Topic Overview
What is hepatitis B?
Hepatitis B is a
virus that infects the
liver. Most adults who get hepatitis B have it for a
short time and then get better. This is called acute hepatitis B.
You can have hepatitis B and not know it. You may not have symptoms. If
you do, they can make you feel like you have the flu. But as long as you have
the virus, you can spread it to others.
Sometimes the virus causes
a long-term infection, called chronic hepatitis B. Over time, it can damage
your liver. Babies and young children infected with the virus are more likely
to get chronic hepatitis B.
What causes hepatitis B?
Hepatitis B is caused by
the hepatitis B virus. It is spread through contact with the blood and body
fluids of an infected person.
You may get hepatitis B if
you:
- Have sex with an infected person without
using a condom.
- Share needles (used for injecting drugs) with an
infected person.
- Get a tattoo or piercing with tools that were not
cleaned well.
- Share personal items like razors or toothbrushes with
an infected person.
A mother who has the virus can pass it to her baby during
delivery. If you are pregnant and think you may have been exposed to hepatitis
B, get tested. If you have the virus, your baby can get shots to help prevent
infection with the virus.
You cannot get
hepatitis B from casual contact such as hugging, kissing, sneezing, coughing,
or sharing food or drinks.
What are the symptoms?
Many people with hepatitis
B do not know they have it, because they do not have symptoms. If you do have
symptoms, you may just feel like you have the flu. Symptoms include:
- Feeling very tired.
- Mild
fever.
- Headache.
- Not wanting to
eat.
- Feeling sick to your stomach or vomiting.
- Belly
pain.
- Diarrhea or constipation.
- Muscle aches and joint
pain.
- Skin rash.
- Yellowish eyes and skin (jaundice).
Jaundice usually appears only after other symptoms have started to go
away.
Most people with chronic hepatitis B have no
symptoms.
How is hepatitis B diagnosed?
A simple blood test
can tell your doctor if you have the hepatitis B virus now or if you had it in
the past. Your doctor also may be able to tell if you have had the vaccine to
prevent the virus.
If your doctor thinks you may have liver damage
from hepatitis B, he or she may use a needle to take a tiny sample of your
liver for testing. This is called a
liver biopsy.
How is it treated?
In most cases, hepatitis B goes
away on its own. You can relieve your symptoms at home by resting, eating
healthy foods, drinking plenty of water, and avoiding alcohol and drugs. Also,
find out from your doctor what medicines and herbal products to avoid, because
some can make liver damage caused by hepatitis B worse.
Treatment
for chronic hepatitis B depends on whether your infection is getting worse and
whether you have liver damage. Most people with chronic hepatitis B can live
active, full lives by taking good care of themselves and getting regular
checkups. There are medicines for chronic hepatitis B, but they may not be
right for everyone. Work with your doctor to decide whether medicine is the
right treatment for you.
Sometimes, chronic hepatitis B can lead to
severe liver damage. If this happens, you may need a liver transplant.
Can hepatitis B be prevented?
The hepatitis B
vaccine is the best way to prevent infection. The vaccine is a series of 3 or 4
shots. Adults at risk and all babies, children, and teenagers should be
vaccinated.
A combination vaccine (Twinrix) that protects against
both hepatitis B and hepatitis A also is available.
To avoid
getting or spreading the virus to others:
- Use a condom when you have
sex.
- Do not share needles.
- Wear latex or plastic gloves
if you have to touch blood.
- Do not share toothbrushes or
razors.
Frequently Asked Questions
Learning about hepatitis B: | |
Being diagnosed: | |
Getting treatment: | |
Living with: | |
Cause
Hepatitis B is
a liver disease caused by infection with the hepatitis B virus (HBV). Hepatitis
B is one of the most common forms of
viral hepatitis, which includes
hepatitis A, B, C, D, and E. But hepatitis has many
other causes, including some medicines, long-term alcohol use, fatty deposits
in the liver, and exposure to certain industrial chemicals.
How HBV is spread
HBV is spread when blood,
semen, or vaginal fluids (including menstrual blood)
from an infected person enter another person's body, usually in one of the
following ways:
- Sexual contact. The hepatitis B virus can
enter the body through a break in the lining of the
rectum,
vagina,
urethra, or mouth. Sexual contact is the most
important risk factor for the spread of HBV in North America.
-
Sharing needles. People who share needles and other equipment (such as cotton,
spoons, and water) used for injecting illegal drugs may inject HBV-infected
blood into their veins.
- Work-related exposure. People who handle
blood or instruments used to draw blood may become infected with the virus.
Health care workers are at risk of becoming infected with the virus if they are
accidentally stuck with a used needle or other sharp instrument contaminated
with an infected person's blood. Infection also can occur if blood splashes
onto an exposed surface, such as the eyes, mouth, or a cut in the
skin.
