for Veterans and the Public
Hepatitis B Entire Lesson
What is hepatitis B?
The term "hepatitis" means inflammation of the liver. When the liver is inflamed, it can have a harder time doing some of its jobs. (See Understanding the Liver.) 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 to a serious, lifelong illness. It results from infection with the hepatitis B virus. Hepatitis B can be either "acute" or "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.
The younger a person is when infected with hepatitis B virus, the greater his or her chance of developing chronic hepatitis B.
Hepatitis B virus is contained in blood and body fluids. It is not contained in food or water. It 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 mother to her 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 of hepatitis B?
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 disease
- 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 infants born to infected mothers
- Are exposed to blood on the job
- Are hemodialysis patients
- Travel to countries with moderate to high rates of hepatitis B
Will you know if you have hepatitis B?
Not necessarily. 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 (or jaundice)
- Not feeling hungry
- Feeling tired
- Muscle, joint, or stomach pain
- Stomach upset, diarrhea, or vomiting
What tests will you have to do?
You can be tested for hepatitis B at your VA medical center. This test is done by taking a sample of your blood.
Your doctor may ask you to do 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
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 have the disease
- Hepatitis B surface antigen
If this test is positive, it means that
- you do currently have hepatitis B infection
- you can spread the virus
- Hepatitis B e antigen
If this test is positive, it means that
- you may have very active hepatitis B and should be followed closely by your doctor and possibly take hepatitis B medications
- you may be very contagious to others
Should all patients with chronic hepatitis B be on treatment?
No, not all patients with hepatitis B need to be on treatment. Choosing the right time for hepatitis B treatment is not a simple decision. It is based on the results of blood tests, the patient's age, and the degree of scarring in the liver. A liver biopsy may be required.
What determines whether a patient with chronic hepatitis B needs treatment?
Hepatitis B drugs are recommended for patients with very active virus and an inflamed liver. These patients will have a very high amount of hepatitis B virus in their blood (sometimes referred to as the hepatitis B viral load) and an unusually high level of a chemical known as ALT, which is one of the "liver enzymes" that helps the liver do its work. People with cirrhosis also may be candidates for treatment.
Over time, patients can go through different phases with their hepatitis B. A patient can have a low amount of virus and normal level of ALT for many years, prolonged periods of high viral loads and ALT levels, or short bursts of high viral activity that later subside. It is important to use hepatitis B treatments during phases of high viral activity and prolonged liver inflammation. Doctors will track the phase of a person's hepatitis B by the results of blood tests. Because infected people go through the various phases of hepatitis B, it is recommended that they have blood tests on a regular basis.
For the small percentage of patients who have chronic hepatitis B and also have chronic hepatitis C, when it comes time to be treated with medication for the hepatitis C virus, the hepatitis C medications can cause the hepatitis B virus to flare. In order to prevent this from happening, these patients will need to take hepatitis B treatment (with different medications) at the same time that they take the hepatitis C virus medications.
Will treatment of hepatitis B cure the infection?
No. Even if treatment is successful, it doesn't completely get rid of the hepatitis B virus from the liver. However, successful treatment can stop the hepatitis B virus from replicating (making copies of itself) and can stop the inflammation and fibrosis. Stopping the inflammation will reduce the chance of developing cirrhosis or liver cancer.
What treatments are available for chronic hepatitis B?
There are two categories of drugs used for hepatitis B treatment.
Injections: Interferon and pegylated interferon
Drugs called pegylated interferon and interferon are both approved by the FDA for the treatment of hepatitis B infection. Pegylated interferon is a long-acting form of interferon that can be used only once per week; standard interferon is a short-acting form used multiple times per week. These are also used in the treatment of hepatitis C and some other diseases. Pegylated interferon is used more commonly than standard interferon.
- Pegylated interferon is given as a shot under the skin.
- 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.
Oral antiviral medications
There are five oral medications approved by the FDA for hepatitis B treatment.
Of these, entecavir and tenofovir are the most commonly used.
The oral antiviral medications for hepatitis B are:
- Easy to tolerate without many side effects
- Taken by mouth once per day
- Usually given for several years
Hepatitis B can develop resistance to these oral hepatitis B drugs. To avoid this, patients should take their hepatitis B medicine every day.
What will I need to do if I am on hepatitis B medications?
If you are receiving hepatitis B medications, you will need to be monitored very closely by your physician. You will need blood tests every 3 to 6 months to monitor the viral load and the ALT level and other hepatitis B tests (such as "e antigen," which often occurs when the viral load is high), and you will need to see your doctor regularly as well.
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 normal body weight and avoid becoming overweight.
- Avoid unsafe sex.
- Avoid sharing drug needles.
- Ask your doctor about tests to check for liver damage.
- Check with your doctor about the hepatitis A vaccination.
- Be up to date on vaccinations for influenza, pneumonia, tetanus/diphtheria/pertussis, and shingles.
- Learn how to protect yourself from other hepatitis viruses.
- Join a support group for people which chronic hepatitis B.
How Do You Protect Yourself Against Hepatitis B?
High-risk behaviors are things that some people do that make them more likely to get a disease. You can get hepatitis B through contact with (or by touching) 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.
- Practice safer sex. Use condoms every time you have sex.
- Don't shoot drugs. If you are using drugs now, try to get help to stop. VA has programs to help you. If you cannot stop, then don't share needles and works.
- Don't share personal care items like razors, toothbrushes, and nail clippers
If you can stop high-risk behaviors like these, it can also prevent you from getting other viruses like HIV (human immunodeficiency virus) and hepatitis C virus. Please speak with your doctor or nurse to get more information about these viruses.
Should you get the hepatitis B vaccine?
