Hepatitis B virus (HBV) infection

Symptoms Of Hepatitis B Virus (HBV) Infection

Many people, especially children, may show no symptoms initially. When symptoms do occur, they often appear 1 to 4 months after exposure and can vary from mild to severe. Common symptoms can include:

• Fatigue or tiredness
• Loss of appetite
• Nausea
• Abdominal discomfort or pain
• Dark urine and pale-colored stools
• Jaundice (yellowing of the skin and eyes)
• Mild fever and joint pain
• Flu-like symptoms such as muscle aches

Symptoms in severe or chronic cases:

• Persistent fatigue and weakness
• Swelling of the abdomen due to fluid buildup (ascites)
• Easy bruising or bleeding caused by impaired liver function
• Confusion or difficulty concentrating (hepatic encephalopathy)
• Signs of liver failure or liver cirrhosis
• Increased risk of liver cancer over time.

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Causes Of Hepatitis B Virus (HBV) Infection

Hepatitis B virus (HBV) mainly attacks the liver cells. The virus gets inside these cells and starts making copies of itself. This process can cause the immune system to react and try to fight the infection, which may lead to inflammation and damage in the liver. 

Incubation period

• The incubation period of HBV ranges from 30 to 180 days
• During this period, the virus replicates in the liver, but symptoms may not be evident initially

Mode of transmission

HBV spreads through exposure to infectious blood or body fluids. Common modes include:

• Perinatal transmission (mother to child during childbirth)
• Sexual contact
• Sharing of needles or syringes
• Exposure to contaminated medical equipment
• Less commonly, through saliva, tears, or sweat, when there is direct blood contact.

Risk Factors For Hepatitis B Virus (HBV) Infection

Hepatitis B virus spreads through various routes, with certain behaviors and conditions significantly increasing the risk of infection. These include:

• Mother-to-child transmission (Perinatal): Babies born to HBV-infected mothers are at high risk, especially without timely vaccination.

• Unprotected sexual contact: Having multiple sexual partners or engaging in unprotected sex increases the risk of HBV transmission.

• Injection drug use: Sharing needles or syringes exposes individuals to infected blood. 

• Healthcare exposure: Accidental needle sticks or exposure to contaminated medical instruments can spread the virus.

• Household contact: Living with someone who has chronic HBV infection increases risk due to potential exposure to bodily fluids. 

• Men who have sex with men (MSM): This group is at higher risk due to the increased likelihood of exposure to infected fluids.

• Travel or residence in high-endemic areas: Regions such as Asia, Africa, and the Pacific Islands have higher rates of HBV.

• Receiving unscreened blood transfusions: Though rare in countries with stringent screening, this remains a risk in areas with limited blood safety measures.

• Age and gender: Older adults and males are at increased risk of HBV infection.

Diagnosis Of Hepatitis B Virus (HBV) Infection

Diagnosing Hepatitis B involves a combination of history, examination, and specific laboratory tests to confirm infection and assess disease activity. It consists of:

1. History and physical examination

• Your doctor will ask about risk factors such as recent exposure to infected blood, vaccination, and travel history.
  

• A physical exam is done to check for signs of liver disease.

2. Serological markers

• Hepatitis B Surface Antigen (HBsAg): Primary marker for acute or chronic infection. Persistent levels beyond six months indicate chronic hepatitis B.

• Anti-Hepatitis B Core Antibody (anti-HBc): This is a simple blood test that checks IgM and IgG antibodies and can show whether you have a recent or past hepatitis B infection.

• Hepatitis B e Antigen (HBeAg): This is a marker of active hepatitis B virus replication and high infectivity.

• Anti-HBe Antibody: This antibody appears after HBeAg clearance, suggesting reduced viral activity and infectivity.

• Anti-Hepatitis B Surface Antibody (anti-HBs): It indicates protection against hepatitis B due to vaccination or recovery from past infection.

Molecular testing

• HBV DNA test: It checks how much virus is in the blood to understand how active the infection is and how well treatment is working.

• Genotyping and resistance testing: Identifies the type of hepatitis B virus and whether it may resist certain medicines.

Liver function and histology

• Liver function test: It helps detect liver damage caused by hepatitis B by measuring enzyme and protein levels in your blood.

• Non-invasive fibrosis assessment (FibroScan): Evaluates liver stiffness to detect fibrosis or cirrhosis.

• Liver biopsy: Occasionally used for detailed tissue analysis when needed.

Special considerations

• Occult HBV infection: The virus is present in the body even if the usual surface marker (HBsAg) doesn’t show up in tests.

