Hepatitis B virus (HBV) is a serious liver infection. More than 1 billion adults and children are infected with HBV worldwide. In the United States, 1 in every 20 people will contract the virus some time in their life.
HBV is transmitted in the blood and body fluids of someone who is infected, the same way the human immunodeficiency virus (HIV), the virus that causes AIDS, spreads.
Yet hepatitis B is nearly 100 times more infectious than HIV. You’re especially at risk if you are an intravenous (IV) drug user who shares needles or other paraphernalia, have unprotected sexual contact with an infected partner, or were born in or travel to parts of the world where hepatitis B is widespread. In addition, women with HBV can pass the infection to their babies during childbirth.
In some people, HBV infection can become chronic, leading to cirrhosis — a condition that causes permanent liver damage — liver failure or liver cancer. As many as 5,000 Americans die each year of a hepatitis B-related illness. Worldwide, the virus kills nearly 1 million people annually.
Most people infected as adults recover fully from hepatitis B, even if their symptoms are severe. Infants and children are much more likely to develop a chronic infection.
Although no cure exists for hepatitis B, a highly effective vaccine can prevent the disease. The vaccine is now administered to most children in the United States along with their other routine immunizations. Adolescents who haven’t been vaccinated and at-risk adults should also receive the vaccine. If you’re already infected, taking certain precautions can help prevent HBV from spreading to others.
Signs and Symptoms of Hepatitis B
Most infants and children with Hepatitis B virus never develop symptoms. The same is true for about one-third of adults. Symptoms usually appear 4 to 6 weeks after you’re infected and can range from mild to severe. They may include some or all of the following:
- Loss of appetite.
- Nausea and vomiting.
- Weakness and fatigue.
- Abdominal pain, especially around your liver, which is located just below your ribs on your right side.
- Yellowing of the skin and the whites of the eyes (jaundice). This occurs when your liver isn’t able to remove the residue of old red blood cells, known as bilirubin, from your blood. Eventually, bilirubin builds up and is deposited in your skin, causing a yellow color.
- Joint pain.
Hepatitis B can damage your liver — and spread to others — even if you don’t have any symptoms. That’s why it’s important to be tested if you think you’ve been exposed to hepatitis B or you engage in behavior that puts you at risk.
Your liver is located on your right side, just beneath your lower ribs. The largest internal organ in your body, it performs more than 500 vital functions, including processing most of the nutrients absorbed from your intestine, removing drugs, alcohol and other harmful substances from your blood and manufacturing bile — the greenish fluid stored in your gallbladder that helps digest fats. Your liver also produces cholesterol, vitamin A, blood-clotting factors and certain proteins.
Because of the complexity of the liver and its exposure to so many potentially toxic substances, it would seem especially vulnerable to disease. But the liver has an amazing capacity for regeneration — it can heal itself by replacing or repairing injured tissue. In addition, healthy cells take over the function of damaged cells, either indefinitely or until the damage has been repaired. Yet in spite of this, your liver is prone to a number of diseases that can cause serious or irreversible damage, including hepatitis B.
Hepatitis B infection may be either acute — lasting less than 6 months — or chronic, lasting 6 months or longer. If the disease is acute, your immune system is able to clear the virus from your body and you should recover completely within a few months. When your immune system can’t fight off the virus, Hepatitis B virus infection may become lifelong, leading to serious illnesses such as cirrhosis and liver cancer.
Most people who acquire hepatitis B as adults have an acute infection. But the outlook isn’t nearly as hopeful for infants and children. Nearly 90 percent of infants infected with HBV during the first year of life and 30 percent to 50 percent of children infected between 1 and 4 years of age become chronically infected. Chronic infection may go undetected for as long as 20 to 40 years until a person becomes seriously ill from liver disease. Approximately 1.25 million Americans are chronically infected with HBV.
Each strain is unique, differing from the others in severity and in the way it spreads. In industrialized countries such as the United States, you’re most likely to become infected with HBV in the following ways:
- Sexual transmission.
You may become infected if you have unprotected vaginal, anal or oral sex with an infected partner whose blood, saliva, semen or vaginal secretions enter your body. You can also become infected from shared sexual devices if they’re not washed or covered with a condom. The virus is present in the secretions of someone who’s infected and enters your body through small tears that can develop in your rectum or vagina during sexual activity.
- Transmission through needle sharing.
