What is Hepatitis B?

Hepatitis B is an infectious hepatitis caused by the hepatitis B virus (HBV). This infection has two possible phases; 1) Acute and 2) Chronic.

1) Acute hepatitis B refers to newly acquired infections. Affected individuals notice symptoms approximately 1 to 4 months after exposure to the virus. In most people with acute hepatitis, symptoms resolve over weeks to months and they are cured of the infection. However, a small number of people develop a very severe, life-threatening form of acute hepatitis called fulminant hepatitis.

2) Chronic hepatitis B is an infection with HBV that lasts longer than 6 months. Once the infection becomes chronic, it may never go away completely.

Most infected adults are able to fight off the virus so their infection is cured. A low percentage of adults infected with HBV go on to develop chronic infection. Children are at much higher risk for chronic infection. A majority of infected young children will fail to clear the virus from their bodies and go on to develop chronic infection.

About two-thirds of people with chronic HBV infection are chronic carriers. These people do not develop symptoms, even though they harbor the virus and can transmit it to other people. The remaining one third develop "active" hepatitis, a disease of the liver that can be very serious.

Symptoms of Hepatitis B

Half of all people infected with the Hepatitis B virus have no symptoms and may never realize that they have been infected. Adults are more likely to develop symptoms than children. For those who do get sick, symptoms usually develop within 1 to 4 months after exposure to the virus. The initial symptoms are often similar to the flu.

Common symptoms of Hepatitis B include:
• Appetite loss
• Feeling tired
• Nausea and vomiting
• Itching all over the body
• Pain over the location of the liver (on the right side of the abdomen, under the lower rib cage)
• Jaundice (a condition in which the skin and the whites of the eyes turn yellow in color)
• Dark urine (the color of cola or tea)
• Pale-colored stools (grayish or clay colored)

Other types of acute viral hepatitis such as hepatitis A and hepatitis C have symptoms that are indistinguishable from Hepatitis B.
Fulminate hepatitis is a severe form of acute hepatitis that can be life-threatening if not treated right away. Fortunately, fulminate hepatitis is rare. The symptoms of fulminate hepatitis develop very suddenly and may include:
• Mental disturbances such as confusion, lethargy, extreme sleepiness or hallucinations (Hepatic Encephalopathy)
• Sudden collapse with fatigue
• Jaundice
• Swelling of the abdomen

Prolonged nausea and vomiting can cause dehydration. Individuals with dehydration may notice these symptoms:
• Extreme weakness
• Confusion or trouble concentrating
• Headache
• Lack of urination
• Irritability

Symptoms of liver damage may include the following:
• Fluid retention causing swelling of the belly (ascites) and sometimes the legs
• Weight gain due to ascites
• Persistent Jaundice
• Loss of appetite, weight loss, wasting
• Vomiting with blood in the vomit
• Bleeding from the nose, mouth, or rectum; or blood in the stool
• Hepatic Encephalopathy (excessive sleepiness, mental confusion, and in advanced stages, development of coma)

What Is the Medical Treatment for Hepatitis B?

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 (multiplying) virus in the blood and liver. Regularly measuring the amount of HBV DNA ('viral load') 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.

• Antiviral agents, while the best therapy known for chronic hepatitis B, do not work in all individuals with the disease.

• There are several antiviral agents for chronic hepatitis B approved by the U.S. Food and Drug Administration (FDA). New drugs are always being tested and treatment recommendations are subject to change.

• Antiviral therapy is not appropriate for everyone with chronic HBV infection. It is reserved for people whose infection is most likely to progress to active hepatitis or cirrhosis.

• Decisions to start medications for treatment of hepatitis B are made by the patient and health care practitioner, often in consultation with a specialist in diseases of the digestive system (gastroenterologist), liver (hepatologist), or an infectious disease specialist.

• The decision to treat is guided by results of liver function tests, HBV DNA tests, and, frequently, liver biopsies after a complete history and physical examination.

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.

How is Hepatitis B Transmitted? How Do You Get Hepatitis B?

The Hepatitis B virus is known as a blood-borne virus because it is transmitted from one person to another via blood or fluids contaminated with blood. Another important route of transmission is from an infected mother to a newborn child, which occurs during or shortly after birth.

• Direct contract with blood may occur through the use of dirty needles during illicit drug use, inadvertent needle sticks experienced by healthcare workers, or contact with blood through other means. Semen, which contain small amounts of blood, and saliva that is contaminated with blood also carry the virus.

• The virus may be transmitted when these fluids come in contact with broken skin or a mucous membrane (in the mouth, genital organs, or rectum) of an uninfected person.

People who are at an increased risk of being infected with the Hepatitis B virus include the following:
• Men or women who have multiple sex partners, especially if they don't use a condom
• Men who have sex with men
• Men or women who have sex with a person infected with Hepatitis B virus
• People with other sexually transmitted diseases
• People with HIV or Hepatitis C
• People who inject drugs with shared needles
• People who receive organ transplants or transfusions of blood or blood products (exceedingly rare these days)
• People who undergo dialysis for kidney disease
• Institutionalized mentally handicapped people and their attendants, caregivers, and family members
• Health care workers who are stuck with needles or other sharp instruments contaminated with infected blood
• Infants born to infected mothers
• People born outside the United States in areas where hepatitis B is common
• People who travel to areas of the world where Hepatitis B is common
• In some cases, the source of transmission is never known.

You cannot get Hepatitis B from the following activities:
• Having someone sneeze or cough on you
• Hugging someone
• Shaking hands
• Breastfeeding your child
• Eating food or drinking water
• Casual contact (such as an office or social setting)