- Childbirth. A newborn baby can get the virus from his or her
mother during delivery when the baby comes in contact with the mother's body
fluids in the birth canal (perinatal transmission). But breast-feeding does not
transmit the virus from a woman with HBV to her child.
- Body
piercings and tattoos. HBV may be spread when needles used for body piercing or
tattooing are not properly cleaned (sterilized) and HBV-infected blood enters a
person's skin.
- Toiletries. Grooming items such as razors and
toothbrushes can spread HBV if they carry blood from a person who is infected
with the virus.
In the past, blood transfusions were a common means of
spreading HBV. Organ transplants could also spread the disease. Today, all
donated blood and organs in Canada and the United States are screened for the virus, so it
is extremely unlikely that you could become infected with the virus from a
blood transfusion or organ transplant.
Contagious and incubation periods
Symptoms appear
an average of 60 to 90 days (although they can appear 45 to 180 days) after you
have contact with the hepatitis B virus (incubation period). Blood, semen, and vaginal fluids (including menstrual blood),
whether fresh or dried, are highly contagious (HBV can be easily spread) during
this period and for several weeks after the onset of symptoms.
- Blood contains the highest quantities of the
hepatitis B virus.
- Blood and other body fluids that contain the
virus can remain contagious for at least a week and possibly much longer, even
if they are dried.
If you have a short-term HBV (acute) infection, you
usually cannot spread the virus after
antibodies against the surface
antigen of HBV appear. This generally takes several
weeks. If you have a long-term (chronic) HBV infection, you are able to spread
the virus as long as you have an active infection.
Symptoms
Less than half of those with short-term
(acute)
hepatitis B infections have symptoms. Symptoms
include:
- Jaundice (the skin and whites of the
eyes appear yellow). Although jaundice is a major sign of liver damage, it
does not occur in most people who have hepatitis B. Jaundice usually appears after other symptoms have started to go
away.
- Extreme tiredness (fatigue).
- Mild
fever.
- Headache.
- Loss of appetite, nausea,
and vomiting.
- Constant discomfort on the
right side of the abdomen under the rib cage, where the liver is located. In
most people, the discomfort is made worse when their bodies are jarred or if
they overwork themselves.
- Diarrhea or
constipation.
- Muscle aches or joint
pain.
- Skin rash.
Most people with chronic HBV have no symptoms.
You may get infected with HBV without knowing it. You may not find out
that you have an HBV infection until you have a routine blood test or donate
blood. Finding out a family member or someone you live with is infected also
may cause you to be tested. Some people never know they have hepatitis B until
a doctor finds that they have
cirrhosis or
liver cancer (hepatocellular carcinoma). But this is
uncommon.
What Happens
Symptoms of infection with
hepatitis B virus (HBV), if they appear at all,
usually begin 60 to 90 days (although they can appear from 45 to 180 days)
after the virus enters the body.
Most people have acute
(short-term) HBV infection. In this infection:
- Most people start to feel better after 2 to 3
weeks and recover completely after 4 to 8 weeks. They develop
antibodies against a type of HBV
antigen that provide lifelong protection against
future infection.
- Only a few people (particularly older adults)
have long-lasting symptoms.
- A small number of people have symptoms
that last for months. They may have signs of abnormal liver function before
they completely recover from the acute infection.
About 1 or 2 out of 10 people with acute HBV infection
develop joint pain and rashes.1 In rare cases, HBV
causes
hives; swelling of the lips, tongue, or other tissue;
swelling of the voice box (larynx); or pain in the abdomen.
If you
stay infected with HBV for 6 months or longer, you have chronic hepatitis B.
The risk of having chronic HBV infection is related to the age at which you
first become infected with the virus.2
- Up to 90% of children who are infected at birth
develop chronic HBV infection.
- About 30% of children who are
infected after birth between the ages of 1 and 5 develop chronic
infection.
- About 6% of infected older children, adolescents, and
adults develop chronic infection.
Most
people with chronic infection have no symptoms. But they can spread the virus
to others (especially to people who live with them and to their sex partners)
unless they receive treatment that controls the infection.
Although
many people with chronic hepatitis B will not develop complications, about 15%
to 25% of people with chronic HBV infection will die of
cirrhosis or
liver cancer.3 Having a lot
of virus in the body (a high viral load) increases the risk of developing
cirrhosis and liver cancer.
- You are more likely to develop cirrhosis if you
carry a specific hepatitis B antigen (called the HBe antigen), are older than
40, and have elevated liver enzymes. For more information on cirrhosis, see the
topic Cirrhosis.