HBV is easily transmitted through needles and syringes contaminated with infected blood. That’s why sharing IV drug paraphernalia puts you at high risk of hepatitis B. Your risk increases if you inject drugs frequently or also engage in high-risk sexual behavior. Although avoiding the use of injected drugs is the most reliable way to prevent infection, you may not choose to do this. If so, one way to reduce your risk is to participate in a needle exchange program in your community. These programs allow you to exchange used needles and syringes for sterile equipment. In addition, consider seeking counseling or treatment for your drug use.
- Transmission through accidental needle sticks.
Hepatitis B is a concern for health care workers and anyone else who comes in contact with human blood. If you fall into one of these categories, get vaccinated against hepatitis B in addition to following routine precautions when handling needles and other sharp instruments.
- Transmission from mother to child.
Pregnant women infected with HBV can pass the virus to their babies. If you have hepatitis B, having your baby receive a shot of hepatitis B immune globulin (H-BIG) at birth, along with the first in a series of three hepatitis B vaccines, will greatly reduce your baby’s risk of getting the virus.
To become infected with HBV, infected blood, semen, vaginal secretions or saliva must enter your body. You can’t become infected through casual contact — hugging, dancing or shaking hands — with someone who has hepatitis B. You also can’t be infected in any of the following ways:
- Coming into contact with the sweat or tears of someone with HBV
- Sharing a swimming pool, telephone or toilet seat with someone who has the virus
- Donating blood
Prevention of Hepatitis B
A hepatitis B vaccine (Engerix-B) has been available since 1981. It’s given in a series of three immunizations and provides more than 90 percent protection for both adults and children. Studies show this protection lasts years and may even be lifelong. In the last decade, the vaccine has been produced in the United States using recombinant DNA technology. That means the HBV antigen used in the vaccine is produced in a laboratory and not derived from the blood of people infected with the virus.
Almost anyone can receive the vaccine, including infants, older adults and those with compromised immune systems. Infants often receive the vaccine in the first year of life — typically at 2, 4 and 9 months of age.
Side effects tend to be mild and may include weakness, fatigue, headache, nausea and soreness or swelling at the injection site.
In recent years, concerns have been raised that the vaccine may trigger serious autoimmune diseases, especially multiple sclerosis (MS) — a potentially debilitating disease that affects the brain and spinal cord. These fears were fueled in the 1990s when several people developed MS shortly after receiving the hepatitis B vaccine.
In February 2001, the results of the first long-term study of the hepatitis B vaccine and MS were published in the New England Journal of Medicine . According to the study, researchers at the Harvard School of Public Health found no link between the administration of Engerix-B and MS.
Some people have also expressed concern that giving hepatitis B vaccine to infants may contribute to sudden infant death syndrome (SIDS). Between 1991 and 1998, 18 newborns died after receiving the hepatitis B vaccine, but investigators have been unable to establish a direct connection between these deaths and the vaccine.
Although vaccination is the best way to protect yourself and others from hepatitis B, the measures listed below can also help keep you safe.
If you’re not infected with HBV
The following measures can help keep you from becoming infected with HBV:
- Educate yourself and others.
Make sure you understand what HBV is and how the virus is transmitted.
- Know the HBV status of any sexual partner.
Don’t engage in unprotected sex unless you’re absolutely certain your partner isn’t infected with HBV, HIV or any other sexually transmitted disease.
- Use a new latex or polyurethane condom every time you have sex.
If you don’t know the health status of your partner, use a new latex condom every time you have anal or vaginal sex. If you’re allergic to latex, use a plastic (polyurethane) condom. Avoid lambskin condoms; they do not protect you from sexually transmitted viruses. If you don’t have a male condom, use a female condom. Use only water-based lubricants, not petroleum jelly, cold cream or oils. Oil-based lubricants can weaken condoms and cause them to break. During oral sex use a condom, dental dam (a piece of medical-grade latex) or plastic wrap. Remember that although condoms can reduce your risk of contracting HBV, they don’t eliminate the risk entirely. Condoms can break or develop small tears, and people don’t always use them properly.
- Use a sterile needle.
If you use a needle to inject drugs, make sure it’s sterile, and don’t share it. Take advantage of needle exchange programs in your community and consider seeking help for your drug use.
- Talk to your doctor if you’re traveling internationally.
If you’re planning an extended trip to a region where hepatitis B is endemic, ask your doctor about the hepatitis B vaccine well in advance. It’s usually given in a series of three injections over a 6-month period.
- Be cautious about blood products in certain countries.
