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Hepatitis B is a liver infection caused by the hepatitis B virus (HBV). It can take two forms- acute infection (sudden onset of infection, which can worsen rapidly but may last for a brief period if treated on time) and chronic infection (long-term). After infection, the hepatitis B virus is present in the body fluids and secretions. In developed countries, HBV mainly spreads through unprotected sex and intravenous drug use. Acute infection causes symptoms such as headaches, abdominal discomfort, body aches, joint pain, nausea, and eventually, yellowing of the skin and eyes due to jaundice. Vomiting and diarrhoea may follow once jaundice develops.

Chronic hepatitis B infection can damage the liver and may even cause liver cancer. For acute hepatitis B infection, usually, adequate rest, optimal intake of fluids, and a healthy diet suffice as a treatment regimen. For chronic hepatitis B, regular monitoring for signs of liver disease is done. Oral antiviral agents may be started if needed. However, once the antiviral treatment begins, the person will need to take the medication for life. If left untreated, chronic HBV infection can progress to liver scarring or liver cancer.

  1. Types of Hepatitis B
  2. Stages of Hepatitis B
  3. Hepatitis B symptoms
  4. Hepatitis B causes & risk factors
  5. Prevention of Hepatitis B
  6. Diagnosis of Hepatitis B
  7. Hepatitis B treatment
  8. Hepatitis B complications and prognosis
  9. What is Hepatitis B
  10. Medicines for Hepatitis B
  11. Doctors for Hepatitis B

Types of Hepatitis B

Hepatitis B infection is of two types based on the period between exposure to the virus and onset of initial symptoms. 

Acute infection

Acute infection is a common type of hepatitis B infection. However, in most of these cases, the infection is usually not severe and it takes time for the symptoms of hepatitis B infection to manifest. It takes one to four months from the time the virus enters the body to the onset of infection and then to the appearance of the first symptoms. If symptoms occur, they usually last for several weeks, but some people may have fatigue for as long as six months.

Chronic infection

A person is said to have chronic HBV infection if his/her blood sample shows the presence of an antigen known as hepatitis B surface antigen (HBsAg) for at least six months. Antigens are proteins found on the surface of HBV. Presence of HBsAg in the bloodstream is one of the earliest signs of HBV infection. 

Stages of Hepatitis B

Current studies support the concept of three distinct stages of HBV infection, which can be used to describe acute and chronic HBV infections. These are:

  • First stage
    The first stage (“immune tolerant” phase) is the initial stage of the infection. There is evidence of the hepatitis B virus in the bloodstream, which can be detected by the presence of hepatitis B e antigen (HBeAg-a viral protein) in the blood. The serum levels of the liver enzyme transaminase are, however, normal at this stage (this enzyme is used to assess liver function). When a child or an adult has an acute HBV infection, this stage represents the incubation period before the body’s immune system responds to the HBV infection.
  • Second stage
    In the second stage (“immune response stage”), the inflammatory process causes the destruction of HBV-infected cells, thereby increasing the transaminase levels. If this phase lasts for more than six months, then the infection is termed as a chronic HBV infection.
  • Third stage
    The third stage (“inactive carrier state”) marks the end of active viral replication. In the blood, HBeAg is negative, hepatitis B e antibody (anti-HBe) is formed, and the transaminase levels become normal. A low level of the HBV genetic material may still be present. Most of the adults with acute HBV infection rapidly enter this stage.

Hepatitis B symptoms

The symptoms may vary depending on whether the infection is acute or chronic.

Acute hepatitis B

Symptoms of acute hepatitis B, if they appear, can include:

Chronic hepatitis B

Most people with chronic hepatitis B do not manifest any obvious signs and symptoms and may remain symptom-free for many years together. When symptoms do appear, they are similar to those of an acute infection. Symptoms may include an aversion to food, cigarettes, and intermittent, mild to moderate, right upper abdominal pain. Certain blood tests that account for the liver function may begin to show abnormal values at this stage. 

