Brief Overview: According to the CDC, “Hepatitis B is a vaccine-preventable liver infection caused by HBV. HBV is transmitted when blood, semen, or another body fluid from a person infected with the virus enters the body of someone who is uninfected. Hepatitis B can range from a mild, short-term, acute illness lasting a few weeks to a serious, long-term, chronic infection. Acute hepatitis B can lead to a lifelong infection known as chronic hepatitis B. Left untreated, chronic hepatitis B can cause serious health problems, including liver damage, cirrhosis, liver cancer, and even death. There are some medications for chronic hepatitis B; they aren't a cure and are only helpful for some people with chronic hepatitis B.”
Prevalence: The CDC estimates that 640,000 people in the U.S. have chronic hepatitis B.
Etiology: Hepatitis B is caused by Hepatitis B virus. Hepatitis B is contagious. It is spread through contact with infected blood and bodily fluids. Chronic infection occurs when the virus remains in the body for 6 months or more.
Risk Factors:
- History of acute hepatitis
- Unprotected sex with an infected person
- Sharing drugs, needles, or other drug equipment with others
- HIV, Hepatitis C
- Being born to people with Hepatitis B
- Liver damage, liver disease
- Spending time in jail, prison
- Dialysis
- Immunosuppressed
- Workplace blood exposures
- Living with someone who has Hepatitis B
- Men who have sex with men
Commonly Associated Conditions:
- Cirrhosis
- Hepatocellular carcinoma
- Chronic Kidney Disease
- Hepatitis D coinfection
Common Medications:
- Treatment is not always needed right away
- Antiviral therapy
Common Labs, Imaging, and Tests:
- Labs: Hepatitis B antigen and antibody tests, HBeAg, anti-HBe, Hepatitis B DNA, CMP, CBC, PT/INR
- Screening for HIV, HCV, HDV
- Alpha-fetoprotein (AFP)
- Liver ultrasound, liver biopsy
- Elastography, assessment of liver fibrosis
Common Symptoms:
- Typically, asymptomatic
- Fatigue
- Loss of appetite
- Abdominal pain (typically RUQ)
- Joint pain
- Muscle aches
Common Treatments:
- Medications (see above)
- Surgical intervention may be indicated
- Treatment is not always needed right away. Sometimes your doctor will closely monitor you before recommended treatment.
Physical Findings:
- Typically, normal physical exam
- Hepatomegaly may be present
Potential Complications and Contraindications:
- Glomerular disease
- Polyarteritis nodosa
- Cirrhosis
- Hepatocellular carcinoma
- Hepatic decompensation, liver failure
- Liver transplant may be needed if severe liver damage occurs
- Hepatitis D
- Reactivated Hepatitis B
General Health and Lifestyle Guidance:
- Avoid alcohol
- Smoking cessation
- Ask your healthcare provider before taking any OTC medications, supplements, vitamins, or herbal remedies
- Ask your healthcare provider if you need to avoid NSAIDs
- Consume a healthy, balanced diet. Maintain optimal weight.
- Exercise regularly, as directed by your healthcare provider.
- Stay up to date on all age-appropriate vaccinations (Hep A, flu vaccine, Tdap, etc.). Talk to your healthcare provider about which vaccines are recommended for you.
- According to UpToDate, “treatment should not be stopped without discussing this with your doctor because, in some cases, the virus can come back quickly, causing severe liver injury.”
Suggested Questions to Ask Patients:
- Do you know when or how you contracted hepatitis B?
- Are you aware of your current liver health or viral load?
- Have you had imaging or labs done recently?
- Do you have any symptoms like fatigue, pain, or yellowing of the skin?
Suggested Talking Points:
- There is currently no cure for Hepatitis B. You will need lifelong monitoring.
- You may be managed by multiple specialists for this.
- Treatment goal is to keep the virus suppressed and prevent liver damage and any complications.
- Encourage household and sexual contacts to talk to their healthcare providers about testing and vaccination
- Practice safe sex and avoid sharing razors, toothbrushes, or needles, etc.
- Make sure to follow up with your healthcare providers as directed. Complete all lab work and testing that is ordered.
- According to Cleveland Clinic, “You’re contagious as long as the virus is active in your body. If you have active chronic hepatitis B, you’ll be contagious for the rest of your life. If you have inactive chronic hepatitis B, the risk would be lower.” Ask your healthcare provider about your risk of spreading Hepatitis B.
Sources:
- UpToDate
- Cleveland Clinic
- CDC