Although the blood supply is now well screened in the United States, this isn’t always the case in other countries. If an emergency requires that you receive blood or blood products in another country, get tested for HBV as soon as you return home.
- If you’re pregnant, get tested.
If you’re infected with HBV
If you’ve received a diagnosis of HBV, the following guidelines can help protect others:
- Follow safer sex practices.
The only foolproof way to protect your sexual partner or partners from HBV infection is to avoid practices that expose them to blood, saliva, semen or vaginal secretions. Barring that, carefully follow guidelines for safer sex, including using a new latex condom every time you have vaginal or anal sex and a dental dam, condom or piece of plastic wrap during oral sex. If you use sexual devices, don’t share them.
- Tell your sexual partner(s) you have HBV.
It’s important to tell anyone with whom you’ve had sex that you have HBV. Your partners need to be tested and receive medical care if they have the virus. They also need to know their HIV status so they don’t infect others.
- Don’t share needles or syringes.
If you use IV drugs, never share your needles and syringes with anyone.
- Don’t donate blood or organs.
- Don’t share razor blades or toothbrushes.
These items may carry traces of infected blood. Some experts also suggest not sharing your comb, hairbrush and nail clippers.
- If you’re pregnant, be sure to tell your doctor you have HBV.
That way, your baby can be treated as soon as he or she is born.
Treatment for Hepatitis B
If you know you’ve been exposed to HBV, call your doctor immediately. Receiving an injection of hepatitis B immune globulin within 24 hours of coming in contact with the virus may help protect you from developing hepatitis B. You should also receive the first in a series of three shots of the hepatitis B vaccine.
Once you’ve developed chronic hepatitis B, few treatment options exist. In some cases — especially if you don’t have symptoms or liver damage — your doctor may suggest monitoring, rather than treating, your condition. In other cases, your doctor may recommend treatment with antiviral medications. When liver damage is severe, liver transplantation may be the only option.
Doctors use two drugs to treat chronic Hepatitis B virus infection:
Your body naturally produces interferon to help protect against invading organisms such as viruses. Giving additional interferon that has been manufactured in a laboratory may stimulate your body’s immune response to HBV and help prevent the virus from replicating in your cells. Not everyone is a candidate for treatment with interferon. In a few cases, interferon eliminates the virus completely, although the infection can later return. Interferon has a number of side effects — many of which resemble symptoms of hepatitis B. These include depression, fatigue, muscle pains, body aches, fever and nausea. Symptoms are usually worse during the first 2 weeks of treatment and in the first 4 to 6 hours after receiving an injection of interferon. You commonly receive three injections of interferon a week for 4 to 6 months. A more serious side effect that may occur over time is a decreased production of red blood cells. The Food and Drug Administration (FDA) recently approved the use of another drug, pegylated interferon. This medication is given just once a week and is an alternative to standard interferon treatments.
- Lamivudine (Epivir).
This antiviral medication helps prevent HBV from replicating in your cells. It’s usually taken in pill form, once a day for 12 months. Lamivudine helps about 40 percent of people who take the medication. Common side effects include cough, diarrhea, nausea or vomiting and hair loss. If you experience worsening jaundice or any unusual bruising, bleeding or fatigue, call your doctor right away.
When your liver has been severely damaged, a liver transplant may be an option. The encouraging news is that these transplants are increasingly successful. Today, more than 90 percent of people are alive a year after having this procedure. Unfortunately, not enough donor organs are available for every person who needs a transplant.
Complementary and Alternative Medicine for Hepatitis B
In Europe, the herb milk thistle ( Silybum marianum ) has been used for centuries to treat jaundice and other liver disorders. Today, scientific studies have confirmed that the chief constituent of milk thistle, silymarin, may aid in healing and rebuilding the liver to treat Hepatitis B. Silymarin seems to stimulate the production of antioxidant enzymes that help the liver neutralize toxins. It also seems to increase the production of new liver cells and may even improve the severe scarring of cirrhosis which is caused by Hepatitis B. But although milk thistle can help the liver, it won’t cure hepatitis and it won’t protect you from contracting the virus.
Milk thistle is available in capsules or alcohol-free extracts. Check with your doctor before trying this or any other herb to make sure it won’t interact with other medications you’re taking.
Below is a link that provides documentation to what we believe to be a safe and effective alternative to protecting yourself from the Hepatitis B virus and an aid in healing and rebuilding the liver. Also provided are links to the top selling resource books when fighting the battle of Hepatitis B.
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