Hepatitis B

Hepatitis B is a viral infection that affects the liver and can lead to both acute and chronic liver problems. The infection is caused by the hepatitis B virus (HBV), which damages liver cells and triggers an inflammatory response in the liver. This can cause symptoms such as tiredness, jaundice, dark urine, nausea, and abdominal pain. However, some people can be infected without having immediate symptoms.

Hepatitis B is a highly contagious disease that is mainly transmitted through contact with contaminated blood or body fluids. This can happen through sharing needles (for example when taking drugs), unprotected sexual contact, or through open wounds. Also, the disease can be transmitted from mother to child during birth.

The course of hepatitis B may vary. In some people, the infection goes away on its own within a few months (acute hepatitis B), while in others it takes a chronic form, which can lead to serious liver problems such as liver cirrhosis and liver cancer.

An effective vaccine is available against hepatitis B, which protects against the infection and is particularly recommended for people at risk, such as healthcare workers, people with mixed sexual contacts, and babies born to mothers who carry the virus. Early diagnosis and treatment are important to prevent liver damage and prevent further spread of the virus.

When patients become infected with the Hepatitis B virus, it can feel like they have the flu. Some people also see yellowing of the skin or eyes (jaundice). These symptoms improve after a few weeks to months.

Most patients (> 90%) with hepatitis B will recover from the Hepatitis B virus (acute hepatitis B) within 6 months.

In 1/20 adult people who get a hepatitis B infection, the virus stays in the body for life. This is then called chronic hepatitis B. Chronic hepatitis B usually develops in patients who were infected from the mother at birth. This is often seen in countries where many people are infected with the hepatitis B virus, such as China, South-East Asia, Africa.

Most patients with chronic Hepatitis B have no or few symptoms (e.g. fatigue). Despite the fact that patients have few symptoms of chronic hepatitis B, they remain contagious. When a patient is infected with the hepatitis B virus for a long time, cirrhosis of the liver originated. Chronic hepatitis B also increases the risk of liver cancer.

There are several ways to get the hepatitis B virus, usually via blood-to-blood contact:

• When a pregnant woman is infected with the hepatitis B virus, it is also possible that she infects her baby with this virus (mother-child infection).
• Sharing contaminated needles for drug use via the veins.
• Having unprotected sexual contact with someone infected with the Hepatitis B virus.
• Use contaminated needles to place tattoos, piercings, or acupuncture.
• Sharing toothbrushes, razor blades with someone infected with the Hepatitis B virus.

Blood tests

The virus can be measured via a blood test and thus the distinction can be made between the different forms of hepatitis B.

There are two forms of chronic hepatitis B:

• Chronic hepatitis B with an active form of liver inflammation. Certain blood values have then increased (e.g.: ALT has increased). If this occurs, medication is often needed to suppress the virus and to reduce the risk of liver cirrhosis and liver cancer.
• Chronic hepatitis B that is not active ('dormant' form) and where there are no abnormalities in the blood (ALT is normal). Regular blood tests are necessary for this form of chronic hepatitis B to monitor the activity of the virus. If you have this form of hepatitis B, you are still contagious to other people. You are, as it were, a 'carrier' of the virus.

A blood test involves taking a tube of blood from a vein on the inside of the arm, usually in the crease of the elbow. In order to see and feel this vein properly, a thrust band is pulled tightly around the upper arm. The vein is pricked with a needle so that the blood is drawn into the tube. The needle is used only once and then destroyed.

Fibroscan

The fibroscan is an examination that measures the stiffness of the liver. The more scar tissue, the stiffer the liver.

A fibroscan is an examination in which a type of ultrasound head is placed between the ribs on the right side of the body (where the liver is located). Tiny shock waves are sent to the liver. The examination takes about 10 minutes and does not hurt.

Liver biopsy

A biopsy is taking a piece of tissue from the liver and then examining it further. When the cause of liver cirrhosis is difficult to find, when proof is needed to reimburse certain medications, to measure liver damage, etc., a liver biopsy is necessary. There are two types of liver biopsy:

• Percutaneous liver biopsy: In this biopsy, the doctor pierces the skin, between the ribs, to remove a piece of liver. (link to folder: 0520 1180-NL)
• Transjugular liver biopsy: When there is too much risk of bleeding (e.g. When the patient takes a blood thinner that cannot be stopped, if the patient has a clotting disorder, etc.), a transjugular liver biopsy is chosen. This means that a small piece of liver tissue is removed via your blood vessels.

After both biopsies, the pieces of tissue go to the lab to be further examined. You will receive the results at the next consultation, which will be scheduled shortly afterwards.

Most patients who have a hepatitis B infection do not require treatment. The body's “fighting system” (immune system) is usually strong enough to get the virus out of the body within 6 months (acute hepatitis B).

If the virus does not go away after 6 months and therefore there is “chronic hepatitis B”, medication may be necessary. Although this is not the case in all patients with chronic hepatitis B. Only patients who have an active form of chronic hepatitis B with increased liver levels in the blood (see studies: blood collection) receive medication that will suppress the virus.

Medication

The medications that currently exist for patients with chronic hepatitis B are pills that usually have to be taken daily for life (Zeffix®, Baraclude®, Vemlidy®, Viread®). The virus can never disappear completely from the body, but the medication will suppress the virus. This means that the medication fights against the virus, but is still insufficient to get it out of the body completely. However, by taking the medication, the virus can cause much less damage to the liver.

Preventing further liver damage

If you are infected with chronic hepatitis B, it is important to avoid other factors that also cause damage to the liver. For example: do not overuse alcohol, avoid obesity, etc.

Pregnancy

In Belgium, every pregnant woman is tested for hepatitis B.

If you have chronic hepatitis B and want to become pregnant, it is important to discuss this with your doctor or nurse. If the virus is very present in the blood, medication may be started first before pregnancy and childbirth.

If you are infected during delivery as a mother, your baby will receive an injection immediately after birth. After that, your baby will be vaccinated against hepatitis B according to the vaccination schedule from Kind & Gezin.

It's safe to breastfeed your baby as a mom with chronic hepatitis B.

Medication that reduces your resistance to infectious diseases.

If you have chronic hepatitis B and, for example, you get cancer that requires chemotherapy or high doses of cortisone, a consultation with a liver specialist is necessary before starting these treatments. Chemotherapy and high doses of cortisone mean that your own resistance to infectious diseases no longer works properly. So it is possible that the hepatitis B virus that 'sleeps' wakes up again after you received chemotherapy or high doses of cortisone.

Vaccination is the best protection against hepatitis B

Vaccination against hepatitis B has been used successfully in Belgium for years. It's in the standard vaccination schedule recommended to every baby in Belgium. Hepatitis B vaccination is not mandatory.

People with a higher chance of getting hepatitis B are best vaccinated:

• Infants born to infected mothers.
• Travellers to countries where hepatitis is common: China, Southeast Asia, Africa.
• Family members of an infected person.
• Residents of psychiatric institutions.
• Employees who come into frequent contact with blood or blood products

If you are already infected with chronic hepatitis B, it is important to take a few measures to avoid infecting other people:

• Use condoms when having sexual intercourse.
• Do not share razor blades, toothbrushes, etc.
• Do not share needles when taking drugs through the veins.
• Use plasters for open wounds.
• Get everyone close to you vaccinated against hepatitis B
• Having tattoos and piercings installed in sterile conditions

Learn more about Hepatitis B here [uptodate.com]