HEPATITIS B

Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). For
some people, hepatitis B infection becomes chronic, meaning it lasts more
than six months. Having chronic hepatitis B increases your risk of developing
liver failure, liver cancer or cirrhosis — a condition that permanently scars of
the liver.

Most adults with hepatitis B recover fully, even if their signs and symptoms are
severe. Infants and children are more likely to develop a chronic (long-lasting)
hepatitis B infection.

A vaccine can prevent hepatitis B, but there's no cure if you have the
condition. If you're infected, taking certain precautions can help prevent
spreading the virus to others.
Symptoms
• Signs and symptoms of hepatitis B range
from mild to severe. They usually appear
about one to four months after you've been
infected, although you could see them as
early as two weeks post-infection. Some
people, usually young children, may not
have any symptoms.
Hepatitis B signs and symptoms may include:
• Abdominal pain
• Dark urine
• Fever
• Joint pain
• Loss of appetite
• Nausea and vomiting
• Weakness and fatigue
• Yellowing of your skin and the whites of your eyes
(jaundice)
When to see a doctor?
If you know you've been exposed to hepatitis B,
contact your doctor immediately. A preventive
treatment may reduce your risk of infection if you
receive the treatment within 24 hours of
exposure to the virus.
If you think you have signs or symptoms of
hepatitis B, contact your doctor.
Causes
•Hepatitis B infection is caused by the
hepatitis B virus (HBV). The virus is
passed from person to person through
blood, semen or other body fluids. It
does not spread by sneezing or
coughing.
Common ways that HBV can spread are:
• Sexual contact. You may get hepatitis B if you have unprotected sex with
someone who is infected. The virus can pass to you if the person's blood,
saliva, semen or vaginal secretions enter your body.
• Sharing of needles. HBV easily spreads through needles and syringes
contaminated with infected blood. Sharing IV drug paraphernalia puts you
at high risk of hepatitis B.
• Accidental needle sticks. Hepatitis B is a concern for health care workers
and anyone else who comes in contact with human blood.
• Mother to child. Pregnant women infected with HBV can pass the virus to
their babies during childbirth. However, the newborn can be vaccinated to
avoid getting infected in almost all cases. Talk to your doctor about being
tested for hepatitis B if you are pregnant or want to become pregnant.
Acute vs. chronic hepatitis
B
Hepatitis B infection may be either short-
lived (acute) or long lasting (chronic).
• Acute hepatitis B infection lasts less than six months. Your
immune system likely can clear acute hepatitis B from your
body, and you should recover completely within a few
months. Most people who get hepatitis B as adults have an
acute infection, but it can lead to chronic infection.
• Chronic hepatitis B infection lasts six months or longer. It
lingers because your immune system can't fight off the
infection. Chronic hepatitis B infection may last a lifetime,
possibly leading to serious illnesses such as cirrhosis and liver
cancer.
The younger you are when you get
hepatitis B — particularly newborns or
children younger than 5 — the higher
your risk of the infection becoming
chronic. Chronic infection may go
undetected for decades until a person
becomes seriously ill from liver disease.
Risk factors
Hepatitis B spreads through contact with blood, semen or other body
fluids from an infected person. Your risk of hepatitis B infection
increases if you:
• Have unprotected sex with multiple sex partners or with someone
who's infected with HBV
• Share needles during IV drug use
• Are a man who has sex with other men
• Live with someone who has a chronic HBV infection
• Are an infant born to an infected mother
• Have a job that exposes you to human blood
• Travel to regions with high infection rates of HBV, such as Asia, the
Pacific Islands, Africa and Eastern Europe
Complications
Having a chronic HBV infection can lead to
serious complications, such as:
• Scarring of the liver (cirrhosis). The inflammation associated with a
hepatitis B infection can lead to extensive liver scarring (cirrhosis),
which may impair the liver's ability to function.
• Liver cancer. People with chronic hepatitis B infection have an
increased risk of liver cancer.
• Liver failure. Acute liver failure is a condition in which the vital
functions of the liver shut down. When that occurs, a liver transplant
is necessary to sustain life.
• Other conditions. People with chronic hepatitis B may develop
kidney disease or inflammation of blood vessels.
Prevention
The hepatitis B vaccine is typically given as three or four injections
over six months. You can't get hepatitis B from the vaccine.