- Risk factors for developing
liver cancer after chronic HBV infection include being male, having a family
history of liver cancer, being over 40 years old, having cirrhosis, and also
having
hepatitis C.
Other problems that can develop in relation to HBV
infection but are uncommon include:
- Hepatitis D (delta) virus infection,
which only occurs in those with hepatitis B and may make the HBV infection more
severe. Infection with hepatitis D is rare in Canada and the United
States.
- Fulminant hepatitis, which causes sudden and severe
liver failure. A stay in the hospital is needed.
- Inflammation of the blood vessels (vasculitis), which may result in kidney disease,
arthritis, belly pain, inflammation of a nerve
(mononeuritis), and
Raynaud's phenomenon.
- Inflammation and
disruption of the kidney (membranoproliferative glomerulonephritis).
People with hepatitis B who engage in high-risk behaviour
(such as having multiple sex partners or injecting illegal drugs) are at
increased risk for hepatitis C and
HIV, the virus that causes
AIDS.
What Increases Your Risk
People who practice certain
behaviours or have certain jobs are at high risk for becoming infected with
hepatitis B virus (HBV). If you are a member of a
high-risk group, you should receive the
hepatitis B vaccine.4
Risk factors for hepatitis B that you can control
include:
- Being sexually active, including having
unprotected sex with someone who is infected with the virus or whose sexual
history is unknown to you.
- Having more than one sex partner. (Your
risk for HBV infection is higher if you have another
sexually transmitted infection such as
chlamydia.)
- Sharing needles or other
equipment (such as cotton, spoons, and water) to inject illegal drugs.
Job and lifestyle risk factors for hepatitis B include:
- Handling blood or body fluids as a routine part
of your job. This includes health care workers, such as doctors, dentists,
nurses, and blood and laboratory technicians, and students in these
jobs. It also includes morticians and embalmers.
- Being an
employee or resident of an institution for the developmentally
disabled.
- Being an employee or inmate of a long-term
prison.
- Spending more than 6 months in parts of the world where
hepatitis B is common or where a large number of people have been infected for
a long time with HBV. Such areas include Southeast and Central Asia, the
islands of the South Pacific, the Amazon River basin, the Middle East, Africa,
Eastern Europe, and China.
- Being a sexually active homosexual or
bisexual man.
- Living with someone who has long-term (chronic) HBV
infection.
- Getting body piercings and tattoos from a tattoo artist
who uses poor infection-control practices.
Risk factors for hepatitis B that you cannot control include:
- Being born to a woman who is infected with HBV
(if the newborn doesn't promptly receive the
hepatitis B vaccine and
hepatitis B immunoglobulin). But breast-feeding does
not transmit the virus from a woman who has HBV to her child.
- Having
at some time lived in a part of the world where hepatitis B is
common.
- Having a blood-clotting disorder, such as
hemophilia, that requires you to receive
clotting factors from human donors.
- Having
severe kidney disease that requires you to have your blood filtered through a
machine (hemodialysis).
- Being bitten by a person who
is infected with HBV. (Note: HBV is not spread by kissing.)
Most people in North America who have hepatitis are in
one of the high-risk groups. But some people do not know how they became
infected.
People with hepatitis B who engage in high-risk behaviour
(such as having multiple sex partners or injecting illegal drugs) are at
increased risk for hepatitis C and
HIV, the virus that causes
AIDS.
Hepatitis B and C: Should I Be Tested?
When To Call a Doctor
Contact a doctor immediately if you have been diagnosed with
hepatitis B and develop severe
dehydration (caused by vomiting and an inability to
hold down fluids) or any of the following signs of rapidly developing liver
failure:
- Extreme irritability (greater than would be
expected in a person who is feeling ill).
- Impaired ability to think
or reason clearly.
- Extreme drowsiness.
- Swelling of the
arms, legs, hands, feet, abdomen, and/or face (edema).
- Heavy
bleeding from the nose, mouth, or rectum (including blood in the stool), or
under the skin.
- Yellowing of the skin and the whites of the eyes (jaundice).
If you witness a person with hepatitis B become
unconscious, call 911 or other emergency
services.
Call to make an appointment if:
- You have any of the hepatitis B risk factors
listed in the What Increases Your Risk section of this topic, and you think you
need to be tested for hepatitis B virus (HBV) infection or receive the
hepatitis B vaccine.
- You have any symptoms of hepatitis B (see
the Symptoms section of this topic).
- Someone in your household has
been diagnosed with hepatitis B.
- Your sex partner has been
diagnosed with hepatitis B.
- You have been bitten by or exposed to
the blood or body fluids (such as
semen or vaginal fluids, including menstrual blood) of
someone who has hepatitis B.