Hepatitis B causes & risk factors

Causes

The hepatitis B virus spreads when a body fluid contaminated with the hepatitis B virus enters the body of another person who is not infected. The virus can spread by the following modes:

  • During childbirth, hepatitis B can spread from an infected mother to her newborn baby.
  • Unprotected sex with an infected partner.
  • Direct contact of a healthy person with the blood or open wounds of an infected person.
  • Getting a tattoo or body piercing in unhygienic conditions with unsterilized instruments.
  • Medical/ dental treatment with non-sterilised equipment.
  • Sharing needles, syringes, or other drug equipment.
  • Blood transfusion using hepatitis B contaminated blood. This can happen in facilities where the blood is not tested for hepatitis B prior to transfusion.
  • Sharing items such as toothbrushes, razors with an infected person.

Many people with hepatitis B virus infection are not aware that they are infected, as they might not show symptoms immediately. However, they may still spread the virus to others. 

Risk factors

People at highest risk of hepatitis B infection are as follows:

  • Babies born to mothers who already have a hepatitis B infection.
  • People born or raised in a country where an infection with hepatitis B virus is common.
  • People with a history of any sexually transmitted disease (STD).
  • Sexual partners of people infected with hepatitis B.
  • Close contact with someone (such as a family member) who has a long-term (chronic) hepatitis B infection.
  • Homosexual males.
  • Health care and public health workers who are exposed to blood during routine medical, surgical, and sterilisation procedures.
  • Drug addicts who share needles and syringes.
  • Unprotected sex (inclusive of anal and oral sex).
  • People with multiple sexual partners.
  • Travellers visiting places where the infection is common.
  • People who are on dialysis.

Hepatitis B is found throughout the world, but in certain areas, as mentioned below, it is more common:

  • The Indian subcontinent
  • Some parts of South America
  • Middle East
  • East and Southeast Asia
  • Pacific Islands
  • Sub-Saharan Africa
  • Southern parts of central and eastern Europe 

Prevention of Hepatitis B

For hepatitis B prevention, hepatitis B vaccine is the mainstay. WHO recommends hepatitis B vaccination of all infants, immediately after birth, preferably within 24 hours.

In most cases of HBV infection, one of the following two schedules is followed:

Three-dose schedule

  • The first dose is to be given when the child is born.
  • The second and third doses are to be given along with the first and third doses of DPT vaccine (diphtheria, whooping cough, and tetanus vaccine).

Four-dose schedule

  • A dosage at birth is followed by three monovalent or combined vaccine doses and is commonly given with other routine vaccines for infants.
  • The protection acquired through this vaccine lasts for at least 20 years. In most cases, the protection against HBV is life-long. WHO does not recommend any booster vaccination.

Apart from vaccination, there are other easy ways to help stop the transmission of hepatitis B:

  • After any exposure to blood, thoroughly wash your hands with soap and water. See your physician immediately to prevent infection and get immunised. If possible, take the person along whose blood your skin got exposed to.
  • Always use protection during sexual intercourse. Do not have unprotected sex unless you are very sure that your partner is not infected.
  • Ensure that new sterile needles are used for tattoos, acupuncture, or body piercing.
  • Avoid direct contact with blood and bodily fluids of an unknown person.
  • Clean blood spills with a fresh bleach solution diluted in water in the ratio 1:9.
  • Cover all cuts carefully.
  • For blood transfusions, always opt for certified facilities that screen blood for hepatitis B and other blood-borne infections.
  • Avoid sharing of sharp items like toothbrushes, razors, earrings or body rings or nail clippers.
  • Discard sanitary napkins/tampons after double wrapping them in a paper.
  • Stay away from drug abuse.
  • If you are traveling to a region where hepatitis b is common, ask your doctor about taking the hepatitis B vaccine.

Hepatitis B and pregnancy

When a woman is pregnant, it is recommended that she should be screened for HBsAg, (hepatitis B surface antigen) irrespective of previous test results or vaccinations. The chances of transmission of hepatitis B during amniocentesis (a test to detect genetic disorders, chromosomal abnormalities in the baby prior to its birth) are low. Women with chronic hepatitis B can continue breastfeeding if the infant receives HBIG (Hepatitis B Immunoglobulin) passive prophylaxis and vaccine active prophylaxis.  

Diagnosis of Hepatitis B

Apart from a detailed medical history and symptomatic assessment, your doctor will advise you to take certain tests to aid in diagnosis.