The hepatitis B vaccine is recommended for:

• Newborns
• Children and adolescents not vaccinated at birth
• Those who work or live in a center for people who are
developmentally disabled
• People who live with someone who has hepatitis B
• Health care workers, emergency workers and other people who
come into contact with blood
• Anyone who has a sexually transmitted infection, including HIV
The hepatitis B vaccine is recommended for:
• Men who have sex with men
• People who have multiple sexual partners
• Sexual partners of someone who has hepatitis B
• People who inject illegal drugs or share needles and syringes
• People with chronic liver disease
• People with end-stage kidney disease
• Travelers planning to go to an area of the world with a high
hepatitis B infection rate
Take precautions to avoid
HBV
 Other ways to reduce your risk of HBV
include:
• Know the HBV status of any sexual partner. Don't engage in
unprotected sex unless you're absolutely certain your partner isn't
infected with HBV or any other sexually transmitted infection.
• Use a new latex or polyurethane condom every time you have
sex if you don't know the health status of your partner. Remember
that although condoms can reduce your risk of contracting HBV,
they don't eliminate the risk.
• Don't use illegal drugs. If you use illicit drugs, get help to stop. If
you can't stop, use a sterile needle each time you inject illicit
drugs. Never share needles.
 Other ways to reduce your risk of HBV
include:
• Be cautious about body piercing and tattooing. If you get a
piercing or tattoo, look for a reputable shop. Ask about how
the equipment is cleaned. Make sure the employees use
sterile needles. If you can't get answers, look for another
shop.
• Ask about the hepatitis B vaccine before you travel. If you're
traveling to a region where hepatitis B is common, ask your
doctor about the hepatitis B vaccine in advance. It's usually
given in a series of three injections over a six-month period.
Diagnosis
Your doctor will examine you and look for signs of liver damage, such
as yellowing skin or belly pain. Tests that can help diagnose hepatitis B
or its complications are:
• Blood tests. Blood tests can detect signs of the hepatitis B virus in
your body and tell your doctor whether it's acute or chronic. A
simple blood test can also determine if you're immune to the
condition.
• Liver ultrasound. A special ultrasound called transient elastography
can show the amount of liver damage.
• Liver biopsy. Your doctor might remove a small sample of your liver
for testing (liver biopsy) to check for liver damage. During this test,
your doctor inserts a thin needle through your skin and into your
liver and removes a tissue sample for laboratory analysis.
 Screening healthy people for hepatitis B
Doctors sometimes test certain healthy people for hepatitis
B infection because the virus can damage the liver before
causing signs and symptoms. Talk to your doctor about
screening for hepatitis B infection if you:
• Are pregnant
• Live with someone who has hepatitis B
• Have had many sexual partners
• Have had sex with someone who has hepatitis B
• Are a man who has sex with men
Others:
• Have a history of a sexually transmitted illness
• Have HIV or hepatitis C
• Have a liver enzyme test with unexplained abnormal results
• Receive kidney dialysis
• Take medications that suppress the immune system, such as those used to
prevent rejection after an organ transplant
• Use illegal injected drugs
• Are in prison
• Were born in a country where hepatitis B is common, including Asia, the Pacific
Islands, Africa and Eastern Europe
• Have parents or adopted children from places where hepatitis B is common,
including Asia, the Pacific Islands, Africa and Eastern Europe
Treatment
Treatment to prevent hepatitis B infection
after exposure
If you know you've been exposed to the hepatitis B virus
and aren't sure if you've been vaccinated, call your
doctor immediately. An injection of immunoglobulin (an
antibody) given within 12 hours of exposure to the virus
may help protect you from getting sick with hepatitis B.
Because this treatment only provides short-term
protection, you also should get the hepatitis B vaccine
at the same time, if you never received it.
Treatment for acute hepatitis B infection
If your doctor determines your hepatitis B infection
is acute — meaning it is short-lived and will go
away on its own — you may not need treatment.
Instead, your doctor might recommend rest, proper
nutrition and plenty of fluids while your body fights
the infection. In severe cases, antiviral drugs or a
hospital stay is needed to prevent complications.
Treatment for chronic hepatitis B infection
Most people diagnosed with chronic hepatitis B infection need
treatment for the rest of their lives. Treatment helps reduce the
