Should I Get a Hepatitis B Vaccine Again

• Facts
  • Facts you should know well-nigh hepatitis B
• What Is It?
  • What is hepatitis?
• Symptoms/Signs
  • What are the signs and symptoms of astute hepatitis B?
  • What are the signs and symptoms of chronic hepatitis B?
• Manual
  • How does the hepatitis B virus spread?
• Diagnosis
  • How do medical professionals diagnose hepatitis B?
  • What is the office of a liver biopsy in chronic hepatitis B?
• Causes
  • What is the natural course of chronic hepatitis B?
• Treatment
  • What medications care for hepatitis B?
  • What is new in the handling of hepatitis B?
  • What is the role of liver transplantation in hepatitis B?
• Alcohol
  • What are the effects of alcohol on hepatitis B?
• Immunosuppressant Effects
  • What are the effects of immunosuppressive medications on hepatitis B?
• Delta Hepatitis
  • What is delta hepatitis?
• Hep B & Hep C virus
  • What nigh co-infection with hepatitis B virus and hepatitis C virus?
• Hep B & HIV
  • What happens in co-infection with hepatitis B virus and HIV?
• Vaccine
  • What can be washed to preclude hepatitis B?
• Center
  • Hepatitis B (HBV, Hep B) Eye
• Comments
  • Patient Comments: Hepatitis B - Draw Your Experience
  • Patient Comments: Hepatitis B - Treatments
  • Patient Comments: Hepatitis B - Diagnosis
  • Patient Comments: Hepatitis B - Transmission
• More than
  • Find a local Gastroenterologist in your boondocks

Facts you should know about hepatitis B

Hepatitis B is preventable through vaccination. All children should receive the vaccine.

• The hepatitis B virus is a Dna virus belonging to the Hepadnaviridae family of viruses. Hepatitis B virus is not related to the hepatitis A virus or the hepatitis C virus.
• Some people with hepatitis B never clear the virus and are chronically infected. Approximately 2 billion individuals in the earth have evidence of by or nowadays hepatitis B, and ane.two million people in the U.South. are chronically infected with hepatitis B. Many of these people appear salubrious merely can spread the virus to others.
• Hepatitis B infection is transmitted through sexual contact, contact with contaminated blood (for example, through shared needles used for illicit, intravenous drugs), and from mother to child. Hepatitis B is non spread through food, h2o, or casual contact.
• Serologic (blood) markers specifically for hepatitis B virus are used to diagnose hepatitis B viral infection. The blood tests can also place the stage of the infection (past or present) and people who are at the highest gamble for complications.
• Injury to the liver by the hepatitis B virus is caused by the torso'due south immune response every bit the body attempts to eliminate the virus.
• In the United states, most adults who get hepatitis B are able to articulate the virus and cure themselves of infection. The remaining adults with acute hepatitis B continue to develop chronic hepatitis B. Those who acquire the infection in childhood are much more likely to take chronic infection. Chronic hepatitis B may atomic number 82 to cirrhosis or liver failure. Approximately 15% to 25% of people with chronic infection volition die prematurely as a outcome of the infection.
• Progression of chronic hepatitis B viral infection occurs insidiously (subtly and gradually), commonly over several decades. The class is adamant primarily past the age at which the hepatitis B viral infection is caused and the interaction between the virus and the body's allowed system.
• Treatment with electric current antiviral drugs suppresses viral reproduction in about 50% to 90% of patients with chronic hepatitis B. The medications are also effective in reducing inflammation and improving claret tests. This can filibuster or reduce complications such as cirrhosis. However, only nigh one-half of people treated to achieve sustained viral suppression, and relapse is common. The medications exercise not cure the infection.
• Liver transplantation should exist considered for patients with impending liver failure due to acute (initial) infection or avant-garde cirrhosis.
• Hepatitis B is preventable through vaccination. All children should receive the vaccine. In addition, adults at high risk for hepatitis B should be vaccinated. Unvaccinated people who are exposed to hepatitis B should be evaluated by a physician to determine if they need specific immune globulin (HBIG).

Is Hepatitis B Contagious?

The disease, hepatitis B, is contagious. HBV, the viral cause of hepatitis B, is transmitted person-to-person by

• claret,
• semen, or
• any other body fluid from the infected person.

Moreover, hepatitis B can exist transferred through sexual contact, sharing needles, or from female parent to infant at the time of birth.

What is hepatitis?

• Readers Comments 46
• Share Your Story

Inflammation of the liver due to the hepatitis B virus (HBV), once thought to be passed just through claret products. The hepatitis B can also exist transmitted via needle sticks, body piercing, and tattooing using unsterilized instruments, the dialysis process, sexual and even less intimate close contact, and childbirth.

