Acute Hepatitis B Symptoms
There are three phases of acute hepatitis B infection, and symptoms may differ depending on the stage. Early in the disease, called the prodromal phase, symptoms may include:
- Fever
- Dark urine and light stool color
During the icteric phase:
- Jaundice develops
- Anorexia, nausea and vomiting may worsen
- Irritated skin lesions may develop
- Other symptoms may subside
How Hepatitis B Is Spread
The hepatitis B virus is found in the blood and bodily fluids, such as semen and vaginal fluids, of an infected person.
It can be spread:
- from a mother to her newborn baby, particularly in countries where the infection is common
- within families in countries where the infection is common
- by having sex with an infected person without using a condom
- by having a tattoo, body piercing, or medical or dental treatment in an unhygienic environment with unsterilised equipment
Hepatitis B is not spread by kissing, holding hands, hugging, coughing, sneezing or sharing crockery and utensils.
Diagnosis Of Hepatitis B
Blood tests are available to determine if you are or have been infected with hepatitis B. It may take 6 months from the time of infection before a blood test can detect antibodies to hepatitis B, so follow-up testing may be required. During this 6-month period, until you know whether you are infected or not, take action to prevent potential infection of other people.
There are also tests that can assess liver damage from hepatitis B. The interpretation of these tests can be complicated and specialist advice is needed, so talk to your doctor.
All pregnant women are tested for hepatitis B. If you are found to have chronic hepatitis B, your doctor can help reduce the risk of transferring the infection to your newborn child.
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Natural History Of Chronic Hepatitis B
The course of chronic HBV infection has been grouped into four phases: the immune tolerant phase, the immune active/hepatitis B e antigen âpositive chronic hepatitis phase, the HBeAg-negative inactive phase, and the immune active/HBeAg-negative chronic hepatitis phase. However, these terms may not accurately reflect the immunological status of patients in each phase but are useful for prognosis and determining need for therapy., The duration of each phase varies from months to decades. Transition can occur from an earlier to a later phase, but regression back to an earlier phase can also occur. It should be noted that not all patients go through all four phases. Furthermore, while the cutoff levels of alanine aminotransferase used to define different phases were traditionally based on upper limits of normal determined by clinical diagnostic laboratories, recent studies suggest that the true normal values are lower.
How Is Acute Hepatitis B Treated
Acute hepatitis B doesnt always require treatment. In most cases, a doctor will recommend monitoring your symptoms and getting regular blood tests to determine whether the virus is still in your body.
While you recover, allow your body to rest and drink plenty of fluids to help your body fight off the infection. You can also take an over-the-counter pain reliever, such as ibuprofen , to help with any abdominal pain you have.
See a doctor if your symptoms are severe or seem to be getting worse. You may need to take a prescription antiviral medication to avoid potential liver damage.
Like acute hepatitis B, chronic hepatitis B may not require medical treatment to avoid permanent liver damage. In some patients, monitoring symptoms and getting regular liver tests is appropriate.
Treatment generally involves antiviral medications, such as:
- peginterferon alfa-2a injections
- antiviral tablets, such as tenofovir or entecavir
Antiviral medications can help to reduce symptoms and prevent liver damage. But they rarely completely get rid of the hepatitis B virus. Instead, the goal of treatment is to have the lowest viral load possible. Viral load refers to the amount of a virus in a blood sample.
Theres no cure for hepatitis B, but the condition is easily preventable by taking a few precautions. Hepatitis B is often spread through sexual contact, shared needles, and accidental needle sticks.
You can reduce your risk of developing hepatitis B or spreading the virus to others by:
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Antiviral Medication For Hepatitis C
For people with hepatitis C, the goal of treatment with antiviral medication is to prevent the virus from replicating, or copying itself, and to eliminate the virus from the bloodstream. If the hepatitis C virus has been in the body for more than six months, the infection is considered chronic. Without treatment, most people with acute hepatitis C develop the chronic form of the disease.
Your doctor decides which antiviral medicationor combination of medicationsto prescribe based on the results of a blood test called a genotype test. There are six genotypes, or strains, of the hepatitis C virus, and people with certain genotypes respond more quickly to medical treatment.
For many years, the standard treatment for chronic hepatitis C consisted of the antiviral medications pegylated interferon and ribavirin. Ribavirin is taken by mouth every day, and interferon is an injection that you or a caregiver can administer once a week at home.