risk of liver disease and prevents you from passing the infection
to others. Treatment for chronic hepatitis B may include:
• Antiviral medications. Several antiviral medications — including
entecavir (Baraclude), tenofovir (Viread), lamivudine (Epivir),
adefovir (Hepsera) and telbivudine (Tyzeka) — can help fight the
virus and slow its ability to damage your liver. These drugs are
taken by mouth. Talk to your doctor about which medication
might be right for you.
Treatment for chronic hepatitis B may include:
•Interferon injections. Interferon alfa-2b (Intron A) is a man-made version of a
substance produced by the body to fight infection. It's used mainly for young
people with hepatitis B who wish to avoid long-term treatment or women who
might want to get pregnant within a few years, after completing a finite course
of therapy. Interferon should not be used during pregnancy. Side effects may
include nausea, vomiting, difficulty breathing and depression.
•Liver transplant. If your liver has been severely damaged, a liver transplant
may be an option. During a liver transplant, the surgeon removes your
damaged liver and replaces it with a healthy liver. Most transplanted livers
come from deceased donors, though a small number come from living donors
who donate a portion of their livers.
Other drugs to treat hepatitis B are being developed.
Lifestyle and home remedies
If you've been infected with hepatitis B, take
steps to protect others from the virus.
• Make sex safer. If you're sexually active, tell your partner you
have HBV and talk about the risk of transmitting it to him or her.
Use a new latex condom every time you have sex, but remember
that condoms reduce but don't eliminate the risk.
• Tell your sexual partner to get tested. Anyone with whom you've
had sex needs to be tested for the virus. Your partners also need
to know their HBV status so that they don't infect others.
• Don't share personal care items. If you use IV drugs, never share
needles and syringes. And don't share razor blades or
toothbrushes, which may carry traces of infected blood.
Coping and support
If you've been diagnosed with hepatitis B infection,
the following suggestions might help you cope:
• Learn about hepatitis B. The Centers for Disease Control and Prevention
is a good place to start.
• Stay connected to friends and family. You can't spread hepatitis B
through casual contact, so don't cut yourself off from people who can
offer support.
• Take care of yourself. Eat a healthy diet full of fruits and vegetables,
exercise regularly, and get enough sleep.
• Take care of your liver. Don't drink alcohol or take prescription or over-
the-counter drugs without consulting your doctor. Get tested for
hepatitis A and C. Get vaccinated for hepatitis A if you haven't been
exposed.
HEPATITIS C
Hepatitis C is a viral infection that causes liver inflammation, sometimes
leading to serious liver damage. The hepatitis C virus (HCV) spreads through
contaminated blood.
Until recently, hepatitis C treatment required weekly injections and oral
medications that many HCV-infected people couldn't take because of other
health problems or unacceptable side effects.
That's changing. Today, chronic HCV is usually curable with oral medications
taken every day for two to six months. Still, about half of people with HCV
don't know they're infected, mainly because they have no symptoms, which
can take decades to appear. For that reason, the U.S. Centers for Disease
Control and Prevention recommends a one-time screening blood test for
everyone at increased risk of the infection. The largest group at risk includes
everyone born between 1945 and 1965 — a population five times more likely
to be infected than those born in other years.
Symptoms
Long-term infection with the hepatitis C virus
(HCV) is known as chronic hepatitis C.
Chronic hepatitis C is usually a "silent"
infection for many years, until the virus
damages the liver enough to cause the signs
and symptoms of liver disease
Among these signs and symptoms are:
• Bleeding easily
• Bruising easily
• Fatigue
• Poor appetite
• Yellow discoloration of the skin and eyes
(jaundice)
• Dark-colored urine
Other Signs:
• Itchy skin
• Fluid buildup in your abdomen (ascites)
• Swelling in your legs
• Weight loss
• Confusion, drowsiness and slurred speech (hepatic
encephalopathy)
• Spider-like blood vessels on your skin (spider angiomas)
Every chronic hepatitis C infection starts with an acute phase. Acute
hepatitis C usually goes undiagnosed because it rarely causes
symptoms. When signs and symptoms are present, they may include
jaundice, along with fatigue, nausea, fever and muscle aches. Acute
symptoms appear one to three months after exposure to the virus
and last two weeks to three months.

