Hepatitis B

What are hepatitis and hepatitis B?

Hepatitis means inflammation of the liver. There are many causes of hepatitis. For example, drinking too much alcohol, various drugs and chemicals, and also several different viruses can cause hepatitis. One virus that causes hepatitis is called the hepatitis B virus. This leaflet is only about hepatitis B. See separate leaflets called Hepatitis A and Hepatitis C, which are caused by different viruses.

Hepatitis B is a virus which is carried in the bloodstream to the liver. It can then affect and damage your liver.

How common is hepatitis B?

The exact number of people infected is not known. In the UK around 1 person in 350 is thought to have chronic (persistent) hepatitis B infection. Worldwide, it is much more common and hepatitis B is the most common cause of hepatitis. For example, in parts of Asia and Africa more than 1 person in 10 has chronic hepatitis B infection.
How can you get hepatitis B?

Hepatitis B is a very infectious disease.

From mother to baby (sometimes called vertical transmission)

Worldwide, the most common way the virus is passed on is from an infected mother to her baby. This usually occurs during childbirth. This is very common in some parts of the world where many people are infected with this virus (but is rare in the UK). All women in the UK are now tested for hepatitis B when they are pregnant.

What are the symptoms and how does hepatitis B progress?

It is helpful to think of two phases of infection with hepatitis B virus.

An acute phase when you are first infected
A chronic (persistent) phase when the virus remains long-term in some cases.


How is hepatitis B diagnosed and assessed?

A simple blood test can detect if you are infected with the hepatitis B virus. This test detects a protein on the surface of the virus called hepatitis B surface antigen (HbsAg). If you are found to be infected (if you are HBsAg-positive), then other tests may be advised to check on the severity of infection, liver inflammation and damage to the liver.

For example:

A blood test can detect various parts of the virus. This can assess how active the virus is (if it is multiplying rapidly which indicates that it is more likely to cause liver damage).
Blood tests called liver function tests. These measure the activity of enzymes (chemicals) and other substances made in the liver. This gives a general guide as to whether the liver is inflamed, and how well it is working. See separate leaflet called Liver Function Tests.
An ultrasound scan of the liver.
A biopsy (small sample) of the liver may be taken to look at under the microscope. This can show the extent of any inflammation and cirrhosis. See separate leaflet called Liver Biopsy.
A blood test can also be performed to show if you have immunity to hepatitis B.
Other tests may be done if cirrhosis or other complications develop.
There are other specialised blood tests being developed which assess the development and severity of cirrhosis.

Can hepatitis B be prevented?
Immunisation

A vaccine is available to protect against hepatitis B. This should be offered to anyone who is at increased risk of being infected with the hepatitis B virus. For example, sexual and household contacts of someone infected with hepatitis B. (See separate leaflet called Hepatitis B Immunisation for a full list of people at increased risk who should be immunised.)
Post-exposure prevention

If you are not immunised and have been exposed to the virus, you should see a doctor immediately. (For example, if you are a healthcare worker and you have a needlestick injury.) You can be given an injection of antibodies called immunoglobulin as well as starting a course of immunisation. This may prevent infection from developing.
Preventing infection in newborn babies at risk

All pregnant women in the UK are offered a hepatitis B blood test. If the mother is infected, her baby is given injections of antibodies and also immunised straight after birth. (The transmission of the virus to the baby is thought to occur mainly during childbirth and not during the pregnancy.) With this treatment there is a good chance of preventing infection developing in the baby.
If I am infected, how can I prevent passing on the virus to others?

If you have a current hepatitis B infection you should:

Avoid having sex with anyone (especially any sex without using a condom) until they have been fully immunised and have been checked to see that the immunisation has worked by a blood test.
Not share any injecting equipment such as needles, syringes, etc.
Not donate blood or semen or carry a donor card.
Not share razors, toothbrushes, etc, that may be contaminated with blood.
Cover any cuts or wounds with a dressing.
Make sure that, if any of your blood spills on to the floor or other surfaces following an accident, it is cleaned away with bleach.

What is the treatment of hepatitis B?
Treatment for the acute phase

No treatment can clear the virus from the body. If you develop symptoms when first infected, treatment aims to help ease symptoms until they go - for example, drinking plenty of water to avoid dehydration. Rarely, a severe hepatitis develops which may need hospital care. No treatment can prevent acute hepatitis B from becoming chronic.
Treatment for chronic infection

Treatment for hepatitis B does not cure hepatitis B but works to delay or even to prevent complications from developing, like liver damage and cirrhosis. People with chronic hepatitis B usually need treatment to stop or to reduce the activity of the virus, so limiting liver damage. A liver specialist will usually advise on when treatment may be beneficial. There are two types of treatment currently given:

Interferon. This medicine is similar to a substance produced in your body, which is also called interferon. It works to fight infections by boosting your immune system. Interferon is usually given as an injection each week.
Antiviral medicines. These work by stopping the hepatitis B virus from multiplying in the body. They include lamivudine, adefovir, tenofovir, telbivudine, and entecavir. Your doctor will discuss these in more detail with you, as the medicine used can vary between people. A combination of antiviral medicines is sometimes used.

Treatment with medicines is usually continued for many years.

Side-effects with these medicines can occur. You will be monitored regularly while you are taking treatment, which includes blood tests. Some people need to change their medicines, or take a lower strength, if they have troublesome side-effects. Also, in some people, resistance can develop to their treatment medicine, which means that it does not work so well. If this happens then it is likely you will have to change the medicine you take.

The treatment of hepatitis B is a developing area of medicine. New medicines continue to be developed and the information above is very general. There are some newer medicines that have been introduced in the last few years that show promise to improve the outlook. The specialist who knows your case can give more accurate information about the outlook for your particular situation.
Liver transplant

For some people with advanced cirrhosis, liver transplantation may be an option. Although this is a major operation, the outlook following a liver transplant can be very good. However, the new liver may also eventually become damaged by the persisting hepatitis B infection.
Diet and alcohol

Most people with chronic hepatitis B will be advised to eat a normal healthy balanced diet. Ideally, anybody with inflammation of the liver should not drink alcohol. If you already have liver inflammation, alcohol increases the risk and speed of developing cirrhosis.