The term 'hepatitis' simply means inflammation of the liver. Hepatitis may exist acquired by a variety of viruses or other infections, medications, or a toxin such equally alcohol. Hepatitis viruses that can crusade injury to liver cells in add-on to hepatitis B include the hepatitis A and hepatitis C viruses. These viruses are not related to each other or to the hepatitis B virus, and they differ in their construction, the ways they are spread amongst individuals, the severity of symptoms they tin can crusade, the way they are treated, and the outcome of the infection. Other hepatitis viruses (hepatitis D, hepatitis E, and hepatitis G) cause disease much less commonly.

Other viruses that infect the liver but which are not specifically "hepatitis viruses" include Epstein-Barr virus (EBV, the virus that causes mononucleosis) and cytomegalovirus (CMV).

What is the telescopic of the problem?

Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV).

In 2015, hepatitis B resulted in 887,000 deaths, mostly from complications (including cirrhosis and hepatocellular carcinoma).

It is estimated that 257 million people are living with hepatitis B virus infection (defined as hepatitis B surface antigen-positive). According to the Centers for Disease Command (CDC), approximately xix,000 new cases of hepatitis B occurred in the United States in 2016.

Later a marked reject in astute hepatitis B virus (HBV) infections reported to CDC since the 1990s, due to the widespread introduction of hepatitis B vaccination, there has been no consequent trend in acute HBV cases since 2012; that is, reported cases have been fluctuating around 3,000 cases each twelvemonth. In 2016, in that location were 3,218 cases reported to the CDC. After adjusting for under-ascertainment and under-reporting, the estimated number of new HBV infections in 2022 was 20,900.

When a person first gets hepatitis B, they are said to have an 'astute' infection. Well-nigh people are able to eliminate the virus and are cured of the infection. Some are non able to clear the virus and have a 'chronic' infection with hepatitis B that is ordinarily life-long (encounter below). In the United States, an estimated ii.2 million people are chronically infected with hepatitis B.

Hepatitis B is found throughout the world. Some countries have much higher rates of infection than the United states; for example, in Southeast Asia and Sub-Saharan Africa, as many as x% to 30% of adults are chronically infected with hepatitis B.

What kind of a virus is hepatitis B?

The hepatitis B virus is a DNA virus, meaning that its genetic material is made up of deoxyribonucleic acids. Information technology belongs to a family of viruses known as Hepadnaviridae. The virus is primarily found in the liver but is too present in the claret and certain body fluids.

Hepatitis B virus consists of a core particle (central portion) and a surrounding envelope (outer coat). The core is made up of Dna and the core antigen (HBcAg). The envelope contains the surface antigen (HBsAg). These antigens are present in the blood and are markers that are used in the diagnosis and evaluation of patients with suspected viral hepatitis.

How does the hepatitis B virus cause liver injury?

The hepatitis B virus reproduces in liver cells, but the virus itself is not the direct crusade of harm to the liver. Rather, the presence of the virus triggers an immune response from the torso as the trunk tries to eliminate the virus and recover from the infection. This allowed response causes inflammation and may seriously injure liver cells. Therefore, there is a balance between the protective and destructive effects of the immune response to the hepatitis B virus.

QUESTION

Liver disease refers to whatsoever abnormal process that affects the liver. See Respond

What are the signs and symptoms of acute hepatitis B?

Acute hepatitis B is the menstruum of affliction that occurs during the first one to four months after acquiring the virus. Virtually healthy adults do non develop significant symptoms during astute infection. Early symptoms may be non-specific, including fever, a flu-similar disease, and joint pains. Symptoms of acute hepatitis may include:

• fatigue,
• loss of appetite,
• nausea,
• jaundice (yellowing of the skin and eyes), and
• pain in the upper right abdomen (due to the inflamed liver).

Rarely, acute hepatitis amercement the liver then badly information technology can no longer office. This life-threatening condition is chosen "fulminant hepatitis." Patients with fulminant hepatitis are at risk of developing haemorrhage problems and blackout resulting from the failure of the liver. Patients with fulminant hepatitis should be evaluated for liver transplantation.

What determines the outcome of astute hepatitis B?

The body's immune response is the major determinant of the outcome in acute hepatitis B. Individuals who develop a potent immune response to the infection are more probable to clear the virus and recover. However, these patients also are more than probable to develop more severe liver injury and symptoms due to the strong immune response that is trying to eliminate the virus. On the other hand, a weaker immune response results in less liver injury and fewer symptoms but a higher risk of developing chronic hepatitis B. People who recover and eliminate the virus will develop life-long immunity, that is, protection from subsequent infection from hepatitis B.

Most infants and children who acquire acute hepatitis B viral infection have no symptoms. In these individuals, the immune system fails to mount a vigorous response to the virus. Consequently, the gamble of an infected infant developing chronic hepatitis B is approximately 90%. In contrast, merely 30% to l% of people older than 5 years who have acute hepatitis B develop chronic hepatitis B.

Daily Health News

Trending on MedicineNet

What are the signs and symptoms of chronic hepatitis B?