• Immunocompromised people: May need more detailed testing because standard tests might miss the infection.

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Specialists To Visit

Seeing the right specialist can ensure timely diagnosis and effective treatment of hepatitis B. Doctors who can help:

• General physician
• Gastroenterologist
• Hepatologist
• Infectious disease specialist
• Obstetrician (for pregnant women)

A general physician is your first point of contact for symptoms, tests, and vaccination guidance.

A gastroenterologist specializes in liver diseases and manages hepatitis B-related liver complications.

A hepatologist focuses exclusively on liver health and advanced hepatitis B care.

An infectious disease specialist helps manage complex or chronic hepatitis B cases, especially with co-infections.

An obstetrician ensures safe pregnancy management if you're HBV-positive and protects the baby from infection.

When to see a doctor?

Consult a doctor: 

• If you experience symptoms like fatigue, jaundice, or abdominal pain
• After unprotected sex with a partner whose HBV status is unknown
• If you share needles or drug-injecting equipment
• Before starting immunosuppressive therapy
• During pregnancy (for HBV screening)
• If a family member or close contact is diagnosed with HBV
• Before or after travel to high-risk regions
• For regular monitoring, if you are living with chronic HBV.

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Prevention Of Hepatitis B Virus (HBV) Infection

Preventing hepatitis B is crucial, as it can lead to serious liver diseases. The good news is that hepatitis B is highly preventable through a combination of vaccination and safe practices. These include:

1. Get vaccinated

• The hepatitis B vaccine is over 95% effective and offers long-term protection.

• WHO recommends administering the first dose within 24 hours of birth, followed by 2–3 additional doses. 

• Adults aged 19–59 and those at higher risk should also be vaccinated. 

For infants (3-dose schedule):

• Birth dose: Within 24 hours of birth

• Second dose: At 6 weeks of age

• Third dose: At 14 weeks of age

This is often given in combination vaccines like Pentavalent (which includes DTP, Hib, Hep B).

For children and  unvaccinated adults (Standard 3-dose schedule):

• First dose: Day 0

• Second dose: 1 month after the first dose

• Third dose: 6 months after the first dose

Note: For individuals needing rapid protection, such as travelers, an accelerated Hepatitis B vaccination schedule of 0, 7, and 21 days can be followed, with a booster dose recommended at 12 months to ensure long-term immunity.

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2. Practice safe sex

• Always use condoms and limit the number of sexual partners to reduce the risk of infections.

Using condoms consistently and correctly is one of the most effective ways to prevent sexually transmitted infections, including hepatitis B.
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3. Avoid sharing personal items

• Never share needles, syringes, razors, or toothbrushes, as they can carry infected blood.

4. Prevent mother-to-child transmission

• Pregnant women should be tested for hepatitis B. 

• If positive, the newborn should receive the hepatitis B vaccine and hepatitis B immune globulin (HBIG) within 12 hours of birth. 

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5. Use post-exposure prophylaxis

• If exposed to hepatitis B, receiving HBIG and starting the vaccine series promptly can prevent infection.

Treatment Of Hepatitis B Virus (HBV) Infection

Treatment for hepatitis B virus (HBV) infection aims to suppress viral replication, prevent disease progression, and reduce the risk of liver-related complications. Management strategies differ based on acute or chronic infection. They include:

Acute hepatitis B

• Supportive care: Most healthy adults with acute HBV infection recover without antiviral therapy. Management focuses on monitoring and symptomatic relief. 

• Antiviral therapy: Indicated for severe cases showing signs like prolonged jaundice, coagulopathy (blood not clotting properly), or hepatic encephalopathy (confusion or personality changes due to the liver not removing toxins from the blood).

Chronic Hepatitis B (CHB)

• First-line antiviral agents: These are preferred due to their potent antiviral activity and low resistance rates. Common drugs include:
  • Tenofovir disoproxil fumarate (TDF)
  • Entecavir 

• Alternative agents: May be considered in selected patients; however, it has higher side effects and viral resistance. Examples include:

  • Pegylated Interferon-alpha (Peg-IFN-α)
  • Lamivudine
  • Adefovir
  • Telbivudine

Liver transplant

• If your liver is severely damaged, a liver transplant might be needed. 

• In this procedure, the diseased liver is replaced with a healthy one, usually from a deceased donor, though sometimes a living person can donate a portion of their liver. 

Treatment considerations

• Decompensated liver disease: It is a serious stage of chronic liver disease where the liver can no longer perform its vital functions properly due to severe damage. Entecavir is recommended if there's no history of lamivudine resistance; otherwise, tenofovir is preferred. 