Watchful Waiting
Watchful waiting is a period of time during
which you and your doctor observe your symptoms or
condition without using medical treatment. Because of the need to prevent the
spread of hepatitis B, watchful waiting is not recommended if you have symptoms
of hepatitis B or if you think you have come in contact with the hepatitis B
virus (HBV). Because all forms of
viral hepatitis have similar symptoms, it is important
to see a doctor for a blood test when symptoms arise, so
that he or she can rule out other forms of the illness. A
doctor also can advise you about how to prevent the spread
of the virus.
Who To See
Your family doctor, general practitioner, or pediatrician can usually diagnose a hepatitis B virus (HBV) infection.
You may be referred to one of the following specialists who may work with your doctor to
plan treatment:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Examinations and Tests
Your doctor will
diagnose
hepatitis B virus (HBV) infection based on a physical
examination, your medical history, and blood tests. You will be asked questions
about risk factors for hepatitis B (such as about your job or sexual activity)
and about factors that could make the disease worse (such as your alcohol use
or family history of liver cancer).
If your
doctor thinks you may be infected with the virus, you will
need tests to find out more about your condition.
Blood
tests done to help diagnose hepatitis B include:
- Hepatitis B
antigens and
antibodies, which help tell
whether you are or were infected with HBV, whether you have been immunized,
and whether you have long-term (chronic) HBV infection.
You also may get tested for hepatitis B viral DNA (HBV DNA), which detects genetic material (DNA) from the hepatitis B virus.
HBV DNA indicates that the virus is multiplying in your body (active) and that
you can pass the virus to others. For more
information, see the topic
Hepatitis B Virus Tests.
- Tests that determine whether the
hepatitis A,
hepatitis C, or
Epstein-Barr (which causes infectious mononucleosis,
or "mono") viruses are causing your hepatitis if the results of your tests show
that HBV is not multiplying in your body.
- Tests that determine the
cause of liver
inflammation if it is not a viral
cause.
- Tests that determine whether you are infected with
hepatitis D along with hepatitis B.
- Hepatitis B and C: Should I Be Tested?
Blood tests done to help find out if your liver
has been damaged include:
Tests may be done if you have chronic HBV infection and are
considering antiviral treatment. These tests also may be used to find out
whether treatment has helped control liver damage caused by
chronic HBV infection. They include:
- Diagnostic imaging.
- Removing a tissue sample from the liver (liver biopsy).
If you have chronic hepatitis B, the Canadian National Advisory Committee on Immunization (NACI) recommends that you be vaccinated for
hepatitis A if you have not been vaccinated or are not
immune to this disease.4 For more information on Hepatitis A, see the topic
Hepatitis A.
If you are at risk for liver
cancer, an
alpha-fetoprotein (AFP) test may be done. If the AFP
level is elevated, it may point to liver cancer.
If you have
chronic HBV infection, you will need to visit your doctor
regularly. He or she will do blood tests to monitor your liver function and the
activity of the hepatitis B virus in your body. Some of the tests can tell your
doctor whether HBV is actively multiplying in your liver,
which increases your risk for chronic
hepatitis. Chronic hepatitis can lead to
cirrhosis or
liver cancer (hepatocellular carcinoma).
Early detection
The Canadian National Advisory Committee on Immunization (NACI) recommends that all pregnant women have
the hepatitis B surface antigen test.4 This test can tell if a woman has an
active HBV infection. This test also may be repeated later in the pregnancy if
a woman is at high risk for infection. For more information on risk factors,
see the What Increases Your Risk section of this topic.
People who
were exposed to the hepatitis B virus in the past, especially people who moved
to Canada from a country where the virus is common, often develop
lifelong protection (immunity) against HBV and do not need to be vaccinated.
But people from countries where HBV infection is common may carry the virus and
should be screened for the virus.
You can be tested for
hepatitis B before getting vaccinated.
- Antibody testing will show if you have an active hepatitis B infection and need treatment.
- If testing shows you are already protected against hepatitis B, you will not need to get the hepatitis B vaccine.
- You can receive the
hepatitis B vaccine even if you already have antibodies against HBV in your
blood, and no harm will result.
Treatment Overview
Treatment of
hepatitis B viral (HBV) infection depends on how
active the virus is and whether you are at risk for liver damage such as
cirrhosis. Short-term (acute) hepatitis B usually goes
away on its own. Home treatment is used to relieve symptoms and help prevent
spread of the virus. In long-term (chronic) HBV infection, treatment includes
monitoring the condition and using antiviral medicines to prevent liver
damage. If hepatitis B has severely damaged your liver, a liver transplant may
be considered.
The Canadian Association for the Study of the Liver
has made
recommendations on who should receive antiviral
treatment for chronic hepatitis B based on the presence of hepatitis B
antigens, level of
HBV DNA, and the levels of liver
enzymes in your blood.5
Treatment of short-term (acute) hepatitis B infection
Initial treatment for
hepatitis B infection depends on whether you:
- Have been recently infected with the hepatitis B virus
(HBV).