You may need the vaccination against hepatitis B if you have not previously been vaccinated against hepatitis B AND you have any of the following reasons for receiving the vaccination:
- Chronic hepatitis C
- Alcoholic hepatitis
- Liver cirrhosis or liver fibrosis
- Other chronic liver disease
- Awaiting or received liver transplant
- Findings consistent with liver disease (such as esophageal varices)
- HIV infection
- Use of injection drugs currently or in the past
- Have a sex partner who has hepatitis B
- Have had more than one sex partner in the past 6 months
- Men who have sex with men
- Share a household with someone who has chronic hepatitis B
- Travel to countries with high or intermediate rates of hepatitis B infection (there are high rates of hepatitis B in China and other parts of Asia, in the Amazon, and in the southern parts of eastern and central Europe; there are intermediate rates of hepatitis B in the Middle East and Indian subcontinent)
- Reside or work in a prison or correctional facility
- People with end-stage renal disease including patients receiving dialysis
- People who are seeking evaluation or treatment for a sexually transmitted disease (STD)
- Work in a high-risk profession with reasonable anticipation of risk of exposure to blood or body fluids, such as:
- Health care centers
- Dialysis centers
- Emergency response or firefighting
- Law enforcement
- Clients and staff in the following settings:
- Institutions and non-residential daycare facilities for persons with developmental disabilities
- STD treatment facilities
- HIV testing and treatment facilities
- Facilities providing drug-abuse treatment and prevention
- Health care settings that target services to injection-drug users or men who have sex with men
- Facilities for chronic hemodialysis patients
- Persons aged 19-59 who have diabetes mellitus SHOULD receive the vaccination. Persons aged 60 and older who have diabetes mellitus MAY receive the vaccination, and should discuss it with their health care providers.
Certain ethnic groups have higher rates of hepatitis B virus infection. You may need the vaccination if you are African American, Latino, Native American, Haitian, Alaskan Native, Vietnamese, Chinese, Korean, or Filipino.
Patients with the following conditions should discuss hepatitis B vaccination with their doctor: pregnancy, immunocompromising conditions, diabetes, heart disease, chronic lung disease, asplenia, chronic alcoholism.
Should pregnant or breast-feeding women receive the hepatitis B vaccination?
Pregnancy is not a contraindication to vaccination. Some data suggest that developing fetuses are not at risk of adverse events when hepatitis B vaccine is administered to pregnant women.
Do I need to be tested for hepatitis B before getting the vaccination?
Your provider may decide to test your blood for antibodies to hepatitis B, but this is not mandatory for everyone. If you have antibodies to hepatitis B, it means that you were infected with hepatitis B in the past, or you were previously vaccinated for hepatitis B. Either way, you don't need to get the hepatitis B vaccination if you already have antibodies to hepatitis B.
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 the 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. Unlike the vaccine, which is not given after exposure, HBIG is given before a potential exposure. HBIG will protect you for 3 to 6 months, but it is strongly recommended that you also begin the 3-shot hepatitis B vaccination series within 7 days of your exposure.
How is the hepatitis B vaccine given?
The hepatitis B vaccine is a "recombinant vaccine," which means that it is a fragment of the hepatitis B virus that has been produced in a laboratory. The vaccination for hepatitis B is given as 3 injections over a 6-month period--an initial dose, followed by a second dose 1 month later, and a third dose 5 months after the second.
If you need hepatitis A vaccination in addition to hepatitis B, you can do these individually or as a combined vaccine that covers both. The combination vaccine is given as 3 injections over a 6-month period--an initial dose, followed by a second dose 1 month later, and a third dose 5 months after the second.
If you are not able to get the shots on time, it is not necessary to restart the series, but you should continue from the last dose given. Babies born to mothers who have chronic hepatitis B should get the first shot within 12 hours after birth, followed by a second shot 1 month later, and the third shot 5 months after the second. Babies born to mothers who are not infected with the hepatitis B virus should get the first shot within 1 to 2 months after birth, the second shot a month later, and the third shot 5 months after the second.
You will NOT get hepatitis B from the vaccine.
You will be protected for about 13 years. If it has been many years since you received your hepatitis B vaccination, or if you do not know when you were vaccinated, ask your doctor to check to see if you have antibodies against hepatitis B.
What vaccines are available for hepatitis B?
There are 2 vaccines for hepatitis B on the market. There is 1 combination vaccine on the market for hepatitis A and B together.
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.
Products and Publications
- Hepatitis B Fact Sheets for Veterans
Two-page printable fact sheets
- The ABCs of Hepatitis
Two-page guide to the symptoms, treatment, and prevention of hepatitis A, B, and C
- ABCs of Hepatitis (video)
This 15-minute video was created for general education on hepatitis A, B, and C in substance use disorder programs.Transcript included.
- Drinking Diary and Change Plan
Wallet card for patients to record their alcohol use over a 4-week period as a way to monitor and reduce their drinking behavior.
Definitions of terms commonly used with viral hepatitis and related conditions.
- American Liver Foundation
A national nonprofit organization dedicated to the prevention, treatment, and cure of hepatitis and other liver diseases through research, education, and advocacy. Web site features a database directory of hepatitis clinical trials, lay-oriented facts sheets, and links to additional resources.
- Centers for Disease Control and Prevention: Viral Hepatitis
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.
- Hepatitis Risk Assessment
5-minute assessment developed by the federal Centers for Disease Control and Prevention that gives you a personalized report of your hepatitis risk
- Hepatitis Risk Assessment
- NATAP: Hepatitis
Recogizing that coinfection with viral hepatitis among people with HIV is a growing problem, the National AIDS Treatment Advocacy Project (NATAP) has developed an extensive amount of information on hepatitis, both in the context of HIV coinfection and as a separate illness. NATAP provides coverage of key conferences, maintains a selection of hepatitis articles, and features an ask-the-expert forum on hepatitis C.