Acute hepatitis C infection doesn't always become chronic. Some

people clear HCV from their bodies after the acute phase, an outcome
known as spontaneous viral clearance. In studies of people diagnosed
with acute HCV, rates of spontaneous viral clearance have varied from
14 to 50 percent. Acute hepatitis C also responds well to antiviral
therapy.
Causes
Hepatitis C infection is caused by the hepatitis C virus. The infection
spreads when blood contaminated with the virus enters the bloodstream
of an uninfected person.
Globally, HCV exists in several distinct forms, known as genotypes. The
most common HCV genotype in North America and Europe is type 1. Type
2 also occurs in the United States and Europe, but is less common than
type 1. Both type 1 and type 2 have also spread through much of the
world, although other genotypes cause a majority of infections in the
Middle East, Asia and Africa.
Although chronic hepatitis C follows a similar course regardless of the
genotype of the infecting virus, treatment recommendations vary
depending on viral genotype.
Risk factors
Your risk of hepatitis C infection is increased if you:
• Are a health care worker who has been exposed to
infected blood, which may happen if an infected needle
pierces your skin
• Have ever injected or inhaled illicit drugs
• Have HIV
• Received a piercing or tattoo in an unclean environment
using unsterile equipment
Your risk of hepatitis C infection is increased if
you:
• Received a blood transfusion or organ transplant before 1992
• Received clotting factor concentrates before 1987
• Received hemodialysis treatments for a long period of time
• Were born to a woman with a hepatitis C infection
• Were ever in prison
• Were born between 1945 and 1965, the age group with the
highest incidence of hepatitis C infection
Complications
Normal liver vs. liver cirrhosis
Liver cancer
Hepatitis C infection that continues over many
years can cause significant complications, such as:
• Scarring of the liver (cirrhosis). After 20 to 30 years
of hepatitis C infection, cirrhosis may occur. Scarring
in your liver makes it difficult for your liver to
function.
• Liver cancer. A small number of people with hepatitis
C infection may develop liver cancer.
• Liver failure. Advanced cirrhosis may cause your liver
to stop functioning.
Prevention
Protect yourself from hepatitis C infection by
taking the following precautions:
• Stop using illicit drugs, particularly if you inject them. If you use illicit
drugs, seek help.
• Be cautious about body piercing and tattooing. If you choose to
undergo piercing or tattooing, look for a reputable shop. Ask questions
beforehand about how the equipment is cleaned. Make sure the
employees use sterile needles. If employees won't answer your
questions, look for another shop.
• Practice safer sex. Don't engage in unprotected sex with multiple
partners or with any partner whose health status is uncertain. Sexual
transmission between monogamous couples may occur, but the risk is
low.
Screening for hepatitis C
Health officials recommend that anyone at high risk of
exposure to HCV get a blood test to screen for hepatitis C
infection. People who may want to talk to their doctors about
screening for hepatitis C include:
• Anyone who has ever injected or inhaled illicit drugs
• Anyone who has abnormal liver function test results with no
identified cause
• Babies born to mothers with hepatitis C
• Health care and emergency workers who have been exposed
to blood or accidental needle sticks
Other:
• People with hemophilia who were treated with clotting factors
before 1987
• People who have ever undergone long-term hemodialysis
treatments
• People who received blood transfusions or organ transplants
before 1992
• Sexual partners of anyone diagnosed with hepatitis C infection
• People with HIV infection
• Anyone born from 1945 to 1965
• Anyone who has been in prison
Other blood tests