- Have the symptoms of an acute HBV
infection.
- Have chronic HBV infection.
If you believe you have recently been exposed to HBV, you
should receive the first of
three immunization shots of
hepatitis B vaccine. You may also receive a shot of
hepatitis B immunoglobulin (HBIG). It is important to receive this treatment within 7 days
after a needle stick and within 2 weeks after sexual contact that may have
exposed you to the virus. The sooner you receive treatment after exposure, the
more effective treatment is.
If you have the symptoms of acute
hepatitis B, treatment with medicine is usually not needed. Home treatment
usually will relieve your symptoms and help prevent the spread of the virus. To
help relieve symptoms and prevent the spread of the infection:
- Slow down. Reduce your activity level to
match your energy level. Don't go to work or school unless your workload can be
lightened. Avoid strenuous exercise. As you start to feel better, go back to
your regular activities gradually.
- Eat right. Even though food may
not appeal to you, it is important to get adequate nutrition. For most people,
nausea and loss of appetite become worse as the day goes on. Try eating a
substantial (but not heavy) meal in the morning and lighter meals later in the
day.
- Drink plenty of liquids to avoid
dehydration. It is important that you keep your body
well-hydrated when you have hepatitis B, especially if you have been vomiting.
Drink plenty of water and, if you can tolerate them, drink fruit juices and
broth to obtain additional calories.
Rehydration drinks help replenish
electrolytes.
- Avoid alcohol and drugs.
Hepatitis B makes it difficult for your liver to process drugs and alcohol. If
you take drugs (prescription or illegal) or drink alcohol when you have
hepatitis, their effects may be more powerful and may last longer. Also,
alcohol and some drugs can make liver damage worse. You should avoid alcohol
until your doctor feels that your liver is completely
healed, which may take as long as 3 to 4 months. Tell your doctor about all of
the prescription and over-the-counter medicines you are taking.
- Try to
control itching. People with hepatitis B sometimes
develop itchy skin. You might try non-prescription medicines, such as Benadryl
or Chlor-Tripolon, to control itching. But talk to your
doctor before taking any
over-the-counter medicines.
- Prevent the spread of HBV by informing people you live with or sleep with about
the illness, by not sharing personal toiletries (such as razors and
toothbrushes), and by using a condom or abstaining from sex.
For more information on treating the symptoms of acute
HBV infection, see the Home Treatment section of this topic.
You
may be given medicine to treat an acute hepatitis B infection if:
- Tests continue to detect a certain
antigen (HBeAg) after 12 weeks.
- Your liver
enzyme levels are higher than normal, meaning that you may have some liver
damage.
- The amount of hepatitis B virus DNA is high, which means
there is a lot of virus in the body (high viral load).
But using medicine to treat hepatitis B is not usually done unless a person is very sick.
Treatment of long-term (chronic) hepatitis B infection
If you have chronic HBV infection, treatment depends on how active the
virus is in your body and the potential for liver damage. The goal of treatment
is to stop liver damage by preventing the virus from multiplying.
Antiviral medicine is used if the virus is active and you are at risk
for liver damage. Medicine slows the ability of the virus to multiply.
Antiviral medicine for hepatitis B includes:
Antiviral therapy is not recommended for everyone who
has a chronic hepatitis B viral infection. Your doctor may recommend antivirals
if you have or are likely to develop liver damage, such as
cirrhosis. For more information, see:
- Hepatitis B: Should I Take Antiviral Medicine for Chronic Hepatitis B?
Whether or not you are taking medicine, you will need
to visit your doctor regularly. He or she will do blood
tests to monitor your liver function and the activity of the hepatitis B virus
(HBV) in your body. Some of the tests can find out whether HBV is actively
multiplying in your liver, which increases your risk of liver damage, such as
cirrhosis or
liver cancer. If you develop advanced liver damage
because of hepatitis and your condition becomes life-threatening, you may need
a liver transplant. But not everyone is a good candidate
for a liver transplant.
Prevention
You can protect yourself from
hepatitis B virus (HBV) infection by avoiding contact
with the body fluids of someone whose health and sexual history are not known
to you. To prevent infection:
- Use a condom when you have sex.
- Do
not share needles.
- Do not share toothbrushes or
razors.
- Wear latex or plastic gloves if you have to touch
blood.
The
hepatitis B vaccine is the most effective way to prevent infection with HBV. The
vaccine is up to 95% effective against HBV infection if you receive all the
shots in the vaccination series (3 or 4 shots given at different times).6 The vaccine provides protection against HBV infection for at
least 20 years.7 A
combination vaccine for hepatitis A and B also is
available. Immunization schedules vary from province to province. Vaccination is generally recommended for:
- All newborn babies. Vaccination is especially recommended for babies born to mothers infected with HBV.