• Pregnancy: Tenofovir is safe and effective in reducing mother-to-child transmission when administered in the third trimester. 

• HIV coinfection: Requires coordinated treatment to address both HBV and HIV infections, often involving tenofovir-based regimens. 

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Home-care For Hepatitis B Virus (HBV) Infection

If you've been diagnosed with hepatitis B, proper home care can support your recovery and protect your liver from further damage. Here's what you can do:

Get plenty of rest

• Fatigue is common with hepatitis B

• Listen to your body and get enough sleep and rest to recover

Stay well-hydrated

• Drink plenty of water, coconut water, and clear soups to support liver function and flush out toxins.

Eat a liver-friendly diet

Foods to eat:

• Fresh fruits and vegetables like papaya, carrots, spinach, beets, etc

• Whole grains like brown rice, oats, etc

• Lean proteins like tofu, fish, and eggs

• Healthy fats, such as avocados and nuts, in moderation

• Herbal teas

Foods to avoid:

• Fried, oily, and processed foods

• Red meat and high-fat dairy

• Sugary snacks and sodas

• Alcohol and tobacco (strictly avoid)

• Excessive salt can worsen liver swelling.

Complications Of Hepatitis B Virus (HBV) Infection

Untreated HBV infection can lead to the following complications:

• Chronic hepatitis B: When the infection lasts more than 6 months, it increases the risk of serious liver problems.

• Portal hypertension: It is increased blood pressure in the liver’s veins due to scarring, which can cause internal bleeding.

• Liver cirrhosis: Long-term liver damage that leads to scarring and poor liver function.

• Hepatocellular carcinoma (HCC): A type of liver cancer that may develop from chronic HBV infection.

• Fulminant liver failure: A rare but life-threatening condition where the liver suddenly fails, requiring urgent liver transplant.

• Liver decompensation: When the liver can no longer perform vital functions, causing symptoms like confusion (encephalopathy), swelling (ascites), or bleeding.

• Hepatorenal syndrome: A serious condition where kidney function rapidly declines due to severe liver disease.

• Hepatic encephalopathy: A buildup of toxins in the brain due to poor liver function, leading to confusion, personality changes, or even coma.

• HBV-associated arthritis: A sudden, painful inflammation of one or more joints, often knees, wrists, or fingers, that can occur early in infection but usually resolves quickly without becoming chronic.

• Extrahepatic manifestations (less common): HBV can affect other parts of the body and cause:

  • Polyarteritis nodosa (PAN a rare blood vessel inflammation)

  • Glomerulonephritis (inflammation in the kidneys)

  • Vasculitis (inflammation of the blood vessels).

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Alternative Therapies For Hepatitis B Virus (HBV) Infection

Some alternative therapies have been explored for managing the Hepatitis B virus (HBV) infection. While these therapies are not substitutes for standard antiviral treatments, they have shown potential benefits in supporting liver health and managing the symptoms. Always consult a doctor before starting anything new:

1. Herbal remedies

• Milk thistle: Contains silymarin, which may have antioxidant and anti-inflammatory properties beneficial for liver health. 
  

• Turmeric (Haldi): Curcumin, the active compound in turmeric, has shown some antiviral properties, but more research is required regarding this.

• Phyllanthus amarus: A herb used in Ayurveda, it has shown promise in reducing HBV activity in early studies and supporting liver function.

2. Ayurveda

Ayurveda focuses on restoring liver balance using natural herbs, dietary changes, and lifestyle practices. Certain herbs are traditionally used to support liver detox and immunity. While these may help manage symptoms, they are not a substitute for medical treatment and should be used under expert guidance.

3. Acupuncture

Acupuncture is a traditional Chinese therapy that involves inserting thin needles into specific body points to restore energy balance. While it doesn’t cure hepatitis B, it may help relieve symptoms like fatigue, improve liver function, and enhance overall well-being when used alongside standard treatment. 

Living With Hepatitis B Virus (HBV) Infection

Chronic HBV infection can take a toll on your daily life, physically, emotionally, and socially. Fatigue, anxiety about health, and the long-term risk of liver complications can affect your overall well-being. Tips to improve quality of life:

• Follow your treatment plan: Stay consistent with medications and doctor visits

• Eat liver-friendly meals: Focus on whole foods and avoid alcohol or processed items

• Move your body: Light activity like walking or yoga can help with fatigue and mood

• Protect your mental health: Talk to someone you trust, join a support group, or seek counseling

• Prevent infections: Stay up-to-date with vaccinations (like hepatitis A) and avoid sharing personal items

• Rest well and hydrate: Give your body what it needs to heal and stay strong.