Hepatitis B Symptoms, Types and Causes of Infection

Men More at Risk of Hepatitis B

USA, New Jersey, Jersey City, Doctor discussing medical results with male patient in hospital
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Hepatitis is inflammation of the liver caused by a virus. Globally, there are over 400 million chronic carriers of hepatitis B. Of the 200,000 people who contract hepatitis B each year in the USA, 10-15,000 go on to develop a chronic form of the disease.

Men are six times more likely than women to become chronic carriers of the hepatitis B virus (HBV), but the reasons for this are unclear.

Types of Hepatitis B Viruses

Of the adults who get the Hepatitis B virus, 95 per cent clear the virus and do not go on to have the chronic form of the disease.

Some people have few symptoms or none at all, so may not realize they have HBV or that they have had it. Many adults will clear the virus completely within 6 months. The good news is that the protective antibodies produced fighting the infection means that people who have had it will never have to worry about HBV again as they will be immune.

There are three types of hepatitis B infections:

  1. Healthy chronic carriers of hepatitis B are not infectious to others, and although they may have a slightly higher risk of cirrhosis and liver cancer than the general population, they mostly live normal lives. The virus can become reactivated if their immune systems become suppressed, such as during a severe illness, or during treatment with immunosuppressant drugs for diseases like cancer or AIDS, or with drugs such as steroids.
  2. Chronic infectious hepatitis B is highly infectious. The person with it is may have very inflamed and damaged liver even when the person has few or no symptoms. People with this type of hepatitis B are more likely to have a progressive disease leading to cirrhosis. Only 5% to 10% have a spontaneous remission, become non infectious to others and sustain no further or minimal liver damage, although sometimes reactivation of the virus occurs.
  1. Chronic mutant hepatitis B is a mutated strain of the virus with a permanent alteration of the hepatitis B virus’s genetic makeup. Those with it have the potential to be infectious to others, and it is thought to be more resistant  to treatment than the other forms of the disease.

How Do You Get Hepatitis B?

Hepatitis B is transmitted through contaminated bodily fluids:

  • blood
  • sweat
  • tears
  • saliva
  • semen
  • vaginal secretions
  • menstrual blood
  • breast milk.

Transmission can occur when using the same syringe as an infected person, receiving blood transfusions prior to 1975 (blood supplies are now screened in most countries), and having tattoos or body piercing. Hepatitis B can also be transmitted during child birth from mother to child, during medical procedures, through occupational exposure, and during sexual intercourse.

Having Hepatitis B does not necessarily mean that a person is infectious to other people, only some people with HBV are contagious.

Discovering Whether You Have Hepatitis B

There are many ways people may discover they have hepatitis. Because there are sometimes so few specific symptoms beyond fatigue, for example, that it may only be diagnosed when blood tests are performed—sometimes for unrelated reasons, such as prior to giving blood donations, medicals for insurance purposes, general health checks or following work related injuries.

Signs and Symptoms of Hepatitis B

Acute Hepatitis B Symptoms
In its severe form, hepatitis B symptoms can make the person feel extremely ill.

Others may believe they have the flu, and some may experience no symptoms at all.

Symptoms include: jaundice, fever, abdominal pain, poor appetite, nausea, vomiting, fatigue, dark colored urine, light colored stools, muscle and joint pains and rash. The liver may be enlarged and tender.

Chronic Hepatitis B Symptoms
Again, signs and symptoms can vary and many people will be unaware that anything profound is wrong, or experience only vague symptoms. These can include mild or restless fatigue, jaundice and enlarged liver.

Unfortunately if chronic hepatitis is not cleared by the body or is not successfully treated and cured, then liver disease or liver failure may result.

Fulminant Hepatitis
Fulminant hepatitis is a severe but very rare form of acute hepatitis. It may begin with fatigue and nausea, but within a few weeks the signs and symptoms become pronounced. About 2 weeks after jaundice develops, encephalopathy develops. 

Encephalopathy is a state of impaired or altered mental status. In its mild form there may be some short term memory loss, forgetfulness, slurring of speech, small behavioral personality or behavioral changes, or changes in sleep patterns. In its severe form a person may experience severe loss of memory, such as not knowing the date, the year, their own name or address, confusion, exhibit inappropriate behavior, poor coordination, asterixis (uncontrollable flapping of the hands), fetor hepaticus (foul smelling breath), and coma. Up to 85 per cent of people with this type of rare hepatitis will die without a liver transplant.

Diagnostic Tests for Hepatitis B

Blood Tests for Hepatitis B
Blood tests will show the presence of the disease and what is affected. A hepatitis B serology blood test will give an accurate diagnosis of the type of hepatitis present as there are different strains of the virus.

Blood Test-Liver Function Tests for Hepatitis B
These blood tests show how well the liver is functioning but it does not accurately assess all of the many and varied functions that the liver is responsible for in our bodies.

They do check the level of liver enzymes, transaminases and cholestatic enzymes, bilirubin and liver protein levels, all of which can be affected by the liver virus.

High levels of transaminases in the blood do not always reveal how badly the liver is inflamed or damaged. Elevations in these can also occur as a result of genetic liver disease, liver tumors and heart failure. The normal ranges of AST and ALT transaminases are around 0 to 40 IU/L and 0 to 45 IU/L respectively. In chronic hepatitis B the levels are usually two to three times above the normal range.

