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 lead to symptoms such as fatigue, jaundice, dark urine, nausea, and abdominal pain. However, some people may be infected without experiencing any immediate symptoms.

Hepatitis B is a highly contagious disease that is primarily transmitted through contact with infected blood or bodily fluids. This can occur through the sharing of needles (for example, during drug use), unprotected sexual contact, or through open wounds. The disease can also be transmitted from mother to child during childbirth.

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

An effective vaccine is available against hepatitis B, which protects against infection and is especially recommended for people at increased risk, such as healthcare workers, people with multiple sexual partners, and infants born to mothers who are carriers of the virus. Early diagnosis and treatment are important to prevent liver damage and curb the further spread of the virus.

When patients become infected with the hepatitis B virus, they may feel as if they have the flu. In some people, you may also notice a yellowing of the skin or eyes (jaundice). These symptoms improve after a few weeks to months.

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

In 1 out of 20 adults who become infected with hepatitis B, the virus remains in the body for life. This is known as chronic hepatitis B. Chronic hepatitis B usually develops in patients who were infected at birth by their mother. We often see this in countries where many people are infected with the hepatitis B virus, such as China, Southeast Asia, and Africa.

Most patients with chronic hepatitis B have few or no symptoms (e.g., fatigue). Although patients with chronic hepatitis B have few symptoms, they remain contagious. If a patient is infected with the hepatitis B virus for a long time, cirrhosis of the liver may develop. Chronic hepatitis B also increases the risk of liver cancer.

There are several ways to contract the hepatitis B virus, usually through blood-to-blood contact:

• If a pregnant woman is infected with the hepatitis B virus, there is also a possibility that she will pass the virus on to her baby (mother-to-child transmission).
• Sharing contaminated needles for intravenous drug use.
• Having unprotected sexual contact with someone infected with the hepatitis B virus.
• Using contaminated needles for tattoos, piercings, or acupuncture.
• Sharing toothbrushes or razors with someone infected with the hepatitis B virus.

Blood Test

The virus can be detected through a blood test, which allows for the differentiation between the various forms of hepatitis B.

There are two forms of chronic hepatitis B:

• Chronic hepatitis B with an active form of liver inflammation. Certain blood levels are elevated in this case (e.g., ALT is elevated). If this occurs, medication is often needed to suppress the virus and reduce the risk of liver cirrhosis and liver cancer.
• Chronic hepatitis B that is not active (“dormant” form) and in which 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 virus’s activity. If you have this form of hepatitis B, you are still contagious to others. You are, so to speak, a “carrier” of the virus.

During a blood test, a small tube of blood is drawn from a vein on the inside of the arm, usually in the crook of the elbow. To make it easier to see and feel this vein, a tourniquet is tightened around the upper arm. A needle is inserted into the vein, drawing the blood into the tube. The needle is used only once and then disposed of.

Fibroscan

A Fibroscan is a test that measures the stiffness of the liver. The more scar tissue there is, the stiffer the liver.

A Fibroscan is a test in which a type of ultrasound transducer is placed between the ribs on the right side of the body (where the liver is located). Small shock waves are sent to the liver. The test takes about 10 minutes and is painless.

Liver biopsy

A biopsy is the removal of a small sample of liver tissue for further examination. A liver biopsy is necessary when the cause of liver cirrhosis is difficult to determine, when evidence is needed for reimbursement of certain medications, to assess liver damage, etc. There are two types of liver biopsy:

• Percutaneous liver biopsy: In this procedure, the doctor inserts a needle through the skin, between the ribs, to remove a small sample of liver tissue. (link to brochure: 0520 1180-NL)
• Transjugular liver biopsy: When there is an excessive risk of post-procedure bleeding (e.g., when the patient is taking a blood thinner that cannot be discontinued, when the patient has a coagulation disorder, etc.), a transjugular liver biopsy is performed. This involves removing a small sample of liver tissue through your blood vessels.

After these two biopsies, the tissue samples will be sent to the lab for further examination. You will receive the results at your next appointment, which will be scheduled shortly thereafter.

Most patients with a hepatitis B infection do not require treatment. The body’s own “defense system” (immune system) is usually strong enough to clear the virus from the body within 6 months (acute hepatitis B).

If the virus has not cleared after 6 months—meaning you have “chronic hepatitis B”—you may need medication. However, this is not the case for all patients with chronic hepatitis B. Only patients who have an active form of chronic hepatitis B with elevated liver enzyme levels in their blood (see tests: blood draw) are prescribed medication to suppress the virus.

Medication

The medications currently available for patients with chronic hepatitis B are pills that usually must be taken daily for life (Zeffix®, Baraclude®, Vemlidy®, Viread®). The virus can never be completely eliminated from the body, but the medication does suppress the virus. This means that the medication fights the virus, but not yet effectively enough to eliminate it entirely from the body. However, taking the medication significantly reduces the damage the virus can cause to the liver.

Preventing Further Damage to the Liver

If you have chronic hepatitis B, it is important to avoid other factors that can also damage the liver. For example: do not drink alcohol excessively, avoid being overweight, etc.

Pregnancy

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

If you have chronic hepatitis B and are planning to become pregnant, it is important to discuss this with your doctor or nurse. If the virus is present in high levels in your blood, you may need to start taking medication before pregnancy and childbirth.

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

It is safe for a mother with chronic hepatitis B to breastfeed her baby.

Medication that lowers your resistance to infectious diseases.

If you have chronic hepatitis B and, for example, develop cancer that requires chemotherapy or high doses of cortisone, you must consult a liver specialist before starting these treatments. Chemotherapy and high doses of cortisone can impair your body’s natural ability to fight off infectious diseases. As a result, the “dormant” hepatitis B virus may reactivate after you receive chemotherapy or high doses of cortisone.

Vaccination is the best protection against hepatitis B

Hepatitis B vaccination has been used successfully in Belgium for many years. It is part of the standard vaccination schedule recommended for every baby in Belgium. Hepatitis B vaccination is not mandatory.

People who are at higher risk of contracting hepatitis B should be vaccinated:

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

If you are already infected with chronic hepatitis B, it is important to take certain precautions to avoid infecting others:

• Use condoms during sexual intercourse.
• Do not share razor blades, toothbrushes, etc.
• Do not share needles when using drugs intravenously.
• Use bandages on open wounds.
• Have everyone in your immediate circle vaccinated against hepatitis B
• Getting tattoos and piercings done under sterile conditions

Read more about hepatitis B here [uptodate.com]