The liver is a vital organ that has many functions. These include a part in the immune system, production of clotting factors, producing bile for digestion; storing nutrients including sugars, fats and minerals for use by the body subsequently; processing medications; and breaking down toxic substances. Patients with chronic hepatitis B develop symptoms in proportion to the degree of abnormalities in these functions. The signs and symptoms of chronic hepatitis B vary widely depending on the severity of the liver damage. They range from few and relatively mild signs and symptoms to signs and symptoms of severe liver illness (cirrhosis or liver failure).

Most individuals with chronic hepatitis B remain symptom free for many years or decades. During this time, the patient'south liver office blood tests usually are normal or only mildly abnormal. Some patients may deteriorate and develop inflammation or symptoms, putting them at take a chance for developing cirrhosis.

Cirrhosis of the liver due to hepatitis B

Inflammation from chronic hepatitis B can progress to cirrhosis (severe scarring) of the liver. Significant amounts of scarring and cirrhosis lead to liver dysfunction.

Symptoms may include:

• weakness,
• fatigue,
• loss of appetite,
• weight loss,
• chest enlargement in men,
• a rash on the palms,
• difficulty with blood clotting, and
• spider-similar blood vessels on the skin.

Decreased absorption of vitamins A and D can cause impaired vision at night and thinning of bones (osteoporosis). Patients with liver cirrhosis likewise are at risk of infections because the liver plays an important office in the immune arrangement.

Advanced cirrhosis of the liver due to hepatitis B

In patients with avant-garde cirrhosis, the liver begins to fail. This is life-threatening condition.

Several complications occur in advanced cirrhosis:

• Defoliation and even blackout (encephalopathy) results from the disability of the liver to detoxify certain toxic substances.
• Increased pressure in the blood vessels of the liver (portal hypertension) causes fluid to build upward in the abdominal cavity (ascites) and may consequence in engorged veins in the swallowing tube (esophageal varices) that tear easily and may cause massive bleeding.
• Portal hypertension tin can besides cause kidney failure or an enlarged spleen resulting in a decrease of blood cells and the development of anemia, increased risk of infection and haemorrhage.
• In advanced cirrhosis, liver failure also results in decreased production of clotting factors. This causes abnormalities in blood clotting and sometimes spontaneous bleeding.
• Patients with advanced cirrhosis oftentimes develop jaundice because the damaged liver is unable to eliminate a yellow compound, called bilirubin.

Hepatitis B virus and principal liver cancer (hepatocellular carcinoma)

Patients with chronic hepatitis B are at risk of developing liver cancer. The way in which the cancer develops is not fully understood. Symptoms of liver cancer are nonspecific. Patients may have no symptoms, or they may experience abdominal pain and swelling, an enlarged liver, weight loss, and fever. The nigh useful diagnostic screening tests for liver cancer are a blood exam for a poly peptide produced past the cancer called blastoff-fetoprotein and an ultrasound imaging study of the liver. These two tests are used to screen patients with chronic hepatitis B, peculiarly if they have cirrhosis or a family history of liver cancer.

Hepatitis B virus involvement of organs outside of the liver (extra-hepatic)

Rarely, chronic hepatitis B infection can lead to disorders that affect organs other than the liver. These conditions are caused when the normal immune response to hepatitis B mistakenly attacks uninfected organs.

Among these conditions are:

• Polyarteritis nodosa: a disease characterized by inflammation of the small-scale blood vessels throughout the torso. This status can cause a wide range of symptoms, including muscle weakness, nervus damage, deep skin ulcers, kidney problems, high blood pressure, unexplained fevers, and abdominal pain.
• Glomerulonephritis: some other rare condition, which is inflammation of the small-scale filtering units of the kidney.

SLIDESHOW

Hepatitis C, Hep B, Hep A: Symptoms, Causes, Handling See Slideshow

How does the hepatitis B virus spread?

• Readers Comments 5
• Share Your Story

Hepatitis B is spread mainly by exposure to infected blood or body secretions. In infected individuals, the virus can be institute in the blood, semen, vaginal discharge, breast milk, and saliva. Hepatitis B is not spread through food, water, or by casual contact.

In the U.s., sexual contact is the most mutual ways of transmission, followed past using contaminated needles for injecting illicit drugs, tattooing, torso piercing, or acupuncture. Additionally, hepatitis B can exist transmitted through sharing toothbrushes and razors contaminated with infected fluids or blood.

Hepatitis B as well may be spread from infected mothers to their babies at birth (and then-called 'vertical' transmission). This is the most prevalent means of transmission in regions of the world where hepatitis B rates are high. The rate of manual of hepatitis B from mother to newborn is very high, and almost all infected infants will develop chronic hepatitis B. Fortunately, manual tin exist significantly reduced through immunoprophylaxis (run across below).