Blood Test-Liver Proteins and Hepatitis B
Albumin, prothrombin and immunoglobulins—proteins made by the liver—are checked, and abnormal levels are indicative of severe liver disorder. Prothrombin times, because the liver produces many of the clotting factors required to stop bleeding, needs to be determined.

Liver Biopsy
Liver biopsy is one of the main and most accurate diagnostic procedures that can determine what is wrong with the liver and how badly it has been damaged.

As most liver diseases affect the entire organ uniformly, the small sample obtained by biopsy, generally performed under a local anaesthetic, will show any abnormalities. For most, the guided liver biopsy is a safe and efficient diagnostic tool.

Treatments for Hepatitis B

Treatment of Acute Hepatitis B
Acute hepatitis B is treated conservatively with rest and plenty of fluids.

You may not need bed rest; it depends on how ill you feel. If you are up to it, then there is no reason why you should not go to work. It is important to lead a healthy life, so stop smoking (try hard!) and eat a healthy diet. Definitely give up alcohol for a few months as the liver needs time to recover.

Treatments Available for Chronic Hepatitis B
For those people whose bodies are unable to clear the virus, HBV will go on to become a chronic condition. Not long ago there was no treatment for hepatitis B; however there are now a number of treatments available that are proving very effective. The future is looking a lot brighter, and scientists and drug companies are hoping that within the next few years a treatment will be discovered that will offer a cure for everyone with chronic hepatitis B.

Current Treatments for Hepatitis B
Treatment with antiviral therapy is available for people with chronic hepatitis B although it is not recommended for all infected individuals. Treatment is aimed at suppression of the hepatitis B virus and stopping active liver disease.

The FDA (Food and Drug Administration) has approved two drug types, alpha interferon and lamivudine. Alpha interferon, given by injection, stimulates the body’s immune system and is administered for 16 weeks. It is very expensive and does have a number of side effects, a few of them serious. Lamivudine, taken orally for 52 weeks, although it has few side effects, is not as long lasting as interferon. Relapse is a common feature and its use can lead to antiviral resistance.

Response rates to the drugs in successful treatment programs are variable. The FDA reports (Oct. 2002) that it is "above 50 percent in patients with ALT levels greater than five times the upper normal limit of normal, but lower (20%-35%) in patients with ALT levels less than two times the upper limit of normal. In patients with ALT levels less than two times the upper limit of normal, response rates are poor and therapy should be deferred."

A new drug type—nucleotide analogue adefovir dipivoxil (Hepsera)—offers a potential third option and was approved by the FDA for treatment of hepatitis B in September of 2002.

Prognosis for Hepatitis B

Approximately 2 percent of chronic hepatitis B sufferers each year go on to develop cirrhosis.

  • Over five years, the cumulative probability of developing cirrhosis is 15 to 20 percent.
  • The five-year survival rate after cirrhosis develops is between 52 and 80 percent.
  • If decompensated cirrhosis (cirrhosis accompanied by complications such as bleeding and encephalopathy) develops, survival rates decrease to between 14 and 32 percent.
  • There is an increased risk of liver cancer. Worldwide about 1 million people a year die from the complications of Hepatitis B.

Prognosis is less favorable for those with the following factors:

  • Poor general health
  • Access to inadequate health systems, lack of funds, poor hygiene, etc.
  • The elderly
  • Infections of hepatitis D and hepatitis B
  • Infections of hepatitis C as well as hepatitis B
  • Advanced hepatitis
  • Continued consumption of alcohol after a diagnosis of chronic hepatitis

Additional problems of Hepatitis B and D

Hepatitis D (HDV) can only exist with the hepatitis B virus. Hepatitis D is transmitted in the same way as hepatitis B, and can be caught at the same time as HBV (co-infection) or subsequent to HBV infection. Co-infection is known to clear the body well (90 to 95 percent). In the case of superinfection, 70 to 95 percent go on to have the more serious chronic form of HDV.

Hepatitis B Prevention

A vaccine is available, and it is advised for those at risk or in contact with the disease.

The vaccine is 90 to 95 percent effective in preventing hepatitis B and the chronic form of the disease.

79 percent of World Health Organization members have adopted the universal childhood hepatitis B vaccination policy. Unfortunately the cost of the vaccination and the simple means of transmission of this virus mean that the overall incidence of hepatitis B infections continues to rise.

For people who know they are infected carriers of the hepatitis B virus can take precautions to prevent infecting others. These include the appropriate disposal of contaminated waste, using separate toothbrushes and scissors, never sharing needles and syringes with others, always using condoms and avoiding anal intercourse.

If your job involves working in high risk areas, you should consult your doctor for advice on precautions and any effects that it may have on your future health. All people infected with hepatitis B should get a hepatitis A vaccine to prevent becoming infected.

If You Discover You Have Hepatitis B

If you find out you have hepatitis B, don't despair. Get a doctor specializing in hepatology to advise you on the best treatments, and on how you can maximize your health to fight the virus.

Remember you are not alone, there are millions of people with hepatitis B. Find a local support group through the internet or ask your medical team that is providing your care what support systems are available.

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