- Anyone 18
years old or younger who has not previously received the
vaccine.
- People who inject illegal drugs.
- People who
have had more than one sex partner in the past 6 months or who have a history
of sexually transmitted infections.
- Men who have sex with
men.
- Household contacts and sex partners of people who have
hepatitis B.
- People who have blood-clotting disorders, such as
hemophilia, and have received
clotting factors from human donors.
- People
who have a severe kidney disease that requires them to have their blood
filtered through a machine (hemodialysis).
- People who have
liver disease or are infected with
HIV.
- Health care workers and public safety workers who are
likely to be exposed to blood.
- Staff and residents of prisons or
institutions for the developmentally disabled.
- People who will
spend more than 6 months in parts of the world where hepatitis B is common or
where a large number of people have chronic HBV infection. To find
the countries where hepatitis B is common, go to
wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/hepatitis-b.aspx.
Discuss vaccination with your
doctor even if you are not in one of the above categories.
In the United States, about 15 out of 100 of those who become infected do not
know how they got infected.1
In some
cases, a doctor will order
post-vaccination testing to make sure you have
developed immunity to the hepatitis B virus. People who need this testing
include those who have an
impaired immune system or those who are health care
workers or sex partners of people who have long-term (chronic) HBV
infection.
If you are exposed to the virus before you have
received all of the shots in the vaccination series, you may be given a dose of
hepatitis B immunoglobulin (HBIG) soon afterward. In
most cases, HBIG will prevent infection until the vaccine takes effect.
If you have had sex with someone who has hepatitis B and you have not
received all doses of hepatitis B vaccine, you should receive a shot of
HBIG—in addition to continuing the vaccine series—within 14 days of being
exposed to HBV.
Hepatitis B is easily spread, so if you are
already infected, there are many steps you can take to
prevent the spread of HBV to others (such as not
donating blood or not sharing razors or other toiletries). If you are not
infected, there also are steps you can take to
protect yourself against HBV infection (such as
getting vaccinated or using condoms). For more information on preventing the
spread of hepatitis B, see the topics
Immunizations and
Exposure to Sexually Transmitted Infections.
Home Treatment
Home treatment is important for
relieving symptoms and preventing the spread of
hepatitis B virus (HBV).
There is
no specific medical treatment for short-term (acute) hepatitis B. But there are
some things you can do that may help you feel better while the illness is
running its course.
Slow down
- Reduce your activity level to match your
energy level. You don't have to stay in bed, but listen to your body and slow
down when you are tired.
- Don't go to work or school unless your
workload can be reduced to match your energy level.
- Avoid strenuous
exercise.
- As you start to feel better, go back to your regular
activities gradually. If you try to meet your regular pace too soon, you may
get sick again.
Eat right
- Even though food may not appeal to you, it is
important to eat well. For most people, nausea and loss of
appetite become worse as the day goes on. Try eating a substantial (but not
heavy) meal in the morning and lighter meals later in the
day.
- Doctors used to recommend a high-calorie,
protein-rich diet to people who have hepatitis. This is no longer believed to
be of any benefit. And such foods can be hard to eat when you feel nauseated.
Try to have a balanced diet while eating foods that appeal to you.
Avoid dehydration
It is important that you keep
your body well-hydrated when you have hepatitis B, especially if you have been
vomiting.
- Drink plenty of water.
- If you can
tolerate them, fruit juices and broth are other good choices, because they
provide additional calories.
- Many of the "sports drinks" available
in grocery stores can help replace essential minerals (electrolytes)
that are lost during vomiting. You can also make your own
rehydration drink.
Avoid alcohol and drugs
Hepatitis impairs your
liver's ability to process drugs and alcohol. If you take drugs (prescription
or illegal) or drink alcohol when you have hepatitis, their effects may be more
powerful and may last longer. In addition, alcohol and some drugs can make
liver damage worse.
- If you are taking prescription medicines,
your doctor may instruct you to stop using them until your
liver has had time to heal. Do not stop taking prescription medicines unless
your doctor has told you to do so.
- Check with
your doctor before taking any new medicines or
continuing the use of non-prescription medicines, including herbal products
and acetaminophen (such as Tylenol). Acetaminophen can make liver disease
worse, especially if you continue to drink alcohol.
- You should
avoid alcohol until your doctor feels that your liver is
completely healed. This may take as long as 3 to 4 months.
Try to control itching
People with hepatitis
sometimes develop itchy skin. You can
control itching by keeping cool and out of the sun,
wearing cotton clothing, or using non-prescription medicines such as Benadryl
or Chlor-Tripolon. Talk to your doctor if you want to take
non-prescription medicines.