Rarely, hepatitis B can be transmitted through transfused blood products, donated livers and other organs. Nevertheless, blood and organ donors are routinely screened for hepatitis which typically prevents this type of transmission.

Subscribe to MedicineNet'due south Full general Health Newsletter

By clicking Submit, I hold to the MedicineNet'southward Terms & Conditions & Privacy Policy and sympathise that I may opt out of MedicineNet'southward subscriptions at any time.

How do medical professionals diagnose hepatitis B?

• Readers Comments two
• Share Your Story

Infection with hepatitis B is suspected when the medical history and the physical examination reveal risk factors for the infection or symptoms and signs that are suggestive of hepatitis B. Abnormalities in the liver tests (claret tests) as well can raise suspicion; all the same, abnormal liver tests tin can consequence from many conditions that bear on the liver. The diagnosis of hepatitis B can be made just with specific hepatitis B virus blood tests. These tests are known as hepatitis "markers" or "serologies."

Markers found in the blood can confirm hepatitis B infection and differentiate acute from chronic infection. These markers are substances produced by the hepatitis B virus (antigens) and antibodies produced by the immune organization to fight the virus. Hepatitis B virus has three antigens for which there are commonly-used tests - the surface antigen (HBsAg), the cadre antigen (HBcAg) and the e antigen (HBeAg).

HBsAg and anti-HBs

The presence of hepatitis B surface antigen (HBsAg) in the blood indicates that the patient is currently infected with the virus. HBsAg appears an average of four weeks afterwards initial exposure to the virus. Individuals who recover from acute hepatitis B infections clear the blood of HBsAg within approximately four months subsequently the onset of symptoms. These individuals develop antibodies to HBsAg (anti-HBs). Anti-HBs provides consummate immunity to subsequent hepatitis B viral infection. Similarly, individuals who are successfully vaccinated against hepatitis B produce anti-HBs in the blood.

Patients who fail to articulate the virus during an acute episode develop chronic hepatitis B. The diagnosis of chronic hepatitis B is made when the HBsAg is present in the blood for at least six months. In chronic hepatitis B, HBsAg tin can be detected for many years, and anti-HBs does not announced.

Anti-HBc

In acute hepatitis, a specific course of early antibodies (IgM) appears that is directed confronting the hepatitis B core antigen (anti-HBc IgM). Later, another grade of antibody, anti-HBc IgG, develops and persists for life, regardless of whether the private recovers or develops chronic infection. Simply anti-HBc IgM can be used to diagnose an acute hepatitis B infection.

HBeAg, anti-HBe, and pre-core mutations

Hepatitis B e antigen (HBeAg) is present when the hepatitis B virus is actively multiplying, whereas the production of the antibody, anti-HBe, (also called HBeAg seroconversion) signifies a more inactive country of the virus and a lower risk of manual.

In some individuals infected with hepatitis B virus, the genetic cloth for the virus has undergone a structural change, called a pre-cadre mutation. This mutation results in an inability of the hepatitis B virus to produce HBeAg, even though the virus is actively reproducing. This means that even though no HBeAg is detected in the blood of people with the mutation, the hepatitis B virus is still active in these people and they can infect others.

Hepatitis B virus Deoxyribonucleic acid

The best marker of hepatitis B virus reproduction is the level of hepatitis B virus DNA in the blood. Detection of hepatitis B virus DNA in a blood sample signals that the virus is actively multiplying. In acute hepatitis, HBV Dna is present presently after infection, but is eliminated over time in patients' who clear the infection. In chronic hepatitis, levels of HBV Dna often continue to be elevated for many years and so subtract as the immune system controls the virus. HBV DNA levels are sometimes referred to every bit the 'viral load'.

How are the hepatitis B blood tests interpreted?

The post-obit table gives the usual interpretation for sets of results from hepatitis B blood (serological) tests.

Almost Likely Condition*	Tests	Results
Susceptible, not infected, not immune	HBsAg anti-HBc anti-HBs	negative negative negative
Immune due to natural infection	HBsAg anti-HBc anti-HBs	negative positive positive
Immune due to hepatitis B vaccination	HBsAg anti-HBc anti-HBS	negative negative positive
Acutely infected	HBsAg anti-HBc IgM anti-HBc anti-HBs	positive positive positive negative
Chronically infected	HBsAg anti-HBc IgM anti-HBc anti-HBs	positive positive negative negative

*Estimation of the hepatitis B virus claret tests should always exist fabricated past an experienced clinician with knowledge of the patient'southward medical history, concrete exam, and results of the standard liver blood tests. Other weather present in a patient tin can alter the way these test results are interpreted.

From

What is the function of a liver biopsy in chronic hepatitis B?

During a liver biopsy, a pocket-sized sample of liver tissue is nerveless and examined nether the microscope. This exam is valuable because this sample reflects the health of the liver. It can show the corporeality of liver injury (inflammation or cirrhosis). Liver biopsy is not routinely needed to diagnose hepatitis B, simply it is used for monitoring the progression of liver damage in people with chronic hepatitis and helping to cull or evaluate treatment options.