Blood tests

  • Liver function tests
    These are a set of tests for liver enzymes and blood proteins, which help in assessing the liver function. These tests include:
    • Alanine aminotransferase (ALT)
    • Aspartate aminotransferase (AST)
    • Albumin
    • Serum bilirubin
    • Alkaline phosphatase
    • Prothrombin time
    • Alpha-1 antitrypsin
    • 5' nucleotidase
    • Gamma-glutamyl transpeptidase (GGT)
  • Hepatitis B Surface Antigen (HBsAg)
    It is a protein on the surface of the hepatitis B virus and is detected in the blood in case of acute or chronic hepatitis B infection. A positive result means that the person has an infection by the hepatitis B virus and is capable of passing the virus to others.
  • Hepatitis B Surface Antibody (anti-HBs)
    It is an antibody that is produced against HBsAg as part of the body’s normal immune response. A positive test means that the person is protected from infection or is immune because he was previously vaccinated against the virus or has recovered from an acute infection and hence cannot get hepatitis B again.
  • Total Hepatitis B Core Antibody (anti-HBc)
    It is an antibody produced by the body in response to the hepatitis B virus “core antigen". A positive test means a person is either presently infected with the hepatitis B virus or was infected in the past.
  • IgM Antibody to Hepatitis B Core Antigen (IgM anti-HBc)
    It is used to identify acute infection. A positive test means the person was infected with the hepatitis B virus in the last six months.
  • Hepatitis B e Antigen (HBeAg)
    It is a protein found in the blood that is present during an active hepatitis B infection. A positive test means that the person has high levels of virus in the blood and can easily spread the virus to others.
  • Hepatitis B e Antibody (HBeAb or anti-HBe) 
    It is an antibody that is produced by the body in response to the “e” antigen of the hepatitis B virus. A positive test means that the person has chronic hepatitis B virus infection but has a low risk of developing liver problems due to low levels of the virus in the blood. However, the person can spread the infection to others.
  • Hepatitis B Viral DNA 
    This test detects the presence of hepatitis B virus DNA in a person’s blood. A positive test means that either the virus is multiplying in a person’s body and hence, the person is highly contagious or that he/she is at an increased risk of liver damage if he/she has chronic hepatitis B infection.

Imaging tests

Liver ultrasound may be performed to see the extent of liver damage.

Hepatitis B treatment

Acute hepatitis B  
In acute infection, management is mostly supportive and aims at restoring the overall health of the person. Usually, medicines are not prescribed. Doctors recommend adequate nutritional balance, hydration, and rest.

Chronic hepatitis B
A chronic infection is usually treated with oral antiviral medicines like tenofovir or entecavir. Treatment aims to prevent or slow down the development of cirrhosis and to reduce the chances of progressing to liver cancer. The treatment only suppresses the replication of the virus. It does not bring about the cure. Therefore, most people must continue to take treatment life-long.

Lifestyle management

There are many lifestyle changes that can help people to manage hepatitis b infection more effectively. Here are some tips:

  • Avoid alcohol and smoking as both can damage the liver, which is already injured by the hepatitis B virus during HBV infection.
  • Before you start taking any herbal remedies or vitamin supplements, it is important to consult your doctor because some of these alternative treatments could potentially cause liver damage or even interfere with your prescribed drugs.
  • Do not take any over-the-counter drugs (for example, paracetamol) without consulting your doctor as many of these drugs are processed by the liver and may cause damage to it.
  • Avoid eating raw or undercooked shellfish like scallops, mussels, or clams as they have bacterial contamination by an organism called Vibrio vulnificus, which is very toxic to the liver.
  • Avoid inhalation of strong fumes like from paint thinners, household cleaning products, nail polish removers, as they are potentially toxic.
  • Have a healthy diet consisting of lots of vegetables and fruits, whole grains. Cabbage, broccoli, and cauliflower particularly have a protective action on the liver.
  • Look out for moulds on nuts, corn, groundnut, sorghum, and millet before using them. Presence of moulds indicates the presence of “aflatoxins” which are harmful to your liver.
  • Exercise regularly.
  • Protein, fluid and salt intake must be controlled based on the severity of the disease to a level such that they do not worsen liver inflammation.