Be sure to follow the instructions
that are provided with the product. And stop using the product if you have any
side effects.
See your doctor regularly if you have
chronic HBV infection
If you have been diagnosed with long-term
(chronic) HBV infection, your doctor will recommend that
you be vaccinated for
hepatitis A if you have not been vaccinated or are not
immune to this disease. For more information on hepatitis A, see the topic
Hepatitis A. You also will need to visit your
doctor regularly. He or she will do blood tests to monitor
your liver function and the activity of the hepatitis B virus (HBV) in your
body. Some of the tests can tell your doctor whether HBV is actively
multiplying in your liver, which increases your risk for chronic hepatitis.
Chronic hepatitis can lead to liver disease such as
cirrhosis or
liver cancer (hepatocellular carcinoma).
Medications
For people with short-term (acute)
hepatitis B infection (HBV), treatment with medicine
is not usually recommended. Antiviral medicine may be used for long-term
(chronic) HBV infection if the virus is multiplying or liver damage exists or
may develop.
But antiviral therapy is not recommended for everyone
who has chronic hepatitis B viral infection. It is an option for people who
have or appear likely to develop liver damage such as
cirrhosis. Antiviral therapy may not help if you
already have severe liver damage.
The Canadian Association for
the Study of the Liver has made
recommendations on who should receive antiviral
treatment for long-term (chronic) hepatitis B based on the presence of
hepatitis B
antigens in your blood, the level of
hepatitis B virus DNA (HBV DNA) in your blood, and the
levels of your liver
enzymes.5
Medication Choices
- Hepatitis B: Should I Take Antiviral Medicine for Chronic Hepatitis B?
What To Think About
- It is important to weigh the benefits of
treatment against the risks. Treatment for chronic hepatitis B does not cure
the disease, but does suppress it.
- Interferons are given as shots. Adefovir, entecavir,
lamivudine, telbivudine, and tenofovir are taken as pills.
- Interferons have common side
effects, including fever, headaches, and hair loss. They may also cause or
aggravate mental problems. Adefovir, entecavir, lamivudine, telbivudine, and tenofovir
have few side effects but generally need to be taken for a longer period of
time.
- After you have taken adefovir, lamivudine, or telbivudine for 1 year or longer, you can
become resistant to the drug.
Drug resistance means the medicine no longer works
very well. If you develop resistance to lamivudine, you can take
adefovir or tenofovir.
- If you have cirrhosis, you cannot use interferons. But
you can use adefovir, entecavir, lamivudine, and telbivudine.
- After
any kind of treatment for hepatitis B, the virus may return (relapse).
Surgery
Hepatitis B is
a viral infection that affects the liver. There is no surgical treatment for
hepatitis B.
If you have advanced liver damage because of
hepatitis and your condition becomes life-threatening, you may need a
liver transplant.
In rare cases,
short-term (acute) hepatitis B progresses rapidly to liver failure, a
life-threatening condition called
fulminant hepatitis. For some people, liver
transplantation offers the only hope for survival.
Other Treatment
Some people with short-term
(acute)
hepatitis B develop severe nausea and/or
dehydration. If this happens, you might need to be
hospitalized so you can receive additional fluids
intravenously.
Other Places To Get Help
Organizations
| Canadian Digestive Health Foundation |
| Web Address: | www.cdhf.ca |
| |
The Canadian Digestive Health Foundation provides
educational information about digestive diseases and supports research into
their causes and treatment. |
|
| Canadian Liver Foundation |
| 2235 Sheppard Avenue East |
| Suite 1500 |
| Toronto, ON M2J 5B5 |
| Phone: | (416) 491-3353
1-800-563-5483 |
| Fax: | (416) 491-4952 |
| Email: | clf@liver.ca |
| Web Address: | www.liver.ca |
| |
The Canadian Liver Foundation funds medical research and offers
education and support programs for liver disease patients, their families and
friends, health professionals, and the general public. |
|
| Centers for Disease
Control and Prevention (CDC): Division of Viral Hepatitis |
| Phone: | 1-800-CDC-INFO (1-800-232-4636) |
| Web Address: | www.cdc.gov/hepatitis/index.htm |
| |
The Division of Viral Hepatitis provides information
about viral hepatitis online and by telephone 24 hours a day. Pamphlets also
are available. Information is available in English and in Spanish. |
|
| Hepatitis Foundation International |
| 504 Blick Drive |
| Silver Spring, MD 20904-2901 |
| Phone: | 1-800-891-0707
(301) 622-4200 |
| Fax: | (301) 622-4702 |
| Email: | hfi@comcast.net |
| Web Address: | www.hepfi.org |
| |
This organization is a grassroots communication and support network
for people with viral hepatitis. It provides education to patients,
professionals, and the public about the prevention, diagnosis, and treatment of
viral hepatitis. The organization will make referrals to local doctors and
support groups. |
|
| U.S. National Digestive Diseases Information Clearinghouse |
| 2 Information Way |
| Bethesda, MD 20892-3570 |
| Phone: | 1-800-891-5389 |
| Fax: | (703) 738-4929 |
| TDD: | 1-866-569-1162
toll-free |
| Email: | nddic@info.niddk.nih.gov |
| Web Address: | www.digestive.niddk.nih.gov |
| |
This clearinghouse is a service of the U.S. National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the
U.S. National Institutes of Health. The clearinghouse answers questions;
develops, reviews, and sends out publications; and coordinates information
resources about digestive diseases. Publications produced by the clearinghouse
are reviewed carefully for scientific accuracy, content, and readability.
