstetric Implications Of Maternal Chronic Hepatitis B Virus Infection


    Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China

    Explor Med. 2021 2:Online FirstDOI:

    Received: July 15, 2021Accepted: September 17, 2021 Online First: November 29, 2021

    Academic Editor: Elizabeth Ann L. Enninga, Mayo Clinic College of Medicine and Science, USA

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    Treatment Of Hbv Infection

    There are several antiviral treatments available for chronic HBV infection, and everyone with chronic HBV should be linked to care, considered for treatment, and checked for liver damage and liver cancer regularly . Therapy of HBV reduces the amount of virus in the system and lowers the chance of developing to serious liver disease and liver cancer. However, most people cannot be cured of the viral agent, and as such therapy is recommended to continue for life .

    Worthy of note is the fact that there are currently two main antiviral drugs for the treatment of chronic HBV infection . They are nucleoside analogues and interferon including normal IFNs and pegylated IFNs . NA gives a direct antiviral effect by stopping DNA polymerase. It is usually given orally. There are six types of NAs as approved for treatment of HBV by the WHO: Lamivudine , Adefovir , Telbivudine , Entecavir , Tenofovir disoproxil fumarate , and Tenofovir alafenamide . IFNs, especially the Peg-IFNs, have a suppressed antiviral effect than the NA therapy, but its persistent effect can be achieved with a finite therapy. It is usually given via subcutaneous injection. There are reports of combination therapy of NA + NA and Peg-IFN + NA .

    There are serious ongoing clinical trials for the development of more effective treatments and a cure for HBV infection .

    About This Research Topic

    WHO: Viral hepatitis is a global health problem and requires an urgent response

    There are still about 257 million individuals worldwide living with chronic Hepatitis B Virus infection, which are at high risk of liver cirrhosis, liver failure and liver cancer, which account for the majority of end-stage liver diseases. The dysfunctional immune responses play an essential role in …

    Keywords:Hepatitis B Virus, Immune response, Immune tolerance, Immunotherapy, T cell therapy, Innate immunity, Therapeutic vaccine

    Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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    You Can Have It And Not Know It

    What is hepatitis B?

    Hepatitis B is a liver disease caused by the hepatitis B virus . HBV is far more infectious than HIV and can be prevented by a vaccine. People who have not been vaccinated may be at risk of getting infected.

    About 95 percent of adults will recover within 6 months of becoming infected and as a result will develop lifelong protection against it. The remaining 5 percent are unable to clear the virus and will become chronically infected. Chronic hepatitis B infection is treatable.

    It is estimated that less than 1 percent of Canada’s population is infected with either acute or chronic HBV. People who are infected before the age of 7 are at a higher risk of developing chronic infection. In 2011, the overall reported rate of acute hepatitis B infection in Canada was 0.6 reported cases per 100,000 people living in Canada.

    Why is hepatitis B a health concern?

    Many people infected with HBV do not know they have the virus because symptoms can take two to six months to appear and only about 50 percent of people develop symptoms. During this time, they can spread the infection to others. You may not know you have this infection until damage has already been done to your liver. Potential complications from chronic HBV infection include cirrhosis of the liver, liver failure, liver cancer and premature death.

    Why do I need my liver?

    How is hepatitis B spread?

    HBV is spread through contact with infected blood and body fluids including semen and vaginal fluid.

    Hepatitis In The Western Pacific

    Hepatitis is an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis , cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances , and autoimmune diseases can also cause hepatitis.

    There are five main hepatitis viruses, referred to as types A, B, C, D and E. These 5 five types are of greatest concern because of the burden of illness and death they cause and the potential for outbreaks and epidemic spread.

    Hepatitis B and C infections lead to chronic liver disease in hundreds of millions of people. They are the most common causes of liver cirrhosis and liver cancer.

    Technical links

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    What Causes Hepatitis B

    The hepatitis B virus causes hepatitis B. The hepatitis B virus spreads through contact with an infected persons blood, semen, or other body fluids. Contact can occur by

    • being born to a mother with hepatitis B
    • having unprotected sex with an infected person
    • sharing drug needles or other drug materials with an infected person
    • getting an accidental stick with a needle that was used on an infected person
    • being tattooed or pierced with tools that were used on an infected person and werent properly sterilized, or cleaned in a way that destroys all viruses and other microbes
    • having contact with the blood or open sores of an infected person
    • using an infected persons razor, toothbrush, or nail clippers

    You cant get hepatitis B from

    • being coughed on or sneezed on by an infected person
    • drinking unclean water or untreated water that has not been boiled
    • eating food that is unclean or has not been properly cooked
    • hugging an infected person
    • shaking hands or holding hands with an infected person
    • sharing spoons, forks, and other eating utensils
    • sitting next to an infected person

    Mothers who have hepatitis B can safely breastfeed their babies. If a baby receives hepatitis B immune globulin and starts receiving the hepatitis B vaccine to prevent hepatitis B infection shortly after birth, hepatitis B is unlikely to spread from mother to child through breastfeeding.15

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