Hepatitis B complications and prognosis

Prognosis

  • Acute hepatitis B 
    Most people recover completely and develop life-long immunity. Around 1% of people with acute HBV infection develop acute liver failure.
  • Chronic hepatitis B 
    Most people who develop chronic HBV infection have minimal symptoms. The outcome is better in children as compared to adults, but as it is a long-term liver infection, it may lead to liver failure, cirrhosis, and liver cancer.

Complications

Complications related to hepatitis B infection occur if a chronic HBV infection is left untreated. These complications include:

  • Cirrhosis (liver scarring)
    Symptoms usually appear only after extensive liver damage happens. Some of the symptoms are as follows:
    • Fatigue.
    • Itchiness of skin.
    • Loss of appetite.
    • Loss of weight.
    • Feeling sick.
    • Pain or swelling in the abdomen.
    • Ankle swelling.

Though there is no cure for cirrhosis, it is possible to slow-down its progression. A liver transplant may be required in case of severe liver damage.

  • Liver cancer
    There is a 1 in 20 chance of developing liver cancer in people suffering from cirrhosis due to hepatitis B. The symptoms include:
    • Loss of appetite.
    • Weight loss.
    • Easy satiety.
    • Feeling unwell.
    • Jaundice.
  • Fulminant hepatitis B
    Less than 1 in 100 cases of acute hepatitis B can develop fulminant hepatitis B, which can lead to:
    • Collapse.
    • Confusion.
    • Fluid accumulation in the abdominal cavity (ascites).
    • Severe jaundice.
    • Disturbed sleeping pattern.
    • Coma.
    • Bleeding in the digestive tract and other organs due to a reduced blood-clotting function of the liver.
    • Hepatic encephalopathy, which is a psychiatric condition seen in people with an advanced liver disease where the brain function deteriorates severely

Fulminant hepatitis B can be fatal if timely treatment is not started.

What is Hepatitis B

Hepatitis means swelling or inflammation of the liver. When the liver gets inflamed, many of its functions get affected, as most liver functions are interrelated. When the hepatitis B virus infects the liver, the condition is called hepatitis B infection.

Globally, hepatitis B virus (HBV) infection is a significant health problem. According to the studies conducted by the World Health Organization (WHO), over 2 billion people have been reported to be infected with hepatitis B virus. Out of these, approximately 24 crore individuals have chronic liver infections. Every year, more than 7,80 000 people die due to acute or chronic hepatitis B infection.

India accounts for one-fifth of the global population, hence, a large proportion of the worldwide HBV burden is found in India. 10-15% of the worldwide HBV carriers are found in India. Studies estimate that India has around 4 crore HBV carriers. 

Dr. Mahesh Kumar Gupta

Dr. Mahesh Kumar Gupta

गैस्ट्रोएंटरोलॉजी

Dr. Raajeev Hingorani

Dr. Raajeev Hingorani

गैस्ट्रोएंटरोलॉजी

Dr. Vineet Mishra

Dr. Vineet Mishra

गैस्ट्रोएंटरोलॉजी

Medicines for Hepatitis B

Medicines listed below are available for Hepatitis B. Please note that you should not take any medicines without doctor consultation. Taking any medicine without doctor's consultation can cause serious problems.