What is the natural grade of chronic hepatitis B?

The course of chronic hepatitis B is variable and depends on several factors. These factors are the patient's historic period at which the infection began, the extent of viral multiplication, and the allowed system's ability to command the infection.

The infection tin progress from an:

• immune tolerant stage (in which the immune system ignores the virus)
• immune clearance stage (in which the immune system attempts to eliminate the virus)
• quiescent stage (in which the virus is less agile)

Allowed tolerant phase

For individuals infected at birth or at a young age, the immune system initially does not react to the hepatitis B virus. This phase of the infection is known every bit the immune tolerant phase. Despite loftier levels of virus in the body, there may be lilliputian prove of inflammation and no symptoms. This phase typically lasts for years, even up to two or iii decades. It is important to know that the immune tolerant phase is generally not seen in individuals who get infected during machismo.

Immune clearance stage

During the third to fourth decade of chronic hepatitis B acquired in babyhood, the allowed system may start to react to the virus. This is known as the immune clearance phase. In contrast, an infection caused in adulthood usually begins with the immune clearance phase. In the immune clearance stage, the immune system attacks the hepatitis B virus-infected liver cells in an attempt to clear the virus. This causes inflammation, liver injury, and the development of scar tissue. Standard liver blood tests are abnormal, and the liver biopsy shows inflammation and/or formation of scar tissue (fibrosis). The severity of liver cell destruction, the caste of fibrosis, and the duration of the immune clearance phase decide the outcome of chronic hepatitis B. The more than severe the destruction and fibrosis and the longer the phase, the more likely it is that cirrhosis will develop.

Quiescent phase

Post-obit the immune clearance stage, the viral infection may enter a less active phase known as the quiescent phase. During this phase, there are no symptoms, the levels of hepatitis B virus get very low, and the standard liver blood tests become normal or nearly normal. Avant-garde scaring or cirrhosis that may have developed earlier, nonetheless, remains. Occasionally, during the quiescent phase, the virus becomes active once more. This is known as a "flare," and often is associated with symptoms, abnormal liver blood tests, and further injury to the liver. The flares are caused by reactivation of the immune system against the virus. Flares can exist very severe and result in further scarring of the liver. The disease in many of these individuals will progress to cirrhosis and eventually to advanced or cease-stage cirrhosis with its associated complications, including liver cancer.

Infected individuals who experience a mild allowed clearance phase and motility into the quiescent phase are known as healthy carriers of hepatitis B virus. These individuals usually have normal liver tests and do not have symptoms; all the same, they can withal transmit the hepatitis B viral infection to others. The risk of hepatitis B virus carriers developing cirrhosis and liver jail cell cancer is small although the risk is college as compared to people without chronic hepatitis B.

IMAGES

Hepatitis B (HBV, Hep B) Encounter a medical epitome of Hepatitis B along with other sexually transmitted diseases (STDs) Encounter Images

What medications treat hepatitis B?

Astute infection

Acute infection with hepatitis B usually does not require treatment. In rare cases, nevertheless, the infection may crusade life-threatening liver failure. Patients with liver failure due to astute hepatitis B should exist evaluated for liver transplantation.

Chronic infection

If a person is chronically infected with hepatitis B and has few signs or symptoms of complications, medications usually are not used. These patients are watched carefully and given periodic blood tests. One examination measures the 'viral load,' that is, the amount of viral DNA in the blood. Doctors will recommend treatment if there are signs that the virus is start to cause damage or if the viral load is high. Some other reason to prescribe medication is if the patient has a positive examination for the Hepatitis B east-antigen (HBeAg) in the blood. HBeAg is associated with an increased risk of progression of liver affliction and its complications.

In chronic hepatitis B, the goal of treatment is to reduce the risk of complications including cirrhosis and liver failure. Still, it takes decades for complications to occur, which makes it difficult to study the event of medications. As a substitute for waiting years to find out what happens, scientists have used tests like the viral load or liver function tests to evaluate if medicines are working. This is logical because information technology is known that people who have big amounts of the virus in their claret are at highest chance to become cirrhosis. Upwardly to one-third of people with very high viral loads (more than than one meg viral copies per milliliter of blood) volition develop cirrhosis over a decade, compared to only iv.5% of those with low viral loads (fewer than 300 viral copies per milliliter).

Medications tin can reduce the number of viruses in the body and may exist able to eliminate the virus from the bloodstream. Logically, this should pb to them having a low rate of progression to cirrhosis (<1% per year), although large, long-term studies accept non been done. Even in people who clear the virus from their blood, depression numbers of viruses withal alive in the liver and other cells. Thus, the medications practise not cure the disease, just they tin can forestall or delay complications and symptoms. People who take a good response to handling tin can still transmit the virus. Doctors follow blood tests that measure viral load and liver function and they may recommend liver biopsies to evaluate if the medications are working.

