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.
What Is The Treatment For Hepatitis B
Acute hepatitis B usually resolves on its own and does not require medical treatment. If very severe, symptoms such as vomiting or diarrhea are present, the affected person may require treatment to restore fluids and electrolytes. There are no medications that can prevent acute hepatitis B from becoming chronic.
If a person has chronic hepatitis B, they should see their health care provider and determine if medical treatment is appropriate.
Living With Hepatitis B
If you have hepatitis, you should:
- avoid having unprotected sex, including anal and oral sex, unless you’re sure your partner has been vaccinated against hepatitis B
- avoid sharing needles used to inject drugs with other people
- take precautions to avoid the spread of infection, such as not sharing toothbrushes or razors with other people
- eat a generally healthy, balanced diet there’s no special diet for people with hepatitis B
- avoid drinking alcohol this can increase your risk of developing serious liver problems
- speak to your doctor if you’re thinking of having a baby
People with hepatitis B can usually have a healthy pregnancy, but it’s a good idea to discuss your plans with a doctor first as you may need extra care and your medications may need to be changed.
There’s a risk of pregnant women with hepatitis B passing the infection on to their child around the time of the birth, but this risk can be reduced by ensuring the baby is vaccinated shortly after they’re born.
Page last reviewed: 30 January 2019 Next review due: 30 January 2022
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Molecular Mechanisms Of Drug Resistance
Different types of mutations are associated with drug resistance and can emerge during antiviral therapy with nucleoside or nucleotide analogues. Primary mutations typically affect the reverse transcriptase domain of the HBV polymerase, thereby causing steric changes of the polymerase protein that escape the inhibitory effects of the nucleoside analogues . The most relevant hot-spot mutations in the HBV polymerase are displayed in Table 1. However, the polymerase mutants have a dramatically reduced viral replication efficacy in most cases . Secondary compensatory mutations occur in order to restore the viral replication fitness, thereby overcoming deleterious effects of the primary drug-resistant mutations . These mutations are not necessarily located within the enzymatically active sites of the polymerase, but oftentimes stabilize secondary or tertiary viral structures. The eight different HBV genotypes AH partly differ with respect to the position of secondary compensatory mutations and the rate of drug resistance development .
If I Have Hepatitis B And Feel Healthy Do I Need To Keep Going To My Doctor
Chronic hepatitis B is a silent disease because often no symptoms appear until your liver is severely damaged. Although many people with chronic hepatitis B have an inactive disease and will remain healthy, about one in four will have an active disease that may lead to cirrhosis, liver failure, and liver cancer.
Because hepatitis B has no symptoms until your liver is badly damaged, a blood test is the only way for your doctor to find out if your hepatitis B is active or inactive, and to offer treatment, if needed. To help your doctor monitor how your disease behaves over time, you will need lifelong repeat blood tests every six to 12 months. Some tests, such as HBV DNA may need to be done more frequently . No treatment is required while the virus is inactive, but you should continue to get regular blood tests from your doctor to monitor your liver disease.
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Introducing A Blood Borne Virus Testing Facility Within A Substance Misuse Harm Reduction Serviceyour Browser Indicates If You’ve Visited This Link
The Operational Procedures provide specific aims and objectives relating to Harm Reduction including 100% offer of BBV screening and access to HepatitisA& B combined vaccination … when a client moves between different stages of treatment.
National Institute for Health and Care Excellence
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.
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Who Should Be Vaccinated For Hepatitis B
All newborns should be vaccinated. Also, people who are under 18 who were not vaccinated at birth should also get the vaccine. Other groups who should be sure to be vaccinated are those in certain high-risk categories, such as:
- People who have more than one sexual partner.
- Men who have sex with men.
- Adults with diabetes.
- Sexual partners of infected people and people who share households with infected individuals.
- People who are exposed to blood and other bodily fluids, including healthcare and public safety professionals, and people who work in jails and other places taking care of people who cant take care of themselves.
How To Prevent Hepatitis B
Hepatitis B is a liver infection caused by a virus . It can be serious and theres no cure, but the good news is its easy to prevent. You can protect yourself by getting the hepatitis B vaccine and having safer sex. If you have oral, anal, and vaginal sex, use condoms and dental dams to help stop the spread of hepatitis B and other STDs.
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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.
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How Long Does It Last
According to the World Health Organization , the complete vaccine series induces protective antibody levels in of the infants, children, and adolescents who receive it.
Immune memory induced by the HBV vaccine can last for in healthy people. That said, studies into the duration of the protection that the vaccine offers are ongoing.
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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Chronic Hepatitis B Treatment
Antiviral medications are available to treat chronic hepatitis B, but these drugs don’t get rid of the infection.