If an initial blood test shows that you have

hepatitis C, additional blood tests will:
• Measure the quantity of the hepatitis C
virus in your blood (viral load)
• Identify the genotype of the virus
Tests for liver damage
Doctors typically use one or more of the following tests
to assess liver damage in chronic hepatitis C.
• Magnetic resonance elastography (MRE). A
noninvasive alternative to a liver biopsy (see below),
MRE combines magnetic resonance imaging
technology with patterns formed by sound waves
bouncing off the liver to create a visual map showing
gradients of stiffness throughout the liver. Stiff liver
tissue indicates the presence of fibrosis, or scarring of
the liver, as a result of chronic hepatitis C
• Transient elastography. Another noninvasive test,
transient elastography is a type of ultrasound that
transmits vibrations into the liver and measures the
speed of their dispersal through liver tissue to
estimate its stiffness.
• Liver biopsy. Typically done using ultrasound
guidance, this test involves inserting a thin needle
through the abdominal wall to remove a small sample
of liver tissue for laboratory testing
Treatment
Antiviral medications
Hepatitis C infection is treated with antiviral
medications intended to clear the virus from your body.
The goal of treatment is to have no hepatitis C virus
detected in your body at least 12 weeks after you
complete treatment.
Researchers have recently made significant advances in treatment for
hepatitis C using new, "direct-acting" anti-viral medications, sometimes in
combination with existing ones. As a result, people experience better
outcomes, fewer side effects and shorter treatment times — some as short
as eight weeks. The choice of medications and length of treatment depend
on the hepatitis C genotype, presence of existing liver damage, other
medical conditions and prior treatments.

Due to the pace of research, recommendations for medications and

treatment regimens are changing rapidly. It is therefore best to discuss your
treatment options with a specialist.

Throughout treatment your care team will monitor your response to

medications.
Liver transplantation
If you have developed serious complications from chronic hepatitis C
infection, liver transplantation may be an option. During liver
transplantation, the surgeon removes your damaged liver and replaces it
with a healthy liver. Most transplanted livers come from deceased donors,
though a small number come from living donors who donate a portion of
their livers.

In most cases, a liver transplant alone doesn't cure hepatitis C. The

infection is likely to return, requiring treatment with antiviral medication
to prevent damage to the transplanted liver. Several studies have
demonstrated that new, direct-acting antiviral medication regimens are
effective at curing post-transplant hepatitis C. Treatment with direct-
acting antivirals can also be effective in appropriately selected patients
before liver transplantation.
Vaccinations
Although there is no vaccine for hepatitis C, your
doctor will likely recommend that you receive
vaccines against the hepatitis A and B viruses.
These are separate viruses that also can cause
liver damage and complicate the course of
chronic hepatitis C.
Lifestyle and home remedies
If you receive a diagnosis of hepatitis C, your doctor will likely
recommend certain lifestyle changes. These measures will help
keep you healthy longer and protect the health of others as
well:
• Stop drinking alcohol. Alcohol speeds the progression of liver
disease.
• Avoid medications that may cause liver damage. Review your
medications with your doctor, including over-the-counter
medications you take as well as herbal preparations and
dietary supplements. Your doctor may recommend avoiding
certain medications.
• Help prevent others from coming in contact with your
blood. Cover any wounds you have and don't share razors
or toothbrushes. Don't donate blood, body organs or
semen, and advise health care workers that you have the
virus. Also tell your partner about your infection before
you have sex, and always use condoms during intercourse.