HEPATITIS B - Causes, Treatment & Prevention's By: Dr Arun Aggarwal Gastroenterologist

It is estimated that there are more than 250 million carriers of the hepatitis B virus in the world, with over 500,000 dying annually from hepatitis B-related liver disease.

HOW DID ONE GET INFECTED WITH HEPATITIS B? — There are several ways to become infected with hepatitis B virus.

Contaminated needles — this includes tattooing, acupuncture, and ear piercing (if these procedures are performed with contaminated instruments). Sharing needles or syringes can also spread the virus.

Sex — Sexual contact with someone who is infected is one of the most common ways to become infected with hepatitis B.

Mother to infant — Hepatitis B can be passed from a mother to her baby during or shortly after delivery. Having a Cesarean delivery does not prevent the virus from spreading. Experts believe that breastfeeding is safe.

Close contact — Hepatitis B can be spread through close personal contact. This could happen if blood or other bodily fluids get into tiny cracks or breaks in your skin or in your mouth or eyes.

Blood transfusion and organ transplantation

In the hospital — In the hospital, hepatitis B virus can spread from one patient to another or from a patient to a doctor or nurse if there is an accidental needle stick.

HEPATITIS B SYMPTOMS — after a person is first infected with hepatitis B, they can develop a flu-like illness that includes fever, abdominal pain, fatigue, decreased appetite, nausea, and in some cases yellowing of the skin and eyes (jaundice). In the most severe cases, liver failure can develop, which is characterized by jaundice, fluid accumulation (swelling in the legs or abdomen), and confusion. However, many patients do not develop symptoms, particularly if the infection occurs in infants and children. Not having symptoms does not necessarily mean that the infection is under control. Most people with chronic hepatitis B have no symptoms until their liver disease is at a late stage.

Acute hepatitis B — After a person is first infected with hepatitis B, they are said to have acute hepatitis. Most people with acute hepatitis B recover uneventfully.

However, in about 5% cases, the virus makes itself at home in the liver, where it continues to make copies of itself for many years. People who continue to harbor the virus are referred to as "carriers". If liver damage develops because of long standing infection, the person is said to have chronic hepatitis.

Chronic hepatitis B — Chronic hepatitis B develops more commonly in people who are infected with the virus at an early age. Many people with chronic hepatitis B have no symptoms at all; other people have symptoms of ongoing liver inflammation, such as fatigue and loss of appetite.

HEPATITIS B DIAGNOSIS — There are a number of tests that can be used to diagnose or monitor hepatitis B infection. Most of these tests are blood tests and include:

●Hepatitis B surface antigen

●Hepatitis B surface antibody

●Hepatitis B core antibody

●Hepatitis B e antigen

●Hepatitis B e antibody

●Hepatitis B DNA

●Other tests – There are many other tests that can reflect the health of the liver, but are not specific for hepatitis B. These include liver enzyme tests (alanine aminotransferase [ALT] and aspartate aminotransferase [AST]), bilirubin, alkaline phosphatase, albumin, prothrombin time, and platelet count.

A liver biopsy is used to monitor liver damage in people with chronic hepatitis, help decide if treatment is needed, and find signs of cirrhosis or liver cancer.

WILL I DEVELOP CHRONIC HEPATITIS B? — The likelihood of developing chronic hepatitis B largely depends on your age at the time of infection. Chronic infection develops in about 90 percent of children who are infected at birth, in 20 to 50 percent of children who are infected between the ages of 1 and 5 years, and in less than 5 percent of people infected with hepatitis B during adulthood.

WHAT IS THE RISK OF ME HAVING CIRRHOSIS OR LIVER CANCER? — The risk of developing complications (such as cirrhosis, liver failure, or liver cancer) depends on how rapidly the virus multiplies and how well your immune system controls the infection.

 HEPATITIS B TREATMENT

Should everyone be treated? — Specific treatment for acute hepatitis B is usually not needed since in about 95 percent of adults, the immune system controls the infection and gets rid of the virus within about six months.

In people who develop chronic hepatitis, an antiviral medication might be recommended to reduce or reverse liver damage and to prevent long-term complications of hepatitis B.

Once you start treatment, you will have regular blood tests to see how well the treatment is working and to detect side effects or drug resistance. Monitoring will continue after finishing treatment to determine if the infection has come back.

Antiviral medications — If your doctor thinks you should be treated, there are two types of antiviral medications that can be used, nucleos(t)ide analogues (these are oral medications that you take daily) and interferon (an injectable medication). Most patients receive an oral medication; however, your gastroenterologist will discuss these choices with you.

Liver transplantation — Liver transplantation may be the only option for people who have developed advanced cirrhosis.

TIPS TO MAINTAIN LIVER HEALTH — As discussed above, the majority of people with acute hepatitis B spontaneously clear the infection. Those who develop chronic infection should see a gastroenterologist or hepatologist.

Vaccinations — Everyone with chronic hepatitis B should be vaccinated against hepatitis A unless they are known to be immune. Influenza vaccination is recommended once per year.

Liver cancer screening — Regular screening for liver cancer is also recommended, particularly for older individuals, those with cirrhosis, and patients with a family history of liver cancer. In general, this includes an ultrasound examination of the liver every six months.

Diet — No specific diet has been shown to improve the outcome in people with hepatitis B. The best advice is to eat a normal healthy and balanced diet and to maintain a normal weight.

Alcohol — Alcohol should be avoided since it can worsen liver damage.

Prescription and nonprescription drugs — Many medications are broken down by the liver. Thus, it is always best to check with your gastroenterologist before starting a new medication. As a general rule, unless the liver is already scarred, most drugs are safe for people with hepatitis B.

Herbal medications — No herbal treatment has been proven to improve outcomes in patients with hepatitis B, and some can cause serious liver toxicity. Herbal treatments are not recommended for anyone with hepatitis B.

PREVENTION

Preventing infection of close contacts —

●Discuss the infection with any sexual partners and use a latex condom with every sexual encounter.

●Do not share razors, toothbrushes, or anything that has blood on it.

●Cover open sores and cuts with a bandage.

●Do not donate blood, body organs, other tissues, or sperm.

●Immediate family and household members should be tested for hepatitis B. Anyone who is at risk of hepatitis B infection should be vaccinated.

●Do not share any injection drug equipment (needles, syringes).

●Clean blood spills with a mixture of 1 part household bleach to 9 parts water.

Hepatitis B cannot be spread by:

●Hugging or kissing

●Sharing eating utensils or cups

●Sneezing or coughing

●Breastfeeding

Preventing infection from mother to child — If a mother tests positive for hepatitis B surface antigen, certain steps can be taken to decrease the risk of transmitting the virus to the infant. These include:

●Antiviral medications may be recommended for the mother if the amount of virus in her blood (viral load) is high. These medications are used to decrease the viral load.

●Infants should be given a shot soon after birth called hepatitis B immunoglobulin (HBIG). HBIG provides immediate protection to the infant, but the effect only lasts a few months.

●Infants should also receive the hepatitis B vaccine series. The first dose of hepatitis B vaccine should be given at birth. These infants should have a blood test for hepatitis B surface antigen and for hepatitis B antibody at 9 to 12 months of age, or one to two months after the last dose of hepatitis B vaccine if immunization is delayed. If the results of the antibody test suggest that the infant is still susceptible to the infection, additional vaccination is needed.

                                                                                             -:   Dr Arun Aggarwal Gastroenterologist