Thursday, May 19, 2022

What Is Chronic Hepatitis B

What Is My Risk

Managing Chronic Hepatitis B – Advice for GPs

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 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 form of the condition, you probably wont 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 viruss ability to multiply in your system. This helps reduce swelling and liver damage. Youll 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.

Hepatitis B: Screening Prevention Diagnosis And Treatment

THAD WILKINS, MD, MBA RICHARD SAMS, MD, MA and MARY CARPENTER, PharmD Medical College of Georgia at Augusta University, Augusta, Georgia

Am Fam Physician. 2019 Mar 1 99:314-323.

Patient information: See related handout on hepatitis B, written by the authors of this article.

The Centers for Disease Control and Prevention estimated that in 2015 there were 21,900 cases of acute hepatitis B, with an overall incidence of 1.1 cases per 100,000.1 There are an estimated 850,000 to 2.2 million individuals in the United States with chronic hepatitis B.1,2 Approximately 25% of children and 15% of adults with chronic hepatitis B die prematurely from hepatocellular carcinoma or cirrhosis.3 However, treatment reduces morbidity and mortality from the disease.

WHAT IS NEW ON THIS TOPIC

Approximately 1,000 cases of perinatal hepatitis B occur annually in the United States, and nearly 90% of chronic hepatitis B cases in infants develop in the first year of life.

Hepatitis B vaccination is recommended for all medically stable infants weighing 2,000 g or more within 24 hours of birth, unvaccinated infants and children, and unvaccinated adults requesting protection from hepatitis B or who are at increased risk of hepatitis B.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Pregnant women should be screened for hepatitis B at the first prenatal visit.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Pregnant women should be screened for hepatitis B at the first prenatal visit.

eFIGURE A

eFIGURE A

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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 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 .
  • 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.

What Should You Know About Hepatitis B Before You Travel

5 Pearls on Chronic Hepatitis B, Part 1

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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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.

What Is An Active Immune Response

Active immunity refers to the process of exposing the body to an antigen to generate an adaptive immune response: the response takes days/weeks to develop but may be long lastingeven lifelong. Active immunity is usually classified as natural or acquired.

What is an example of Active immunity?

Active immunity can arise naturally, as when someone is exposed to a pathogen. For example, an individual who recovers from a first case of the measles is immune to further infection

What is active and passive immunity? Active immunity occurs when our own immune system is responsible for protecting us from a pathogen. Passive immunity occurs when we are protected from a pathogen by immunity gained from someone else.

What triggers an active immune response?

Active Immunity results when exposure to a disease organism triggers the immune system to produce antibodies to that disease. Active immunity can be acquired through natural immunity or vaccine-induced immunity.

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Hepatocellular Carcinoma Risk In Patients With Chronic Hepatitis B

Chronic hepatitis B is now recognized as one of the most important cause for the development of HCC, accounting for over 50% of the HCC cases worldwide. However, it was not until the mid-1970s that scientists recognized the causative role of chronic hepatitis B in HCC development. This was following the discovery of the hepatitis-associated antigen, now known as the HBsAg, which has been reported to persist in patients with chronic hepatitis B with or without cirrhosis, leading to HCC development in a significant proportion of patients.41 Various mechanisms have been proposed in the pathogenesis of HCC in patients with chronic HBV infection. Integration of the HBV DNA into the hepatocyte genome and the epigenetic regulation of the minichromosome cccDNA result in chromosomal instability and activation of cancer-related genes along with inactivation of cancer-suppressive genes through interference with various cellular transcription and signal transduction processes.42 In addition, chronic hepatitis B results in release of cytokines and growth factors as part of the adaptive immune response, leading to hepatocyte necrosis and fibroblast proliferation, resulting in liver fibrosis/cirrhosis.43

As such, patients with chronic hepatitis B, especially those at high risk, should be continuously screened for HCC, regardless of the virologic remission .27

James E. Balow, … Howard A. AustinIII, in, 2008

How Is Hepatitis B Transmitted

Chronic Hepatitis B: What to do after diagnosis (1/3)

Hepatitis B is spread in several distinct ways: sexual contact sharing needles, syringes, or other drug-injection equipment or from mother-to-child at birth.

In the United States, in 2018, injection drug use was the most common risk factor reported among people with an acute HBV infection, followed by having multiple sex partners. Less commonly reported risk factors included accidental needle sticks, surgery, transfusions, and household contact with a person with HBV infection. In the United States, healthcare-related transmission of HBV is rare.

Mother-to-child transmission of HBV is especially concerning, because it is preventable. An estimated 25,000 infants are born to mothers diagnosed with HBV each year in the United States, and approximately 1,000 mothers transmit HBV to their infants. Without appropriate medical care and vaccinations, 90% of HBV-infected newborns will develop chronic infection, remaining infected throughout their lives. Up to 25% of people infected at birth will die prematurely of HBV-related causes. For this reason, the standard of care for pregnant women includes an HBV test during each pregnancy so that the appropriate steps can be taken to prevent HBV-positive mothers from transmitting the disease to her infant.