The medications in electric current utilize for chronic hepatitis B include the interferons and nucleoside/nucleotide analogues. New agents are beingness developed although they are still nether investigation and considered experimental. There are no accepted guidelines that tell how every patient should be treated. As a result, treatment is individualized.

Interferon

Interferon-alpha has been used to care for hepatitis B for more than 20 years. Interferon-blastoff is a naturally occurring protein that is made in the body by white blood cells to combat viral infections. In addition to its direct anti-viral effects, interferon works confronting the hepatitis B virus by stimulating the body's immune arrangement to clear the virus. Compared to older interferon blastoff agents, pegylated interferon alpha, marketed every bit Pegasys or Pegintron, has a more convenient dosing schedule, may be slightly more than effective and suppresses the virus for a longer period of time. Pegylated interferon alpha is given once a calendar week for 48 weeks.

• A significant reduction in the viral load or elimination of detectable viral DNA from the blood occurs in 25%-37% of people during treatment.
• Claret tests for liver functions normalize in approximately 23%-39% people treated with interferon or pegylated interferon.
• People who have significant abnormalities in liver part before therapy are more than likely to respond to treatment.
• Those who take normal liver blood tests before treatment are less likely to respond to interferon therapy.
• Liver biopsy results show improvement in well-nigh one-third of patients.

Merely about a 3rd of people who accept Hepatitis B e-antigen (HBeAg) in their blood will be able to eliminate HBeAg and produce antibodies confronting the HBe antigen subsequently treatment with interferon. Relapse may occur later on handling is stopped.

Sustained response (undetectable viral load in the blood, normal liver function tests) occurs in approximately less than a third of patients after the drug is stopped. Although this is not a cure (some virus still lives in the liver and elsewhere), people with sustained response are at low risk for complications of liver disease. If the responder's immune system is compromised, for example through the use of steroids or acquiring HIV, the disease tin can recur. Periodic monitoring of blood tests can help confirm that the response continues to exist sustained.

Interferon side effects

Interferon causes several side effects including:

• fatigue, generalized musculus aches, fever, chills and loss of appetite. These influenza-like symptoms occur in approximately 80% of treated patients;
• mood swings, low, anxiety and other neuropsychiatric furnishings may occur; and
• thyroid gland abnormalities resulting in hypothyroidism (as well petty thyroid hormone);
• pregnant suppression of the bone marrow and production of blood cells;
• infection;
• or pilus loss may occur.

The side effects may exist astringent plenty that the patient is unable to proceed treatment. During treatment, the normal immune response to the virus is stimulated and may cause worsening inflammation in the liver. This is unremarkably a good sign showing that the interferon is working, but more extreme responses may in rare cases cause liver failure. Thus, physicians will monitor claret tests closely during therapy. People with unstable liver affliction due to cirrhosis normally should not have interferon because of the increased adventure of liver failure.

Nucleoside/nucleotide analogues

Nucleoside/nucleotide analogues (NAs) are man-made chemicals that mimic the nucleosides and nucleotides that are used for making DNA. When the virus tries to utilise the analogues to make its ain DNA, it is unable to make the Deoxyribonucleic acid and, therefore, cannot reproduce. Examples of these agents include adefovir (Hepsera), entecavir (Baraclude), lamivudine (Epivir-HBV, Heptovir, Heptodin), telbivudine (Tyzeka) and tenofovir (Viread).

Unfortunately, the hepatitis B virus may get resistant to NAs over time (see below). Adefovir may exist effective confronting strains of virus that take become resistant to lamivudine and may be added to lamivudine when resistance appears. Simply switching from one NA to another is not recommended because this leads to virus strains that are resistant to multiple medications.

Currently, the optimal duration of handling with nucleoside/nucleotide analogues is uncertain. people with HBeAg may be treated until six months after the HBeAg disappears from the blood and is replaced past antibodies (anti-HBe), if this occurs. In people without HBeAg, the endpoints are less clear. Some experts advocate treating until the viral load (viral Deoxyribonucleic acid) is undetectable and the surface antigen (HbsAg) has been cleared from the blood. Others propose continuing medications for prolonged periods to suppress the virus. All of these strategies are hampered by the take chances of the virus becoming resistant to the medications. Patients who discontinue treatment with NAs should exist monitored advisedly for recurrent hepatitis, which may exist severe.

Is there a preferred handling for chronic hepatitis B?

There are no clear guidelines to recommend which agent to utilize first in treating chronic hepatitis B, as there are multiple options. Interferon is given for a defined period of fourth dimension and may take a more prolonged response after the medication is discontinued than NAs. Still, interferon is given as an injection, and side effects often are troublesome. NAs are given as a pill and have few side furnishings, but the elapsing of treatment is unclear, and prolonged therapy (years) may be required. NAs may exist preferred in patients with unstable disease and cirrhosis because they are thought to be less likely to cause serious flares of hepatitis with more astringent liver disease.

