Hepatitis B is a viral infection that affects the liver. One of the most common liver infections, Hepatitis B is a serious disease of the human body and about two billion people across the world have been infected by this. It is also known as a silent infection because symptoms do not show for at least six months after the HBV exposure. Although, the disease is preventable and curable, about one million people die from Hepatitis B.
The Hepatitis B virus (HBV) spreads through infected blood and body fluids. It may get transmitted through:
- Direct contact with infected blood
- Unsafe sex with an infected person
- Using needles used by an infected person
- Tattoo piercing using unsterilized tools
- Sharing of personal items, such as razor and toothbrush with an infected person
- Infected mother to child at the time of pregnancy or childbirth
A person may have acute or chronic Hepatitis B depending on the duration for which the virus HBV has been present in his blood:
- Acute Hepatitis B: A person has acute hepatitis B when he initially gets infected with the HBV. Acute Hepatitis B generally does not show any symptoms and an average healthy person gets easily cured of the problem.
- Chronic Hepatitis B: When the virus HBV remains in the blood for six months after initial exposure, the disease takes the form of chronic Hepatitis B. The virus remains in the body for life and needs to be kept under control through medication and diet control. This is a serious condition as it may lead to liver cirrhosis.
In most cases, symptoms of Hepatitis B do not show for about six months after contracting the disease. The infected person has flu-like symptoms. They include:
- Mild fever
- Itching all over the body
- Dark urine
- Tan or gray stools
- Stomach ache
- Loss of appetite
- Yellow eyes and skin
Blood tests, known as Hepatitis B Panel, are conducted to diagnose the presence of HBV in the body. These blood tests are able to detect:
- Viral antigens i.e., proteins generated by a virus
- Antibodies produced by the infected body to fight the virus
- DNA of the virus called viral load
The tests conducted are:
- Hepatitis B Surface Antigen test (HBsAg): This test is most frequently used to detect the infection. Positive test result implies that the person is suffering from Hepatitis B and is contagious. However, this test does not identify the type of hepatitis B.
- Hepatitis B surface antibody test (HBsAb or Anti-HBs): A positive result of this test is indicative of the generation of antibodies to protect against the hepatitis B virus. This means, the person is vaccinated or has recovered from acute hepatitis B and is not contagious to spread the disease.
- Hepatitis B core Antibody test (HBcAb or Anti-HBc): This test detects whether a person is infected with HBV. Positive report indicates that the person is currently suffering from acute or chronic Hepatitis B. The HBc test is not indicative of protection against HBV while HBs indicates the immunity towards HBV.
- Hepatitis B virus DNA test (Viral load): In case, DNA of HBV is detected in the blood, it signifies that the virus is in a state of activity and growing. In acute hepatitis, HBV DNA is present at the beginning of the infection but disappears once the patient has recovered. In chronic hepatitis, the levels of viral load continue to grow for many years.
- Liver function tests: Patients with HBV must get the liver function tests done to check the enzyme formation by the liver. Presence of high level of liver enzymes suggests abnormal liver function due to liver inflammation or damage. Ultrasound or other imaging tests for the liver may also be required.
Treatment and Management
- Acute Hepatitis B infection does not need antiviral medications:
- Patients with mild symptoms can be cared at home and recover with proper rest and intake of lots of fluids
- In case, the infected person has diarrhea or vomiting, he may be given IV fluids to ensure the electrolyte balance in the body
- Chronic Hepatitis B treatment depends on the phase of the disease in a patient. Periodic testing of viral load in blood gives an indication of how fast the HBV is multiplying. Treatment is started when liver functions show deterioration due to increased HBV. The medications used are called antiviral drugs as they stop the growth of the virus.
- Use of antiviral agents is the best therapy for Chronic Hepatitis B. However, it may not be effective for all individuals. It is specifically used for cases where the chronic Hepatitis B has a high probability to turn into cirrhosis.
- The direction of treatment is decided on the basis of Hepatitis B panel tests, liver function tests, and liver biopsies, as well as general health checkup and complete health history examination.
- The use of medications for the treatment of chronic Hepatitis B is decided by the patient in consultation with the gastroenterologist and hepatologist.