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Prevent Infection After Contact With The Virus

If you think you have been in contact with the hepatitis B virus, see your doctor right away. Doctors typically recommend a dose of the hepatitis B vaccine to prevent infection. In some cases, doctors may also recommend a medicine called hepatitis B immune globulin to help prevent infection. You must get the vaccine dose and, if needed, HBIG shortly after coming into contact with the virus, preferably within 24 hours.

Hepatitis B Causes And Risk Factors

Itâs caused by the hepatitis B virus, and it can spread from person to person in certain ways. You can spread the hepatitis B virus even if you donât feel sick.

The most common ways to get hepatitis B include:

  • Sex. You can get it if you have unprotected sex with someone who has it and your partnerâs blood, saliva, semen, or vaginal secretions enter your body.
  • Sharing needles. The virus spreads easily via needles and syringes contaminated with infected blood.
  • Accidental needle sticks.Health care workers and anyone else who comes in contact with human blood can get it this way.
  • Mother to child.Pregnant women with hepatitis B can pass it to their babies during childbirth. But thereâs a vaccine to prevent newborns from becoming infected.

Hepatitis B doesnât spread through kissing, food or water, shared utensils, coughing or sneezing, or through touch.

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How Is Chronic Hepatitis B Diagnosed

There are several blood tests available that can identify whether you are currently infected or have developed immunity to hepatitis B. Your sexual partners and people living in your household should also get tested. If you are diagnosed with chronic hepatitis B infection, you will require life-long blood and liver tests at least every 6 months to assess the condition of your liver. Learning that you have chronic hepatitis B infection can be very upsetting. Because most people do not have symptoms and can be diagnosed decades after their initial exposure to the hepatitis B virus, it can be a shock and a surprise to be diagnosed with chronic hepatitis B. The good news is that most people with this condition can expect to live a long and healthy life because there are medicines that can control and even stop the hepatitis B virus from further damaging your liver. If you have been diagnosed with chronic hepatitis B, contact The Hepatitis Foundation of New Zealand freephone 0800 332 010. They provide a free hepatitis B follow-up programme with information, support and regular blood tests.

Can Hepatitis B Be Treated

Chronic hepatitis B can be successfully treated

If you know you have been exposed to the hepatitis B virus in the previous seven days or less, you can receive an injection of hepatitis B immune globulin that may prevent you from developing the disease. Besides this, there is no treatment for acute hepatitis B.

If you have chronic hepatitis B, two types of treatment exist interferon which is a medication administered by a needle, and antiviral medicines that are taken by mouth. Current approved hepatitis B oral medications include lamivudine, adefovir, telbivudine, tenofovir, and entecavir. These treatments do not provide a cure, but they offer control of the virus so that further damage to your liver can be prevented. When and how to treat your hepatitis B is a decision between you and your doctor. Availability of the medications listed above may vary from province to province based on provincial government drug plans and individual insurance plans.

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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 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 are especially good at protecting the liver.
  • Exercise regularly.
  • Dont smoke and dont 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.

Can Hepatitis Be Cured Completely

All types of hepatitis are treatable but only A and C are curable. Most people with hepatitis A or hepatitis B infection will recover on their own, with no lasting liver damage. In rare cases, people with hepatitis B will develop chronic liver disease, including cirrhosis, liver failure, or liver cancer.

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Symptoms Of Hepatitis B

Many people with hepatitis B will not experience any symptoms and may fight off the virus without realising they had it.

If symptoms do develop, they tend to happen 2 or 3 months after exposure to the hepatitis B virus.

Symptoms of hepatitis B include:

  • flu-like symptoms, including tiredness, a fever, and general aches and pains
  • loss of appetite
  • tummy pain
  • yellowing of the skin and eyes

These symptoms will usually pass within 1 to 3 months , although occasionally the infection can last for 6 months or more .

What Should You Know About Pregnancy And Hepatitis B

Hepatitis B: Treatment and care for a chronic condition

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 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.

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When To Get Medical Advice

Hepatitis B can be serious, so you should get medical advice if:

  • you think you may have been exposed to the hepatitis B virus emergency treatment can help prevent infection if given within a few days of exposure
  • you have symptoms associated with hepatitis B
  • you’re at a high risk of hepatitis B high-risk groups include people born in a country where the infection is common, babies born to mothers infected with hepatitis B, and people who have ever injected drugs

You can go to your local GP surgery, drug service, genitourinary medicine clinic or sexual health clinic for help and advice.

A blood test can be carried out to check if you have hepatitis B or have had it in the past.

The hepatitis B vaccine may also be recommended to reduce your risk of infection.

Whats The Prognosis For Hepatitis B

Your doctor will know youâve recovered when you no longer have symptoms and blood tests show:

  • Your liver is working normally.
  • You have hepatitis B surface antibody.

But some people don’t get rid of the infection. If you have it for more than 6 months, youâre whatâs called a carrier, even if you donât have symptoms. This means you can give the disease to someone else through:

  • Unprotected sex

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