What are the furnishings of alcohol on hepatitis B?

Agents that impairment the liver are especially harmful in patients who already have hepatitis B. For this reason, information technology is recommended that people with hepatitis B avoid drinking booze.

What are the effects of immunosuppressive medications on hepatitis B?

Fifty-fifty in people with chronic hepatitis B, the immune system is working to suppress the virus. Medications that suppress the immune system allow the virus to reproduce in large numbers and may crusade the hepatitis to flare.

Examples of medications that suppress the immune arrangement are:

• prednisone: used to care for many diseases, including asthma, inflammatory bowel disease, and sure types of pare disease and arthritis
• methotrexate (Rheumatrex, Trexall): used to treat certain types of pare disease, arthritis, and cancer;
• cyclophosphamide (Cytoxan): used to treat some cancers.

If an immunosuppressant drug is stopped, the body'southward immune organisation'southward action may rebound and cause severe inflammation of the liver.

What is delta hepatitis?

Delta hepatitis is caused by a virus that only infects people who already take hepatitis B. The delta hepatitis virus (also known as hepatitis D or HDV) is an RNA virus, significant that its genetic material is made up of ribonucleic acid. It is spread through exposure to contaminated blood, especially with illicit, intravenous drug use, and by sexual contact. Delta hepatitis can be acquired at the same time every bit acute hepatitis B. When this happens, infected people are quite ill but nearly are somewhen able to eliminate the viruses from their bodies. People who already have chronic hepatitis B can acquire delta hepatitis likewise. This often causes severe inflammation of the liver, and the viruses are less likely to be cleared.

Delta hepatitis makes chronic hepatitis B much worse. It increases the gamble of complications, specially cirrhosis, which occurs in up to ii-thirds of patients.

In that location is no vaccine against delta hepatitis. Interferon treatment may crusade improvement in the hepatitis, just relapse is mutual later therapy is stopped. Prevention includes avoiding contaminated needles and practicing safer sex (abnegation or limiting the number of partners, using barrier methods of contraception). Universal vaccination of newborns with hepatitis B vaccine effectively prevents delta hepatitis considering the delta hepatitis virus simply causes disease in the presence of hepatitis B virus.

What nearly co-infection with hepatitis B virus and hepatitis C virus?

Hepatitis C is acquired by a virus that is spread through contaminated needles or blood products and, less commonly, through sexual intercourse. Few patients with chronic hepatitis B also are co-infected chronically with hepatitis C virus (HCV). The two viruses interfere with each other and 1 unremarkably predominates. If hepatitis C is the predominant infection, treatment is directed against the hepatitis C. Patients infected with both viruses are at college risk for complications of liver affliction. At that place is no effective vaccine against hepatitis C. People with hepatitis C should be vaccinated against hepatitis B to forestall co-infection.

What happens in co-infection with hepatitis B virus and HIV?

The homo immunodeficiency virus (HIV) and hepatitis B virus are transmitted in similar ways, and it is not uncommon for an individual to accept both infections. People with HIV who learn hepatitis B are more probable to get chronically infected with hepatitis B than people who do not accept HIV. The reason for this is thought to be that HIV suppresses the immune system and impairs the ability of the trunk to eliminate the hepatitis B virus. Some nucleoside/nucleotide analogues (a class of antiretroviral drugs) are used to treat both HIV and hepatitis B, although dosages may vary in the ii different infections. Stopping ane of these agents when the HIV regimen is adjusted may crusade hepatitis to flare.

What is new in the handling of hepatitis B?

• Readers Comments x
• Share Your Story

New agents are nether development to treat hepatitis B. Many of these are nucleoside/nucleotide analogues that investigators promise will be more effective than older agents. Experts also are working on treatment guidelines and the use of multi-drug therapy. Vaccination remains the key to preventing hepatitis B and holds the near promise for reducing affliction burden.

What is the role of liver transplantation in hepatitis B?

Liver transplantation has been successful in patients who accept irreversible, life-threatening complications of hepatitis B. This includes patients with liver failure due to stop-stage cirrhosis or unusually astringent (fulminant) hepatitis. Liver transplantation does non cure hepatitis B, and hepatitis may occur in the new liver. The incidence of recurrent hepatitis has been reduced to less than 10% through use of lamivudine and HBIG in transplant recipients. Use of these agents has also improved long-term survival, with 75% of patients alive later on five years.

What tin be done to prevent hepatitis B?

Hepatitis B is a preventable disease. Vaccination and post-exposure prophylaxis have significantly reduced rates of infection. Risk tin as well be reduced past fugitive unprotected sexual activity, contaminated needles, and other sources of infection.

How effective is vaccination for hepatitis B?