Rather, they slow or stop the virus from damaging the liver, which helps prevent life-threatening hepatitis B complications particularly liver cancer and cirrhosis .
Drug treatments include Roferon-A or Intron A .
In 2015, researchers found that a cancer drug called birinapant was able to completely eliminate HBV infections in animal models, according to two studies in the journal Proceedings of the National Academy of Sciences.
The drug, which works by reversing the negative effects of HBV on the liver’s infection-fighting defenses, was able to clear infections twice as fast when used in combination with Baraclude.
What Is The Medical Treatment For Hepatitis B
Acute hepatitis B infection
Acute hepatitis B infection is not treated with antiviral medications.
- If the infected person is dehydrated from vomiting or diarrhea, a doctor may prescribe IV fluids to help them feel better. Medications may also be used to control these symptoms.
- People with mild symptoms can be cared for at home.
Chronic hepatitis B infection
The degree of liver damage is related to the amount of active, replicating virus in the blood and liver. Regularly measuring the amount of HBV DNA in the blood gives your physician a good idea of how fast the virus is multiplying. The treatments now in use are classified as antiviral drugs because they work by stopping the virus from multiplying.
Treatment is usually started when blood tests indicate that liver functions are deteriorating and the amount of replicating HBV is rising. Many people never reach this point. For those who do, the interval between diagnosis and starting treatment is quite variable.
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How Is Hepatitis B Diagnosed
There are three main ways to diagnose HBV infection. They include:
- Blood tests: Tests of the blood serum shows how your bodys immune system is responding to the virus. A blood test can also tell you if you are immune to HBV.
- Abdominal ultrasound: An ultrasound uses sound waves to show the size and shape of your liver and how well the blood flows through it.
- Liver biopsy: A small sample of your liver tissue is removed though a tiny incision and sent to a lab for analysis.
The blood test that is used to diagnose hepatitis B is not a test that you get routinely during a medical visit. Often, people whove become infected first learn they have hepatitis B when they go to donate blood. Blood donations are routinely scanned for the infection.
The virus can be detected within 30 to 60 days of infection. About 70% of adults with hepatitis B develop symptoms, which tend to appear an average of 90 days after initial exposure to the virus.
What Does It Mean To Have A Successful Treatment What Is A Sustained Virologic Response
In an untreated state, the hepatitis C virus infects the cells of the liver and then continuously lives there, making copies of itself that circulate in the bloodstream. Antiviral medications can destroy the ability of the virus to reproduce, so the amount of virus in the bloodstream then decreases. The amount of virus in the blood is measured by aviral load.
Treatment is successful when the viral load drops toundetectablelevels, which means the virus cannot be detected in the bloodstream at all. The viral load becomes undetectable during treatment and remains undetected after treatment has ended. If there is still no detectable virus in the blood 12 weeks after the end of the treatment, the treatment was successful. This is called a Sustained Virologic Response .
A patient who has achieved an SVR is considered to be cured of the hepatitis C virus.
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How Is Hepatitis B Spread
You can become infected with hepatitis B through exposure to blood, semen and other bodily fluids of an infected person. You can get the infection by:
- 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.
What Treatments Are Available For Chronic Hepatitis B
Hepatitis B treatment is based on the results of blood tests, age, and the degree of scarring in the liver. Hepatitis B treatment is recommended for patients with very active virus and an inflamed liver. People with chronic hepatitis B and cirrhosis also may be candidates for treatment.
Treatment involves taking an oral antiviral medication. In some cases, injections may be used.
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Emergency Hepatitis B Treatment
See your GP as soon as possible if you think you may have been exposed to the hepatitis B virus.
To help stop you becoming infected, they can give you:
- a dose of the hepatitis B vaccine you’ll also need 2 further doses over the next few months to give you long-term protection
- hepatitis B immunoglobulin a preparation of antibodies that work against the hepatitis B virus and can offer immediate but short-term protection until the vaccine starts to take effect
These are most effective if given within 48 hours after possible exposure to hepatitis B, but you can still have them up to a week after exposure.
Where Can I Get More Detailed Information On How To Live With Hepatitis B
More detailed information can be found in the Canadian Liver Foundations Healthy Living with Viral Hepatitis booklet, including:
- What to expect if you have hepatitis B
- The different types of blood tests and what they measure
- How to prepare for an appointment with your doctor
- What choices to make to prevent additional damage to your liver
- Who needs to know if you have hepatitis B and how to tell them
- How to recognize and deal with symptoms
- How to find financial assistance
- What questions to ask when considering alternative therapies.
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Injections: Interferon And Pegylated Interferon
Pegylated interferon is FDA-approved for HBV treatment. It 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.