Medicine NamePack SizePrice (Rs.)
AdeseraAdesera 10 Mg Tablet673.0
AdfovirAdfovir 10 Mg Tablet270.0
AdhebAdheb 10 Mg Tablet680.0
AlentosAlentos 0.5 Mg Tablet809.0
BaracludeBaraclude 0.5 Mg Tablet745.0
CronivirCronivir 0.5 Mg Tablet2142.0
EncarvirEncarvir 0.5 Mg Tablet750.0
EncureEncure 0.5 Mg Tablet694.0
EntalivEntaliv 0.5 Tablet2448.0
EntavirEntavir 0.5 Mg Tablet745.0
EntehepEntehep 0.5 Mg Tablet729.0
FrithvirFrithvir 0.5 Mg Tablet750.0
HepaloHepalo 0.5 Mg Tablet750.0
X VirX Vir 0.5 Mg Tablet2460.0
EntecaEnteca 1 Mg Tablet1470.0
Analiv TabletsAnaliv 500 Mg Tablet134.0
FilolaFilola Injection250.0
HepatreatHepatreat 5 Gm Infusion238.0
HepawinHepawin 5 G Injection230.0
HepmendHepmend Tablet 150 Mg74.0
LornitLornit 0.5 Gm/Ml Infusion296.0
SatmaxSatmax Capsule114.0
Hepa MerzHepa Merz 1.5 Gm Granules202.5
RicovirRicovir 300 Mg Tablet1550.0
TeravirTeravir 300 Mg Tablet1714.0
HepdozeHepdoze 300 Mg Tablet1285.0
ReviroReviro 300 Mg Tablet1725.0
RivofonetRivofonet Tablet1300.0
TavinTavin 300 Mg Tablet1100.0
TenfoclearTenfoclear 300 Mg Tablet1379.0
TenocruzTenocruz 300 Mg Tablet520.0
TenofTenof 300 Mg Tablet440.0
TenohepTenohep 300 Mg Tablet466.0
TentideTentide 300 Mg Tablet1500.0
TenvirTenvir 300 Mg Tablet1379.0
Valten 300 Mg TabletValten 300 Mg Tablet1428.0
VireadViread 300 Mg Tablet2380.0
ForstavirForstavir 200 Mg/300 Mg/600 Mg Tablet2380.0
TeevirTeevir 200 Mg/300 Mg/600 Mg Tablet4000.0
Forstavir EmForstavir Em Tablet1272.0
TofodayTofoday 200 Mg/300 Mg/600 Mg Tablet4330.0
TrustivaTrustiva 200 Mg/300 Mg/600 Mg Tablet3800.0
ViradayViraday 200 Mg/300 Mg/600 Mg Tablet3900.0
VirotrenzVirotrenz 200 Mg/300 Mg/600 Mg Tablet3714.0
VonavirVonavir 200 Mg/300 Mg/600 Mg Tablet3900.0
Biovac BBiovac B 100 Mcg Injection700.0
Elovac BElovac B 10 Mcg Injection53.57
Engerix BEngerix B 10 Mcg Injection300.8
Enivac HbEnivac Hb Injection157.5
Genevac BGenevac B 10 Mcg Injection55.55
G VacG Vac Injection52.25
Hivac BHivac B Injection42.06
Revac B McfRevac B Mcf 10 Mg Vaccine180.0
SamhepSamhep 100 Iu Injection5000.0
Hepagen PlusHepagen Plus 100 Mcg Vaccine528.0
HeparelHeparel 100 Iu/1 Ml Injection6000.0
HepbHepb 100 Iu Injection6875.0
Shanvac BShanvac B 10 Mcg Injection171.43
HepashieldHepashield 20 Y Injection222.23
HeptavirHeptavir 10 Mg Syrup80.0
LamimatLamimat Tablet571.42
LamivirLamivir 150 Mg Tablet101.06
EpivirEpivir Solution1350.0
HepitecHepitec 100 Mg Tablet565.0
LamihopeLamihope 150 Mg Tablet538.06
LavirLavir 150 Mg Tablet564.0
RetrolamRetrolam 150 Mg Injection11.52
ReliferonReliferon 3 Miu Injection500.0
EglitonEgliton 3 Miu Injection380.95
IntalfaIntalfa 3 Miu Injection547.61
ShanferonShanferon 3 Miu Injection892.85
ZavinexZavinex 3 Miu Injection1175.0
Hepafresh (Macleods)Hepafresh 600 Mg Injection1100.0
MaxilivMaxiliv Injection1197.0