The hepatitis B vaccine contains a poly peptide (antigen) that stimulates the body to make protective antibodies. Examples of hepatitis B vaccines available in the United states of america include hepatitis B vaccine-injection (Engerix-B, Recombivax-HB). Three doses (given at 0, i, and half-dozen months) are necessary to assure protection. There are also combination vaccines on the market that provide protection against hepatitis B and other diseases.

Examples include:

• Hepatitis-b-hepatitis-a vaccine - injection (Twinrix), which provides protection against both hepatitis A and hepatitis B.
• Haemophilus B/hepatitis B vaccine - injection (Comvax) provides protection confronting hepatitis B and Haemophilus influenzae blazon b (a cause of meningitis).
• Pediarix provides protection against hepatitis B, tetanus, pertussis (whooping cough), and polio.

Hepatitis B vaccines are effective and safe. Most vaccinated individuals course constructive antibodies and are protected from hepatitis B when they get full three-dose serial of vaccine. In healthcare workers, high-gamble public safety workers, dialysis patients, and sexual partners of infected people, a blood test for antibodies is recommended after vaccination to ensure that the person produced antibodies. For the few who do non form antibodies, revaccination may improve response, especially in infants. All the same, a pocket-sized proportion of individuals will never respond to hepatitis B vaccination. Side furnishings from the vaccine are usually mild and include soreness at the site of injection. The run a risk of serious allergic reactions (anaphylaxis) is less than one per million doses. Vaccination has reduced the number of new cases of hepatitis B in the The states.

In the U.s., hepatitis B vaccination is recommended for all infants at birth. Older children and adolescents should receive the vaccine if they did not do and then at birth.

Adults in high run a risk situations likewise are advised to receive hepatitis B vaccine. This includes:

• health care workers
• dentists
• intimate and household contacts of patients with chronic hepatitis B infection
• public condom workers who may be exposed to blood
• men who have sex with men
• individuals with multiple sexual partners
• dialysis patients
• injection drug users
• people with chronic liver illness
• residents and staff in institutions that care for people with developmental disabilities
• people infected with HIV
• people who require repeated transfusions or blood products.

Centers that serve loftier-adventure individuals are encouraged to provide the vaccine to their clients. Such centers include dialysis units, drug handling facilities, sexually transmitted diseases clinics and correctional facilities. Some countries accept a high prevalence of hepatitis B in their population. Travelers who visit these countries for a prolonged period of fourth dimension (unremarkably six months) and those who may be exposed to claret or semen should consider vaccination.

How effective is hepatitis B allowed globulin (HBIG) in preventing hepatitis B?

HBIG is a product that contains antibodies against hepatitis B. When injected, it provides temporary protection against hepatitis B. HBIG is used when people accept had pregnant exposure to the virus. An instance would be an accidental needle stick in an unvaccinated wellness care worker from a needle contaminated with blood from a person with hepatitis B. HBIG should be given as presently as possible afterwards exposure, preferably within seven days. People who need HBIG should also receive hepatitis B vaccine. HBIG as well is given to patients with hepatitis B following liver transplantation to suppress the hepatitis B virus in the transplanted liver.

What is post-exposure immunoprophylaxis for hepatitis B virus?

Unvaccinated individuals who are exposed to a known instance of hepatitis B or to a person at high hazard for hepatitis B should be evaluated by a physician. Examples of such exposures include needle stick injuries in wellness care workers or sexual intercourse with an infected person. If the exposure is significant, the dr. volition recommend vaccination and likewise may recommend an injection of hepatitis B immune globulin (HBIG). HBIG is prepared from the plasma of blood donors and contains antibodies to hepatitis B. Vaccination and HBIG tin substantially reduce the risk of disease in people exposed to hepatitis B if given within 1 week of a needle stick or ii weeks of sexual intercourse.

Vaccination provides long-term immunity in people who respond to the vaccine. There is no demand for HBIG if an exposure occurs to a vaccinated person who is known to respond to the vaccine; however, a blood examination might be fatigued to verify that the person did reply to the vaccine.

How is transmission of hepatitis B virus from mother to newborn baby prevented?

Infected mothers can pass hepatitis B to their newborn infants. All significant women should have blood tested to make up one's mind if they are infected. Infants born to infected mothers should receive HBIG and hepatitis B vaccine at birth.

Medically Reviewed on two/2/2021

References

Medically reviewed by Venkatachala Mohan, Dr.; Board Certified Internal Medicine with subspecialty in Gastroenterology

REFERENCE:

United States. Centers for Disease Control and Prevention. "Viral Hepatitis FAQs for the Public." January 15, 2009
Previous contributing medical writer and editor: Tse-Ling Fong, Medico and Leslie J. Schoenfield, M.D., Ph.D.

inouyeittless.blogspot.com

Source: https://www.medicinenet.com/hepatitis_b/article.htm

Share this post