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Viral Hepatitis and Liver Disease

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Hepatitis B Entire Lesson

for Veterans and the Public

Hepatitis B Entire Lesson - Hepatitis B for Patients

Getting Tested

What is hepatitis B?

A hepatitis virus is one that lives in liver cells and causes inflammation. Different hepatitis viruses have been given different names, such as A, B, and C.

Hepatitis B is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks ("acute") to a serious, lifelong illness ("chronic").

Acute hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to HBV. Acute infection can — but does not always — lead to chronic infection.

Chronic hepatitis B virus infection is a long-term illness that occurs when the virus remains in a person's body.

Hepatitis B virus is passed from person to person when blood, semen, or other body fluid infected with the virus enters the body of a person who is not infected. People can become infected with the virus during activities such as:

  • Birth (spread from an infected parent to baby during birth)
  • Sex with an infected partner
  • Sharing needles, syringes, or other drug-injection equipment
  • Sharing items such as razors or toothbrushes with an infected person
  • Direct contact with the blood or open sores of an infected person

Who is at risk?

Although anyone can get hepatitis B, some people are at greater risk, such as those who:

  • Have sex with an infected person
  • Have multiple sex partners
  • Have a sexually transmitted illness
  • Are men who have sexual contact with other men
  • Inject drugs or share needles, syringes, or other drug equipment
  • Live with a person who has chronic hepatitis B
  • Are exposed to blood on the job
  • Are hemodialysis patients
  • Travel to countries with moderate to high rates of hepatitis B

What are the symptoms?

You may have hepatitis B for years and never have any symptoms. You can still spread the virus to others even if you don't have symptoms. When people do have symptoms, they can experience:

  • Yellowing skin or eyes (jaundice)
  • Not feeling hungry
  • Feeling tired
  • Muscle, joint, or stomach pain
  • Stomach upset, diarrhea, or vomiting

What tests are needed?

You can be tested for hepatitis B at your VA medical center. This test is done by taking a sample of your blood.

Your provider may recommend the following tests:

Hepatitis B surface antibody (Anti-HBs)

If this test is positive, it means that:

  • you have antibodies against hepatitis B and are safe from getting the disease
  • you were either vaccinated against hepatitis B or exposed to it at some point in your lifetime

Hepatitis B core antibody (Anti-HBc)

If the test is positive, it means that:

  • you have been exposed to hepatitis B and have developed an antibody to only part of the virus
  • they will do more tests to find out if you currently have the infection

Hepatitis B surface antigen (HBsAg)

If the test is positive, it means that:

  • you currently have hepatitis B infection
  • you can spread the virus to others

Hepatitis B e antigen (HBeAg)

If the test is positive, it means that:

  • you may have active hepatitis B and should be followed closely by your provider and possibly need hepatitis B medications
  • you may be very contagious to others

Treatment

Should all patients with chronic hepatitis B be on treatment?

Not all patients with chronic hepatitis B (HBV) need to be on treatment. The decision to treat HBV is based on several factors including blood tests results, the patient's age, and the risk of developing cirrhosis or liver cancer. Sometimes a liver biopsy is needed to see if there is significant liver damage (or scarring) to make a decision.

Hepatitis B medications are recommended for patients with detected HBV virus (also known as hepatitis B viral load) on a blood test and evidence of liver damage. Liver damage can be detected with a liver enzyme known as ALT. People with cirrhosis should be considered for treatment even if the liver enzymes appear normal.

Chronic hepatitis B may change over time. Patients can go through different phases with low amounts of virus and normal level of ALT followed by high viral loads and ALT levels. These bursts of virus activity usually don't cause any symptoms but may cause liver damage overtime. It is important that people with chronic hepatitis B have blood tests on a regular basis to see if treatment is needed.

There are some medications which can cause hepatitis B "reactivation" which can lead to life threatening liver failure. These medications are used to treat some cancers, inflammatory conditions and hepatitis C. Reactivation reactions can be prevented and it is important to let your provider know you have HBV before you start any new medications.

Will treatment of hepatitis B cure the infection?

There is no cure for HBV at this time, but treatment can stop the virus from replicating and triggering liver damage. HBV treatments lower the risk of developing cirrhosis and liver cancer.

What treatments are available for chronic hepatitis B?

Treatment is an oral antiviral medication. In rare cases, injections may be used.

Oral antiviral medications

There are five oral medications approved by the FDA.

  • Entecavir
  • Tenofovir disoproxil fumarate (TDF)
  • Tenofovir alafenamide (TAF)
  • Lamivudine
  • Adefovir

Of these, tenofovir and entecavir are most commonly used. Uncommon adverse effects can include nausea, abdominal pain, diarrhea, headache, fatigue, and dizziness. Talk with your provider if you experience any of these adverse effects.

Medications for hepatitis B are:

  • Easy to tolerate without many side effects
  • Taken by mouth once per day
  • Usually taken indefinitely

Patients who have both chronic HBV and HIV are typically on an HIV medication that includes drugs that treat HBV. If your HIV medication does not contain at least two drugs that work against HBV, your provider may prescribe an additional medication.

Injections: Interferon and pegylated interferon

Pegylated interferon is given as an injection once per week. It can be used alone or with an oral hepatitis B medication. Patients with both chronic hepatitis B and hepatitis D infection may need pegylated interferon alone or combined with an oral hepatitis B pill.

