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
·
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
More Information
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.
·
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.
More Information
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.
Preparing for your appointment
You're likely to start by seeing your family doctor or a general
practitioner. However, in some cases, you may be referred immediately to a
specialist. Doctors who specialize in treating hepatitis B include:
·
Doctors who treat digestive diseases (gastroenterologists)
·
Doctors who treat liver diseases (hepatologists)
·
Doctors who treat infectious diseases
What
you can do
Here's some information to help you get ready for your
appointment.
·
Be aware of pre-appointment
restrictions. When you make the appointment, ask if there's anything you
need to do in advance, such as restrict your diet.
·
Write down your symptoms, including
any that may seem unrelated to the reason for which you scheduled the
appointment.
·
Write down key personal
information, including major stresses or recent life changes.
·
Make a list of all medications, vitamins
and supplements you take.
·
Consider taking a family member
or friend along. Someone who accompanies you may help you remember the
information you receive.
·
Write down questions to ask your
doctor.
Listing questions for your doctor can help you make the most of
your time together. For hepatitis B infection, some basic questions to ask your
doctor include:
·
What is likely causing my symptoms or condition?
·
Other than the most likely cause, what are other possible causes
for my symptoms or condition?
·
What tests do I need?
·
Is my condition likely temporary or chronic?
·
Has hepatitis B damaged my liver or caused other complications,
such as kidney problems?
·
What is the best course of action?
·
What are the alternatives to the primary approach you're
suggesting?
·
I have other health conditions. How can I best manage them
together?
·
Are there restrictions that I need to follow?
·
Should I see a specialist?
·
Should my family be tested for hepatitis B?
·
How can I protect people around me from hepatitis B?
·
Is there a generic alternative to the medicine you're
prescribing?
·
Are there brochures or other printed material I can have? What
websites do you recommend?
What
to expect from your doctor
Your doctor is likely to ask you a number of questions,
including:
·
When did your symptoms begin?
·
Have your symptoms been continuous or occasional?
·
How severe are your symptoms?
·
What, if anything, seems to improve your symptoms?
·
What, if anything, appears to worsen your symptoms?
·
Have you ever had a blood transfusion?
·
Do you inject drugs?
·
Have you had unprotected sex?
·
How many sexual partners have you had?
·
Have you been diagnosed with hepatitis?
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.
_________________________________________________________________________________
Hepatitis
B virus. Credit: iStock
New strategy to cure chronic hepatitis B infection
Hepatitis
B virus. Credit: iStock
Scientists from Karolinska
Institutet and Hannover Medical School have published two studies that provide
insights into how the immune system responds and helps to clear a hepatitis B
infection after treatment interruption. The findings offer a framework for
future tailored treatment strategies and are published in the Journal
of Infectious Diseases and Journal of Hepatology.
Chronic hepatitis B (CHB) caused by
hepatitis B virus (HBV), affects 250 million individuals worldwide. The virus
infects the liver and infected patients are at risk of developing liver
cirrhosis and liver cancer.
Nucleoside/nucleotide analogues
(NAs) are the most commonly used drugs to treat CHB, but this treatment only
suppresses the virus and rarely leads to eradication of the infection. Thus,
for most patients this is a life-long treatment.
The immune
system recovers in some patients
Because of this, new treatment
strategies are continuously evaluated with the aim to achieve
elimination of HBV. One involves doing a structured NA treatment interruption
in patients that have been on the treatment for a couple of years. In 20-30 per
cent of the CHB patients the immune system recovers from being exhausted by the
chronic infection and gains the capacity to efficiently fight the virus when it
starts to replicate after the treatment has been discontinued.
In a clinical trial 15 patients with
CHB underwent a structured treatment cessation. Before, during and after, the
patients were closely monitored and biological samples were continuously
collected for subsequent analysis using flow cytometry. The research focus was
on the parts of the immune system that has the capacity to recognise and
eliminate virus-infected liver cells.
"Interruption of NA treatment
significantly boosts the capacity of immune cells to kill HBV-infected cells
and this activation was also associated with functional cure in the patients.
For patients clearing the infection, we also found that the immune system was
less exhausted and that immune cells specific
for the virus expanded
in vivo," says Ph.D.-student Christine Zimmer at the Department of
Medicine, Huddinge, Karolinska Institutet.
Further
studies necessary
Even though patient recruitment for
this kind of clinical trial is extremely challenging, the findings need to be
confirmed in larger studies.
"Several questions still remain
to be answered such as the identification of the exact component of the immune
system needed to achieve a functional cure of CHB following NA interruption,
and also identifying patients who
will benefit from stopping NA treatment," says Niklas Björkström,
Physician and Associate Professor at the Department of Medicine Huddinge,
Karolinska Institutet, one of the main authors.
More
information: Christine L Zimmer et al.
Increased NK Cell Function After Cessation of Long-Term Nucleos(t)ide Analogue
Treatment in Chronic Hepatitis B Is Associated With Liver Damage and HBsAg
Loss, The Journal of Infectious Diseases (2018). DOI:
10.1093/infdis/jiy097
Hepatitis
B virus-specific T cell responses after stopping nucleos(t)ide analogue therapy
in HBeAg negative chronic hepatitis B. Journal of Hepatology,
online 11 May, 2018, DOI: 10.1016/j.jhep.2018.05.004
Journal
information: Journal of
Infectious Diseases
Provided by Karolinska
Institutet
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