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Discussion

Hepatitis B is a common infection in the United States, with an estimated 0.8 to 1.4 million people chronically infected[1]. An Institute of Medicine report on Hepatitis and Liver Cancer recently identified major gaps in knowledge about hepatitis B among healthcare providers, social-service providers, and the general public, particularly communities at risk for HBV[2]. Misconceptions and lack of awareness about this infection can lead to missed opportunities for diagnosis, prevention, and appropriate care. The following questions and answers provide a framework for counseling and educating patients about chronic hepatitis B.

What is chronic hepatitis B?

Hepatitis B is an infection of the liver caused by a virus. The liver is an organ in the right upper corner of your abdomen (Figure 1) that does a variety of tasks to keep you healthy: it stores nutrients, filters toxins, and produces proteins. Many adults who get infected with hepatitis B virus have a short-term, "acute" illness soon after getting infected, then clear the virus permanently and are subsequently protected from getting infected again. In contrast, other people are not able to get rid of the virus, especially if they are infected early in their life during infancy or childhood--the virus stays with them, causing a lifelong infection. This long-term condition is called chronic hepatitis B: up to 90% of unvaccinated infants (Figure 2) will go on to develop chronic infection compared with only 1-5% adults (Figure 3) when exposed to this virus[1,3].

How common is hepatitis B?

Hepatitis B is a very common global infection, especially in parts of Asia and Africa (Figure 4). More than 350 million people live with chronic hepatitis B infection worldwide[4]. Part of the reason it is so widespread is because many countries do not have comprehensive vaccination policies and most people do not have symptoms from this infection and never get tested. Thus, many people with hepatitis B are unaware of their infection and the fact that they are contagious. Without taking precautions, they can spread this infection to others.

How does someone become infected with hepatitis B?

Hepatitis B is usually spread when blood, semen, or other body fluids from a person with the Hepatitis B virus enters the body of someone who is not infected (Figure 5). The virus is very infectious and is transmitted easily through breaks in the skin or mucus membranes (nose, mouth, eyes and other soft tissues). This can happen through:

  • sexual contact with an infected person
  • sharing personal items such as razors, syringes, or glucose monitors
  • direct contact with infected or contaminated blood, even in small amounts too small to see
  • direct contact with open sores of an infected person
  • an infected mother passing it to her baby at birth

Hepatitis B is not spread through sneezing, coughing, hugging, or breast feeding. Although the virus can be found in saliva, it is not believed to be spread through kissing or sharing utensils.

I have chronic hepatitis B infection. How do I prevent myself from giving this infection to someone else?

It is important to know that if you have chronic hepatitis B you are potentially contagious, even long after you first get infected. The good news is that hepatitis B transmission (passing of the virus from one person to another) can be prevented. The hepatitis B vaccine can provide protection in more than 95% of persons who have never been infected with the virus before. The vaccine does not provide any benefit to someone with chronic hepatitis B, but it can work in someone who has never had the virus. It is important for your sexual partners or household members to get tested for hepatitis B, to determine if they would benefit from the vaccine. Immunization can also protect infants born to infected mothers. For the person who has chronic hepatitis B infection, it is important to use condoms with sexual partners unless they are immune to the virus either from vaccination or resolved infection. If you are in a long-term monogamous relationship, your sexual partners should be tested and vaccinated, unless their test shows they are immune (from vaccination or resolved infection) [1,3,6]. Persons with chronic Hepatitis B should avoid sharing razors, toothbrushes, nail clippers, or other implements that may contain any trace of blood (Figure 6).

What happens to someone who has chronic hepatitis B?

Many people with chronic hepatitis B have no symptoms related to their infection. It is usually a "silent" condition, so they can feel fine even though the liver is being affected but chronic hepatitis can damage the liver very slowly over time. In 15-25% of people who do not receive treatment, chronic hepatitis can eventually progress, usually over the course of decades, to cause cirrhosis[7]. A normal liver has a spongy or rubbery texture whereas a liver with cirrhosis is hard and scarred and cannot function normally (Figure 7). Cirrhosis can lead to liver failure, which causes more symptoms and severe illness. People with chronic hepatitis B are also at increased risk of developing liver cancer, whether or not they have cirrhosis. Liver cancer is uncommon and generally occurs in people who have had their infection for a long time[3].

What kind of treatment is there for this infection?

Is there a cure? There are a variety of treatments for hepatitis B that can control the virus, but only rarely do they result in a "cure" - that is, permanent clearance of the virus and complete resolution of the infection. Treatment may reduce the risk of progressing to cirrhosis and can decrease the chance the person will develop liver cancer[3,5]. The medications used for treatment include a pill taken once daily or an injection given under the skin once weekly. There are advantages and disadvantages of the different types of medications. In most cases, the treatment needs to last at least a year and often longer. Your health professional can work with you to decide whether or not you need therapy, and if so, what kind. Not all patients with chronic hepatitis B need therapy, but everyone with chronic hepatitis B should be seen regularly by a health professional familiar with this infection.

What can I do to protect my liver and stay as healthy as I can with this chronic infection?

There are a number of things you can do to care for your liver when you have chronic hepatitis B (Figure 8). You need to see a health professional regularly for this infection. You should ideally avoid drinking any alcohol (beer, wine, or hard liquor). If you continue to drink alcohol, you should limit your intake to (Figure 8) a maximum of two drinks per week if you are a man, or one drink per week if you are a woman[3,5]. Acetaminophen, commonly know as Tylenol, is actually safe to take if you need it for pain relief, as long as you limit the quantity to no more than four extra-strength tablets (or 2000 mg) per day. Many medications are safe for the liver in someone with chronic hepatitis B. You should let your doctor know about any medications you are taking to be sure they are safe. This includes herbs or other "natural" supplements, as some of these can be harmful to the liver.

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  • The following link will open in a new window. Figure 1 - Location of Liver in Body

    The liver is an organ in the right upper corner of the abdomen.


    Figure 1
  • The following link will open in a new window. Figure 2 - Natural History of Hepatitis B when Infection Acquired in Infancy

    The overwhelming majority of infants who become infected with hepatitis B from their mothers go on to develop the chronic form of the infection.


    Figure 2
  • The following link will open in a new window. Figure 3 - Natural History of Hepatitis B when Infection Acquired as Adult

    Only 1 to 5% of adults will go on to chronic hepatitis B when exposed to the virus.


    Figure 3
  • The following link will open in a new window. Figure 4 - Global Prevalence of Chronic Hepatitis B Virus Infection, 2006

    Hepatitis B is a very common global infection. An estimated 400 million people live with chronic hepatitis B infection worldwide.

    Figure 4
  • The following link will open in a new window. Figure 5 - Transmission of Hepatitis B Virus

    Some of the common ways this infection is spread include unprotected sex with a partner who has chronic hepatitis B, sharing injection equipment with an infected person, receiving blood from an infected person or spread of virus from mother to child during pregnancy or childbirth.

    Figure 5
  • The following link will open in a new window. Figure 6 - How to Prevent Transmission of Hepatitis B VirusFigure 6
  • The following link will open in a new window. Figure 7 - Normal Liver and Liver with CirrhosisFigure 7
  • The following link will open in a new window. Figure 8 - How to care for your liver when you have chronic hepatitis B  Figure 8