OxonegOxoneg 600 Mg Injection1207.9
ThiotresThiotres Injection1197.0
TaspianceTaspiance 180 Mg Injection9175.0
BharglobBharglob 10% W/V Injection1149.0
Recombinant Hepatitis BRecombinant Hepatitis B Vaccine39.43
HepabsvHepabsv 100 Iu Injection4857.98
Hepatitis B (Bha)Hepatitis B Prefilled Syringe11000.0
SebivoSebivo 600 Mg Tablet2800.0
TelbihepTelbihep 600 Mg Tablet833.81
DinmekDinmek 300 Mg/300 Mg Tablet2250.0
Ricovir LRicovir L 300 Mg/300 Mg Tablet1600.0
Tavin LTavin L Tablet1200.0
TenolamTenolam Tablet1430.0
Tenvir LTenvir L Tablet1550.0
VirofovirVirofovir 300 Mg/300 Mg Tablet833.33
VonadayVonaday 300 Mg/300 Mg Tablet3245.0
Hepacure Pn (Tasmed)Hepacure Pn 150 Mg/100 Mg Tablet52.65
HepalairHepalair 150 Mg/100 Mg Tablet29.5
HepasureHepasure 150 Mg/100 Mg Tablet65.71
L & LL &Amp; L Tablet85.0
OrnilivOrniliv Tablet59.62
LivcareLivcare Syrup30.0
Renewliv PRenewliv P Tablet66.33
LamistarLamistar 150 Mg/30 Mg Tablet101.18
LamostadLamostad 150 Mg/30 Mg Tablet105.57
VirolisVirolis 150 Mg/30 Mg Tablet626.75
Liv AptLiv Apt 250 Mg/70 Mg/50 Mg Tablet410.0
NevilastNevilast 150 Mg/30 Mg/200 Mg Tablet192.0
Stavex LnStavex Ln 150 Mg/30 Mg/200 Mg Tablet644.0
Emduo NEmduo N 150 Mg/30 Mg/200 Mg Kit38.45
Emtri JuniorEmtri Junior 40 Mg/10 Mg/70 Mg Tablet77.67
EmtriEmtri 150 Mg/30 Mg/200 Mg Tablet551.38
Lamostad NLamostad N 150 Mg/30 Mg/200 Mg Tablet207.68
Nevilast Baby TabletNevilast Baby 150 Mg/30 Mg/200 Mg Tablet210.0
Nevilast JuniorNevilast Junior 150 Mg/30 Mg/200 Mg Tablet365.4
TriomuneTriomune 150 Mg/30 Mg/200 Mg Tablet584.61
VirolansVirolans 100 Mg/30 Mg/200 Mg Tablet Dt1236.48
Ricovir EmRicovir Em 200 Mg/300 Mg Tablet1952.37
Tavin EmTavin Em Tablet2000.0
Tenof EmTenof Em Tablet1540.0
Tentide EmTentide Em Tablet2000.0
Tenvir EmTenvir Em Tablet2200.0
TofocomTofocom 200 Mg/300 Mg Tablet1971.42
TruvadaTruvada 200 Mg/300 Mg Tablet2510.0
TeluraTelura Tablet3300.0
EffodayEffoday 300 Mg/300 Mg/600 Mg Tablet3300.0
Tenolam ETenolam E Tablet3000.0
TriodayTrioday 300 Mg/300 Mg/600 Mg Tablet3200.0
ZidolamZidolam 150 Mg/300 Mg Tablet210.0
CombivirCombivir 150 Mg/300 Mg Tablet911.12
CytocomCytocom 150 Mg/300 Mg Tablet190.38
Duovir EpDuovir Ep 150 Mg/300 Mg Tablet1324.55
DuovirDuovir 150 Mg/300 Mg Tablet1324.55
LazidLazid Tablet1284.15
VirocombVirocomb 150 Mg/300 Mg Tablet1251.58
Zidolam NZidolam N 150 Mg/300 Mg/200 Mg Tablet210.0
Zidolam N NZidolam N N 150 Mg/300 Mg/200 Mg Tablet654.2
Zidovex LnZidovex Ln 150 Mg/300 Mg/200 Mg Tablet675.0
Cytocom NCytocom N 150 Mg/300 Mg/200 Mg Tablet229.32
Duovir NDuovir N Tablet644.11
Virocomb NVirocomb N 150 Mg/300 Mg/200 Mg Tablet1214.43
Abamune L TabletAbamune L 600 Mg/300 Mg Tablet2950.0
A Bec L TabletA Bec L 600 Mg/300 Mg Tablet2950.0
HepasafeHepasafe Suspension 200 Ml174.0

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