  • Pegylated interferon therapy is usually given for 48 weeks.
  • Pegylated interferon may cause many side effects, such as flu-like symptoms, rashes, irritability, and depression.
  • Side effects to interferon require close monitoring with routine blood tests.

What will I need to do if I am on hepatitis B medications?

  • Take oral medications every day to avoid developing resistance.
  • See your provider on a regular basis
  • If you have cirrhosis or high risk of liver cancer, get liver imaging on time as prescribed by your provider
  • Have periodic laboratory tests to monitor HBV viral load and liver enzymes to monitor disease activity and response to medications
    • You may need blood tests every 3-6 months initially and at least once a year thereafter if virus is undetected in blood.

Besides taking medication, what else can I do to stay healthy if I have hepatitis B?

If you have chronic hepatitis B, here are some suggestions on how to keep yourself healthy:

  • Avoid alcohol completely.
  • Do not smoke.
  • Maintain a healthy weight.
  • Avoid unsafe sex.
  • Avoid sharing needles. If you use injection drugs, ask your provider about getting sterile syringes.
  • See your provider routinely to monitor your liver health.
  • Get vaccinated if not immune to Hepatitis A.
  • Stay up to date on vaccinations for influenza, pneumonia, tetanus/diphtheria/pertussis, shingles, and COVID-19.
  • Learn how to protect yourself from other hepatitis viruses.
  • If you or your parents were born outside the USA, ask your provider if other family members should be tested for HBV (HBV is very common is some countries).

Prevention

Overview

Hepatitis B is a serious disease caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death. You can get hepatitis B through contact with the blood of a person who has the disease. You can also get hepatitis B through contact with other body fluids like semen and vaginal fluids. For example, you can get hepatitis B by having sex or sharing needles with a person who has the disease. Hepatitis B vaccine is available to prevent HBV infection.

Hepatitis B vaccine

Vaccination for hepatitis B is given as an injection in the upper arm and requires more than one dose.

If you need hepatitis A vaccination in addition to hepatitis B, you can do these individually or as a combined vaccine that covers both.

You may need the vaccination against hepatitis B if any of these are true for you:

  • are age 19 to 59 years and have not previously been vaccinated against hepatitis B virus
  • are at increased risk for infection with hepatitis B virus (see below)
  • have chronic liver disease
  • seek protection from hepatitis B infection

Increased risk includes:

  • household contacts of HBV-infected persons;
  • sexual contacts of HBV-infected persons;
  • persons who have shared needles with HBV-infected persons;
  • current or previous injection-drug use;
  • sexually active persons with more than one sex partner (i.e., in the past 6 months), or with a non-monogamous partner;
  • men who have sex with men;
  • persons seeking evaluation or treatment for a sexually transmitted infection (STI);
  • persons with HIV infection;
  • persons with diabetes who are under the age of 60 (adults with diabetes who are older than 60 may choose to be vaccinated);
  • persons with end-stage renal disease on dialysis or expected to be on dialysis;
  • health care personnel, public safety workers, and other persons with risk for exposure to blood or other potentially infectious body fluids;
  • residents and staff in care facilities for developmentally disabled persons;
  • residents in correctional facilities;
  • travelers to countries with high or intermediate prevalence of HBV infection

Do I need to be tested for hepatitis B before getting the vaccination?

In some cases, your provider may decide to test your blood for antibodies to hepatitis B, but this is not mandatory for everyone.

If the test shows that you have antibodies to hepatitis B, it means that you were infected with hepatitis B in the past, have current hepatitis B infection, or you were previously vaccinated for hepatitis B. It is important to discuss the results of your test with your provider. If you already have antibodies to hepatitis B, you don't need to get hepatitis B vaccination.

What should you do if exposed to the hepatitis B virus?

If you know you were recently exposed to the hepatitis B virus, you may get protection from an injection of hepatitis B immunoglobulin (HBIG), which is different from hepatitis B vaccine. HBIG is given only when it is suspected or known that someone has been infected with hepatitis B, and it is given within 24 hours after the exposure. HBIG will protect you for 3 to 6 months, but it is strongly recommended that you also begin the hepatitis B vaccination series within 7 days of your exposure.

What are the side effects of the hepatitis B vaccine?

There are very few side effects caused by the vaccine, but you may experience soreness at the injection site. You will NOT get hepatitis B from the vaccine. Pregnant women have received the hepatitis B vaccine with no risk to their babies.

Resources

Products and Publications

Web Resources

  • AmericanLiver FoundationLink will take you outside the VA website. VA is not responsible for the content of the linked site.
    A national nonprofit organization dedicated to the prevention, treatment, and cure of hepatitis and other liver diseases through research, education, and advocacy.
  • Centers for Disease Control and Prevention: Viral HepatitisLink will take you outside the VA website. VA is not responsible for the content of the linked site.
    Information on all types of viral hepatitis from the CDC's National Center for Infectious Diseases. Site features related CDC guidelines and recommendations as well as training materials, slide sets, fact sheets, and key CDC hepatitis documents.
  • NATAP: HepatitisLink will take you outside the VA website. VA is not responsible for the content of the linked site.
    Recognizing that coinfection with viral hepatitis among people with HIV is a growing problem, the National AIDS Treatment Advocacy Project (NATAP) developed an extensive amount of information on hepatitis, both in the context of HIV coinfection and as a separate illness.