What is hepatitis B?

Hepatitis B is a liver infection caused by the hepatitis B virus (HBV). HBV is one of five types of viral hepatitis. The others are hepatitis A, C, D, and E. Each is a different type of virus, and types B and C are most likely to become chronic.

The Centers for Disease Control and Prevention (CDC) state that around 3,000 people in the United States die each year from complications caused by hepatitis B. It’s suspected that 1.4 million people in America have chronic hepatitis B.

HBV infection can be acute or chronic.

Acute hepatitis B causes symptoms to appear quickly in adults. Infants infected at birth rarely develop only acute hepatitis B. Nearly all hepatitis B infections in infants go on to become chronic.

Chronic hepatitis B develops slowly. Symptoms may not be noticeable unless complications develop.

Hepatitis B is highly contagious. It spreads through contact with infected blood and certain other bodily fluids. Although the virus can be found in saliva, it’s not spread through sharing utensils or kissing. It also doesn’t spread through sneezing, coughing, or breastfeeding. Symptoms of hepatitis B may not appear for 3 months after exposure and can last for 2–12 weeks. However, you are still contagious, even without symptoms. The virus can live outside the body for up to seven days.

Possible methods of transmission include:

  • direct contact with infected blood
  • transfer from mother to baby during birth
  • being pricked with a contaminated needle
  • intimate contact with a person with HBV
  • oral, vaginal, and anal sex
  • using a razor or any other personal item with remnants of infected fluid

Certain groups are at particularly high risk of HBV infection. These include:

  • healthcare workers
  • men who have sex with other men
  • people who use IV drugs
  • people with multiple sex partners
  • people with chronic liver disease
  • people with kidney disease
  • people over the age of 60 with diabetes
  • those traveling to countries with a high incidence of HBV infection

Symptoms of acute hepatitis B may not be apparent for months. However, common symptoms include:

  • fatigue
  • dark urine
  • joint and muscle pain
  • loss of appetite
  • fever
  • abdominal discomfort
  • weakness
  • yellowing of the whites of the eyes (sclera) and skin (jaundice)

Any symptoms of hepatitis B need urgent evaluation. Symptoms of acute hepatitis B are worse in people over the age of 60. Let your doctor know immediately if you have been exposed to hepatitis B. You may be able to prevent infection.

Doctors can usually diagnose hepatitis B with blood tests. Screening for hepatitis B may be recommended for individuals who:

  • have come in contact with someone with hepatitis B
  • have traveled to a country where hepatitis B is common
  • have been in jail
  • use IV drugs
  • receive kidney dialysis
  • are pregnant
  • are men who have sex with men
  • have HIV

To screen for hepatitis B, your doctor will perform a series of blood tests.

Hepatitis B surface antigen test

A hepatitis B surface antigen test shows if you’re contagious. A positive result means you have hepatitis B and can spread the virus. A negative result means you don’t currently have hepatitis B. This test doesn’t distinguish between chronic and acute infection. This test is used together with other hepatitis B tests to determine the state of a hepatitis B infection.

Hepatitis B core antigen test

The hepatitis B core antigen test shows whether you’re currently infected with HBV. Positive results usually mean you have acute or chronic hepatitis B. It may also mean you’re recovering from acute hepatitis B.

Hepatitis B surface antibody test

A hepatitis B surface antibody test is used to check for immunity to HBV. A positive test means you are immune to hepatitis B. There are two possible reasons for a positive test. You may have been vaccinated, or you may have recovered from an acute HBV infection and are no longer contagious.

Liver function tests

Liver function tests are important in individuals with hepatitis B or any liver disease. Liver function tests check your blood for the amount of enzymes made by your liver. High levels of liver enzymes indicate a damaged or inflamed liver. These results can also help determine which part of your liver may be functioning abnormally.

If these tests are positive, you might require testing for hepatitis B, C, or other liver infections. Hepatitis B and C viruses are a major cause of liver damage throughout the world. You will likely also require an ultrasound of the liver or other imaging tests.

Hepatitis B vaccination and immune globulin

Talk to your doctor immediately if you think you have been exposed to hepatitis B within the last 24 hours. If you have not been vaccinated, it may be possible to prevent infection by receiving the hepatitis B vaccine and an injection of HBV immune globulin. This is a solution of antibodies that work against HBV.

Treatment options for hepatitis B

Acute hepatitis B usually doesn’t require treatment. Most people will overcome an acute infection on their own. However, rest and hydration will help you recover.

Antiviral medications are used to treat chronic hepatitis B. These help you fight the virus. They may also reduce the risk of future liver complications.

You may need a liver transplant if hepatitis B has severely damaged your liver. A liver transplant means a surgeon will remove your liver and replace it with a donor liver. Most donor livers come from deceased donors.

Complications of having chronic hepatitis B include:

  • hepatitis D infection
  • liver scarring (cirrhosis)
  • liver failure
  • liver cancer
  • death

Hepatitis D infection can only occur in people with hepatitis B. Hepatitis D is uncommon in the United States but can also lead to chronic liver disease.

The hepatitis B vaccine is the best way to prevent infection. Vaccination is highly recommended. It takes three vaccines to complete the series. The following groups should receive the hepatitis B vaccine:

  • all infants, at the time of birth
  • any children and adolescents who weren’t vaccinated at birth
  • adults being treated for a sexually transmitted infection
  • people living in institutional settings
  • people whose work brings them into contact with blood
  • HIV-positive individuals
  • men who have sex with men
  • people with multiple sexual partners
  • injection drug users
  • family members of those with hepatitis B
  • individuals with chronic diseases
  • people traveling to areas with high rates of hepatitis B

In other words, just about everyone should receive the hepatitis B vaccine. It’s a relatively inexpensive and very safe vaccine.

There are also other ways to reduce your risk of HBV infection. You should always ask sexual partners to get tested for hepatitis B. Use a condom or dental dam when having anal, vaginal, or oral sex. Avoid drug use. If you’re traveling internationally, check to see if your destination has a high incidence of hepatitis B and make sure you are fully vaccinated prior to travel.