We have a well-proven and safe vaccine against the DNA virus that causes Hepatitis B. In fact, over a billion doses have been given with an excellent safety record. If everybody in the world received the Hepatitis B vaccination in infancy at childbirth, the virus should be virtually eliminated. But the cold hard facts are that over one-third, or approximately two billion of the world’s population, have been infected in their lives with the virus at one time or another and about 350 million remain chronic carriers. About 250,000 people are dying annually of complications from Hepatitis B. In the U.S., the numbers are a lot better. About 1.25 million are chronic carriers and only 5,000 a year die of the complications. I don’t mean to sound cold saying that “only 5,000 people die a year from complications.” However, I’m just trying to give you clear, no-frills information on this serious subject.
So why can’t we get a firm handle on the disease? Everybody doesn’t get their scheduled shots in infancy. Parents who are simply “too busy,” misinformed, or just do not take their children in for scheduled immunizations. The other thing is that if it is avoided in childhood, we know several ways people acquire it in later life. For example: Unsafe sex, sharing needles, man-to-man sex, and people who just keep repeating these bad practices. When it comes to HBV, prevention is everything. Nothing short of a liver transplant will bring a certain cure. We have drugs to control the disease, but once it has become chronic, all the treatments are to simply control it and improve the quality of life.
Hepatitis B is a DNA virus that is drawn to liver cells. It has an outer shell called “surface antigen” which surrounds the active core antigen. In adults, the body is able to totally clear the infection and produce protective antibodies against further infections in over 90% of the time. This is not true in infants who will develop the virus over 90% of the time. “Acute” refers to an infection present for less than six months. “Chronic” refers to an infection present over 6 months. The infection becomes symptomatic usually 30 to 180 days after the initial infection. Children and infants most often have no symptoms. Symptoms can include a flu-like illness with general malaise, abdominal pain, vomiting, jaundice, skin or whites of eyes turning yellow, joint pains, loss of appetite, and dark coffee-colored urine. Hepatitis A and Hepatitis C can have identical symptoms. Again, most adults fully recover even if the symptoms are severe. Sometimes the person has to have IV fluids and other treatments for dehydration, possibly even hospitalization. These symptoms gradually resolve over a few weeks.
Now, let’s say you go to the doctor and have blood testing. He/she will usually check your SGOT and SGPT for liver damage, and perform a bilirubin test to see if the bile is being cleared from the liver. He/she would then order an HBV surface antigen to confirm diagnosis and see if you’re infectious. They might check HBV core antibody for similar reasons. The doctor will judge the progress of immunity by checking antibody levels to surface antigens. Once this information is obtained, the doctor should see regularly to see if the hepatitis is acute or chronic. If it is chronic, your doctor may refer you to a gastroenterologist or hepatologist for a liver biopsy. A liver biopsy is a needle which removes a small quantity of liver tissue for biologic and microscopic tests.
Let’s say for purposes of discussion that you now receive a diagnosis of chronic active Hepatitis B. First of all, don’t get overwhelmed, don’t become a hermit and sever all social ties, and don’t lapse into depression. It’s like having any other medical condition. There’s the initial shock and disbelief, followed by a resolution to maintain the best health you can. You should assume a very healthy lifestyle. You’ll have to completely give up the liver toxic effects of drinking alcohol, any liver affecting drugs (illegal drugs or prescribed) and while you’re at it, why don’t you give up smoking? Plan to get regular exercise and plenty of sleep. Eat nutritious foods and avoid stress. Do all the good sense things you should be doing for your health. Maybe you would want to take a multi-vitamin and a little bit of the herb, milk thistle. The herbs in milk thistle are believed to help the recovery and recuperation of the liver. Decide here and now to see your doctor regularly to follow the course of your condition.
The other important thing which you need to resolve is to not give the HBV to anyone else. This is a no-sex or only safe-sex commitment. Use a new condom each time, and avoid multiple sex partners. You need to plainly say to each potential sexual partner, “I have Hepatitis B.” There may be some risk for you. They need to make an informed decision. Informed decision means having all the facts and certainly having completed the HBV vaccination series. This is simply choosing to do the “right thing.” Don’t share toothbrushes or razors with anyone. If somebody actually lives in your household, be sure they have had HBV vaccination. Do not be a blood or organ donor. Please be sure to tell the person drawing your blood that you have HBV so that if, Heaven forbid, they prick their own finger they can take adequate preventative treatment. Medical professionals will not see you as a leper but just want to protect themselves with all the best care for you and protection for them. They are human beings as well. If there is any IV drug use recreationally, absolutely don’t share needles.
If the HBV is progressing, there are treatments available. One is to take interferon shots two to three times a week for the regular interferon or once a week for the pegylated interferon. This is very expensive and has to be taken for a year or until the side effects become unbearable like flu-like illness after each injection. It does stop the infection in about 40% of people. An oral antiviral drug that can be taken daily has almost no side effects. Liver tests and viral DNA measurements are taken to see how well it is working. In about half the treated cases, the inflammation goes away. Unfortunately, HBV can become resistant to it. However, there are other antiviral drugs which can be taken to stop DNA replication. The ultimate goal of treatment is to make the patient more comfortable, and to reduce inflammation which can lead to cirrhosis and hepatic carcinoma later down the road.
Sort of like that old saying says–An ounce of prevention is worth a ton of treatment in Hepatitis B. Everyone needs to receive the HBV vaccine in infancy, or certainly by childhood. Pregnant women who have HBV need to inform their obstetricians so the infant can receive immune globulin and vaccinations at birth. Remember the risk factors: Unprotected sex, sex with more than one partner, STD’s like Chlamydia or gonorrhea, the sharing of needles, being in a household in contact with someone with HBV, and traveling to underdeveloped countries–just to name a few. It is indeed possible to end this disease if everyone was vaccinated and universal preventive precautions were followed.
John Drew Laurusonis, M.D.