In 2013 and 2014, the U.S. Food and Drug Administration approved a group of new medications for the treatment of hepatitis C. These medications, which include sofosbuvir, are very effective and have fewer side effects than older medications, particularly interferon.
Immune Mechanisms Of Hbv Control And Implications For Therapy
The pathogenesis of chronic HBV infection involves not only viral mechanisms by which HBV establishes a persistent infection but also the host responses to infection. The latter includes the response of hepatocytes to HBV infection as well as the interplay of the virus and infected cells with the other parenchymal and nonparenchymal cells in the liver, i.e., Kupffer cells, endothelial cells, fibroblasts, and nonresident immune cells that are recruited to the site of infection. HBV has evolved mechanisms to counteract and escape these different host responses to establish a chronic infection. Recent studies point out a critical role of the liver microenvironment in the elimination or control of HBV . , While much has been learned about the HBV-specific adaptive immunity, the early and innate immune response during acute HBV infection remains largely unknown. In addition, few studies have examined intrahepatic immune responses in patients with chronic HBV infection. Available data suggest impaired responses, but the mechanism of this impairment is unclear.
Figure 2
A concern of the various immunotherapies is the potential risk of autoimmunity and/or exacerbation of liver damage by immune-mediated death of hepatocytes in vivo. Careful consideration of benefit versus risk and close clinical monitoring would be needed in these approaches.
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Is There A Cure
Though there is no vaccine for Hepatitis C, treatments can reduce the viral load to undetectable levels which is considered cured or in remission.
The virus is considered cured when it is not detected in your blood 12 weeks after treatment is completed. This is otherwise known as a sustained virologic response .
Hepatitis C is one of the most serious hepatitis viruses. However, with newer treatments developed over the past few years, the virus is much more manageable than it was in the past.
Current antiviral drugs that help cure hepatitis C may also help prevent the health complications of chronic liver disease.
The reports less than half of people who contract the hepatitis C virus may clear it from their bodies without treatment. For this group of people, the virus will be a short-term acute condition that goes away without treatment.
But for most people, acute hepatitis C will likely develop into a chronic condition that requires treatment.
Since the virus often doesnt produce symptoms until after more significant liver damage occurs, its important to get tested for hepatitis C if you think you might have been exposed.
approved the antiviral drug Mavyret for an 8-week treatment period for people with all genotypes of hepatitis C.
This treatment is now being used for many people instead of the 12-week treatment that was previously required.
Noninvasive ways to test for liver damage caused by hepatitis C are also now available to aid in diagnosis.
What Will I Need To Do If I Am On Hepatitis B Medications
- Take oral medications every day to avoid developing resistance.
- See your provider on a regular basis
- If you have cirrhosis or high risk of liver cancer, get liver imaging on time as prescribed by your provider
- Have periodic laboratory tests to monitor HBV viral load and liver enzymes to monitor disease activity and response to medications
- You may need blood tests every 3-6 months initially and at least once a year thereafter if virus is undetected in blood.
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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.
How Can I Avoid Getting Hepatitis B
There is a safe and effective vaccine that can protect you from getting hepatitis B. The vaccine is usually given in three doses over a six month period. The vaccine will give you long-lasting protection. A combined vaccine for hepatitis A and hepatitis B is also available.
Other ways to protect yourself or your loved ones include:
- Adopt safe sex practices.
- Avoid sharing personal hygiene items
- If you have been exposed to the hepatitis B virus , an injection of hepatitis B immune globulin may help protect you.
- If you are pregnant, make sure you are screened for hepatitis B. If the test result shows that you have the virus, make sure your baby receives the free hepatitis B vaccine. If you have hepatitis B, breastfeeding is safe if the baby has received both protective antibody called immune globulin, and the first dose of hepatitis B vaccine within the first 12 hours of life. Talk to your doctor about having your newborn immunized .
- If you decide to have a tattoo, piercing, manicure or pedicure, ensure that the facility uses single-use needles and inks and/or follows proper sterilization procedures.
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Inhibitors Of Hbv Cccdna Formation And Stability
Because the cytoplasmic nucleocapsid DNA is the precursor for cccDNA biosynthesis, complete inhibition of viral DNA replication in the nucleocapsids with polymerase inhibitors should preclude de novo cccDNA formation. However, clinical studies demonstrated that although NRTI monotherapy for 48-52 weeks reduced circulating viremia by â¼5 log10 and cytoplasmic HBV DNA levels in hepatocytes by approximately 2 log10, reduction of cccDNA was much less pronounced, only by 0.11 to 1.0 log10., Moreover, sequential analyses of viral DNA replicative intermediates and core antigen-positive hepatocytes in the livers of woodchuck hepatitis virus -infected woodchucks before and during clevudine therapy revealed that after more than 6 weeks of therapy, all WHV DNA replicative intermediates were markedly reduced, with the exception of cccDNA, which remained as the predominant viral DNA species in the liver.
