Hepatitis B

What is hepatitis b?

Hepatitis B is a viral infection of the liver spread through blood and body fluids. Adults who catch it usually clear the infection, whereas infection acquired in infancy very often becomes chronic. Chronic infection can silently progress to cirrhosis and liver cancer over decades, so monitoring matters even when people feel well. A highly effective vaccine exists.

Causes

• Hepatitis B virus transmitted through blood and body fluids
• Mother to child transmission at birth
• Unprotected sexual contact
• Sharing needles or unsterile medical equipment
• Needlestick injury

Symptoms

• Often no symptoms, particularly in chronic infection
• Fatigue
• Jaundice with yellowing of skin and eyes
• Dark urine and pale stools
• Nausea and loss of appetite
• Right upper abdominal discomfort
• Joint aches in acute infection

Risk factors

• Birth in a region with high prevalence
• Unprotected sex with multiple partners
• Injecting drug use
• Healthcare occupational exposure
• Household contact with an infected person
• Haemodialysis

Diagnosis

• Hepatitis B surface antigen indicating current infection
• Surface antibody indicating immunity
• Core antibody to distinguish past exposure
• HBV DNA viral load
• Liver function tests and fibrosis assessment
• Ultrasound surveillance for liver cancer in chronic infection

Treatment

• Vaccination for prevention, including at birth in many countries
• Post exposure prophylaxis with vaccine and immunoglobulin
• Supportive care in acute infection
• Antiviral medicines such as tenofovir or entecavir in chronic infection
• Regular monitoring of viral load and liver fibrosis
• Six monthly ultrasound surveillance where cancer risk is raised
• Avoiding alcohol and vaccinating against hepatitis A

Self care

• Attend monitoring appointments even when you feel well
• Take antiviral medicines exactly as prescribed and never stop suddenly
• Avoid alcohol, which accelerates liver damage
• Do not share razors, toothbrushes or needles
• Tell sexual partners so they can be vaccinated
• Get vaccinated against hepatitis A
• Check with a pharmacist before taking new medicines or supplements

When to see a doctor

Book an appointment if:

• Increasing fatigue or abdominal discomfort
• Any yellowing of the skin or eyes
• Before starting immunosuppressive treatment or chemotherapy
• Planning pregnancy
• Household or sexual contacts needing testing and vaccination
• Missed doses of antiviral treatment

Some symptoms need emergency care rather than an appointment. See the warning signs listed above.

Prevention

• Vaccination, which is highly effective and safe
• Birth dose vaccination for babies of infected mothers
• Antiviral treatment in pregnancy where viral load is high
• Use condoms with new or untested partners
• Never share injecting equipment
• Ensure sterile equipment for tattoos and piercings

Outlook

Around 95 percent of adults who acquire hepatitis B clear it completely. Infection acquired in infancy usually becomes chronic. Chronic infection can be suppressed with antivirals, which greatly reduces progression to cirrhosis and liver cancer, though the virus is rarely eliminated. Regular monitoring and six monthly ultrasound surveillance are what keep long term outcomes good.

Related conditions

Common questions