|
|
References
Citations
- Berenguer M, Wright TL (2006). Hepatitis B and D. In M
Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 2, pp. 1647–1679.
Philadelphia: Saunders Elsevier.
- Centers for Disease Control and Prevention
(2009). Hepatitis B: Frequently asked questions
for health professionals. Available online:
http://www.cdc.gov/hepatitis/HBV/HBVfaq.htm.
- American Public Health Association (2008). Viral
hepatitis B. In Control of Communicable Diseases Manual,
19th ed., pp. 284–293. Washington, DC: American Public Health
Association
- National Advisory Committee on Immunization (NACI)
(2006). Canadian Immunization Guide, 7th ed., pp. 1–372.
Ottawa: Public Health Agency of Canada. Also available online:
http://publications.gc.ca.
- Sherman M, et al. (2007). Management of chronic
hepatitis B: Consensus guidelines. Canadian Journal of Gastroenterology, 21(Suppl C): 5C–24C.
- American Academy of Pediatrics (2006). Hepatitis B. In
LK Pickering, ed., Red Book: 2006 Report of the Committee on Infectious Diseases, 27th ed., pp. 335–355. Elk Grove, IL: American
Academy of Pediatrics.
- World Health Organization (2009).
Hepatitis B fact sheet. Available online:
http://www.who.int/mediacentre/factsheets/fs204/en/index.html.
Other Works Consulted
- Janssen H (2005). Pegylated interferon alfa-2b alone
or in combination with lamivudine for HBeAg-positive chronic hepatitis B: A
randomised trial. Lancet, 365(9454):
123–129.
- Papatheodoridis GV, et al. (2008). Current treatment indications and strategies in chronic hepatitis B virus infection. World Journal of Gastroenterology, 14(45): 6902–6910.
- Sorrell MF, et al. (2009). National
Institutes of Health consensus development conference statement: Management of
hepatitis B. Annals of Internal Medicine, 150(2):
104–110.
- Weinbaum CM, et al. (2008). Recommendations
for identification and public health management of persons with chronic
hepatitis B virus infection. MMWR, 57(RR-08): 1–20. Also
available online:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5708a1.htm.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Anne C. Poinier, MD - Internal Medicine |
|---|
| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
|---|
| Primary Medical Reviewer | Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine |
|---|
| Specialist Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
|---|
| Specialist Medical Reviewer | Steven L. Flamm, MD - Gastroenterology |
|---|
| Last Revised | February 2, 2011 |
|---|
Berenguer M, Wright TL (2006). Hepatitis B and D. In M
Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 2, pp. 1647–1679.
Philadelphia: Saunders Elsevier.
Centers for Disease Control and Prevention
(2009). Hepatitis B: Frequently asked questions
for health professionals. Available online:
http://www.cdc.gov/hepatitis/HBV/HBVfaq.htm.
American Public Health Association (2008). Viral
hepatitis B. In Control of Communicable Diseases Manual,
19th ed., pp. 284–293. Washington, DC: American Public Health
Association
National Advisory Committee on Immunization (NACI)
(2006). Canadian Immunization Guide, 7th ed., pp. 1–372.
Ottawa: Public Health Agency of Canada. Also available online:
http://publications.gc.ca.
Sherman M, et al. (2007). Management of chronic
hepatitis B: Consensus guidelines. Canadian Journal of Gastroenterology, 21(Suppl C): 5C–24C.
American Academy of Pediatrics (2006). Hepatitis B. In
LK Pickering, ed., Red Book: 2006 Report of the Committee on Infectious Diseases, 27th ed., pp. 335–355. Elk Grove, IL: American
Academy of Pediatrics.
World Health Organization (2009).
Hepatitis B fact sheet. Available online:
http://www.who.int/mediacentre/factsheets/fs204/en/index.html.