Alternatively, failure to eradicate cccDNA by prolonged NRTI therapy may also be due to the extraordinary stability of cccDNA. cccDNA may persist in a âlatentâ state amid the host chromosomes and remain as a reservoir for later HBV replication. Healthy hepatocytes in the absence of immune response or inflammatory reaction have a half-life of over 6 months.,
Hepatitis B Vs Hepatitis C
Hepatitis has many different types. HBV and the hepatitis C virus have both acute and chronic forms.
The main difference between HBV and HCV is how they spread from person to person. Although HCV is transmissible via sexual activity, this is rare. HCV usually spreads when blood that carries the virus comes into contact with blood that does not.
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What Are Signs Of Hepatitis B
When you first get hepatitis B, it is called acutehepatitis B. Most adults who have hepatitis B willrecover on their own. However, children and someadults can develop chronic hepatitis B.
Acute hepatitis B: Signs of acute hepatitis B canappear within 3 months after you get the virus.These signs may last from several weeks to 6 months.Up to 50% of adults have signs of acute hepatitis Bvirus infection. Many young children do not show anysigns. Signs include:
- Yellow skin or eyes
- Tiredness
- A longer than normal amount of time for bleedingto stop
Can Hepatitis B Be Controlled By Eating Right And Exercising
It is important that people with liver disease follow a healthy, nutritious diet as outlined by Health Canada in Eating Well with Canadas Food Guide.
Alcohol can also damage the liver so it is best that people with hepatitis B do not drink. Following a healthy lifestyle may also prevent fatty liver disease, another liver disease highly prevalent in Canada.
However, hepatitis B cannot be controlled by healthy eating and exercise alone. Hepatitis B can only be controlled by currently available treatment as prescribed by your doctor. Your doctor will need to do regular blood tests to know how much of the active virus is in your blood . The viral load test is used to monitor and manage hepatitis B patients. Viral load can tell your doctor if you need treatment for hepatitis B and how well you are responding to treatment.
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What Is My Risk
Your risk depends of several factors: destination, length of stay, what you do when you are travelling and whether you have direct contact with blood or other body fluids. In certain destinations, your risk may be higher, as some areas have higher numbers of people with chronic hepatitis B in the general population.
The risk increases with certain activities, such as unprotected sex, sharing needles, tattooing and acupuncture.
Aid and health care workers and anyone who receives medical or dental care with unsterilized or contaminated equipment in a country where hepatitis B occurs are also at greater risk.
How Far Have We Got
Some exciting research is underway around the world, including the recent identification of the cell receptor which allows the virus to infect the body. This has enabled studies of the complete virus replication cycle including the viral reservoir that is untouched by current therapies.
New approaches to a possible cure include mechanisms to block the virus entry into the cell and to stop the virus from making the proteins it needs to replicate and infect new cells.
Studies are also underway to enhance patients immune responses so their own natural defences can control or even eliminate the virus. This is similar to immunotherapies already being used to treat some cancers.
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Its likely a hepatitis B cure will require a dual-pronged approach, directly targeting the virus while also enhancing the immune response in people who are infected.
The goal is to reduce the amount of virus in the body and restore the persons immune responses. This is called a functional cure and is similar to what happens when a person naturally gets rid of the virus. It would also mean they didnt need to take drugs any more.
Some of these approaches are now in early stage human clinical trials. More than 30 drugs have been developed and are being tested in people with chronic hepatitis B. However, much more work needs to be done to achieve a cure.
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How Many People Have Hepatitis B
In the United States, an estimated 862,000 people were chronically infected with HBV in 2016. New cases of HBV infection in the United States had been decreasing until 2012. Since that time, reported cases of acute hepatitis B have been fluctuating around 3,000 cases per year. In 2018, 3,322 cases of acute hepatitis B were reported however, because of low case detection and reporting, the Centers for Disease Control and Prevention estimates that there were 21,600 acute hepatitis B infections. New HBV infections are likely linked to the ongoing opioid crisis in the United States.
Globally, HBV is the most common blood-borne infection with an estimated 257 million people infected according to the World Health Organization .
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 dont know it. Before traveling to those places, you should make sure youve 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
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