The Hepatitis B virus (HBV) causes Hepatitis B which harms the liver. It is identified through the HBsAb and HBsAg test explained by doctors at Meri Sehat.

Hepatitis B

Dr. Saad Ullah Siddiqui Clinic

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Saad Ullah Siddiqui

Overview

Hepatitis B is a grave liver infection brought about by the hepatitis B virus (HBV). For certain individuals, hepatitis B disease transitions to a chronic illness. Having chronic hepatitis B increases concern and fear of developing liver failure, malignant growth in the liver, or <a href="https://merisehat.pk/disease/cirrhosis" style="vertical-align: baseline;" target="_blank">cirrhosis </a>&mdash; a condition that irreversibly scars the liver<a href="#accordion">[10]</a>.

Pakistan is unfortunately endemic to HBV with 9,000,000 individuals battling with HBV and its contamination rate is on a consistent ascent<a href="#accordion">[12]</a>. This might be due to and lack of public awareness about the transmission of serious transferable infections including HBV, HCV, and <a href="https://merisehat.pk/disease/hiv" style="vertical-align: baseline;" target="_blank">HIV</a>, which is more prominent in rural areas that also suffer from limited access to tertiary care hospitals<a href="#accordion">[3]</a>.

The clinical course and sequelae of chronic hepatitis differ among people. Disease with HBV prompts a wide range of clinical features, asymptomatic carrier state to acute self-restricting contamination or fulminant hepatic failure, chronic hepatitis with transition to <a href="https://merisehat.pk/disease/cirrhosis" target="_blank">cirrhosis</a>, and hepatocellular carcinoma (HCC)<a href="#accordion">[16]</a>. 
&nbsp;

Hepatitis B can be classified into the following types: 
&nbsp;

<ul>
	<li>Acute Hepatitis B: The body normally endures acute hepatitis B for a short term, under a half year. The immune system is adept and equipped with the necessary proteins and antibodies to clean the circulatory system from remnants and traces of acute hepatitis B on its own. The infected individual can expect a full and uncomplicated recovery within a few months. Several cases of people who contracted hepatitis B after the age of 18 have shown indications of acute infection; however, the risk of it transitioning to chronic hepatitis B infection is not unlikely<a href="#accordion">[10]</a>. 
	&nbsp;</li>
	<li>Chronic Hepatitis B: Chronic hepatitis B infection, unlike the acute or milder version of the infection, persists for a longer period ranging from anywhere from 6 months to years. It persists in the body and liver cells if the immune system fails to adequately fend off the infection. If left untreated or unresolved for a prolonged period of time, there is a threatening possibility of chronic hepatitis B infection continuing to persist forever, most likely prompting difficult diseases like cirrhosis and liver malignant growth<a href="#accordion">[10]</a>. 
	&nbsp;</li>
	<li>Perinatal Hepatitis B: Hepatitis B virus (HBV) infection in a pregnant individual represents a serious risk to her newborn child upon entering the world. Without postexposure immunoprophylaxis, around 40% of newborn children of HBV-infected moms will at some point in their life foster chronic HBV infection. Roughly one-fourth of them will unfortunately be unable to fight against the advancing and prolonged liver damage and thus, pass away<a href="#accordion">[6]</a>. Perinatal HBV transmission can be impeded by distinguishing HBV-infected (i.e., hepatitis B surface antigen [HBsAg]-positive) pregnant individuals and dispensing hepatitis B immune globulin and hepatitis B immunization to their newborn children without any delay and within the first 12 hours after their birth. Hindering the possibility of perinatal HBV transmission is a necessary fragment of medical and public health information to ensure the eradication of hepatitis B from the world. This can be achieved through careful and well-documented public screening and testing processes as listed below: 
	&nbsp;</li>
</ul>

1. General screening of pregnant people for HBsAg during every pregnancy.

2. Evaluating all HBsAg-positive pregnant individuals for HBV DNA to prescribe antiviral treatment during pregnancy. The proposed maternal antiviral treatment comes into effect when HBV DNA is &gt;200,000 IU/mL.

3. Regulating and managing individual cases of HBsAg-positive moms and their newborn children.

4. Arrangement of immunoprophylaxis for newborn children brought into the world by HBV-infected birth mothers, including hepatitis B immunization and hepatitis B immune globulin within 12 hours of birth.

5. Routine inoculation of all newborn children with the hepatitis B antibody series, with the principal portion administered in the first 24 hours of birth<a href="#accordion">[6]</a>. 
 
Understanding and recognizing the stage of the virus would help the doctors with their prognosis and therefore, decide an efficient treatment for the patient based on the severity of the disease. 
&nbsp;

Causes

Hepatitis B is caused by the hepatitis B virus (HBV). The hepatitis B virus is a little DNA virus that has a place within the Hepadnaviridae family. Related infections in this family are additionally tracked down in woodchucks, ground squirrels, tree squirrels, Peking ducks, and herons.

The hepatitis B virus (HBV) has a complicated and long-life cycle. The virus enters the host liver cell and is directed to the core of the liver cell. When inside the core, the viral DNA is changed into a covalently enclosed circular DNA (cccDNA), which fills in as a layout for viral replication (production of another hepatitis B infection). The new HBV virus is bundled and leaves the liver cell, with the stable viral cccDNA staying in the core where it can coordinate into the DNA of the host liver cell, as well as keep on making new hepatitis B virus prototypes. Albeit the life cycle has not been understood in its entirety. Also, portions of this replicative interaction are inclined to some mistakes, which represent various genotypes or hereditary codes of the hepatitis B virus<a href="#accordion">[8]</a>.

HBV transmission can be through various means e.g. percutaneous (i.e., cut through the skin) or mucosal contact with contaminated blood or body liquids (e.g., semen and spit), Listed below are some common ways of transmission: 
&nbsp;

<ol>
	<li dir="ltr" style="list-style-type:decimal">
	Sexual practices with a partner who has tested positive for HBV infection.
	</li>
	<li dir="ltr" style="list-style-type:decimal">
	History of use of intravenous drugs leading to the sharing of needles, syringes, or any other instrument needed for drug preparation.
	</li>
	<li dir="ltr" style="list-style-type:decimal">
	Vertical transmission: HBV positive mother to unborn child during pregnancy
	</li>
	<li dir="ltr" style="list-style-type:decimal">
	Contact with infected blood from either open injuries or via an individual who has HBV infection.
	</li>
	<li dir="ltr" style="list-style-type:decimal">
	Contact with infected needle sticks or sharp instruments.&nbsp;
	</li>
	<li dir="ltr" style="list-style-type:decimal">
	Sharing specific things with an HBV-positive individual can break the skin or mucous layers (e.g., razors, toothbrushes, and glucose-checking gear) and contaminate the blood. 
	&nbsp;
	</li>
</ol>

Since new HBV contaminations are typically asymptomatic, not many individuals are successfully diagnosed till the disease has entered later stages. The infection is usually discovered when symptoms of irreparable liver damage become apparent. 
&nbsp;

Diagnosis

After the screening, the doctor may prescribe the individual a variety of tests to confirm if they have contracted the virus. The tests may be specific for the bloodwork needed to clear the individual from risk or they may be prescribed to assess the liver functioning of an infected person. Assuming that an individual exhibits hepatitis B signs and symptoms and elevated degrees of liver compounds, they will be tested for: 
&nbsp;

<ol>
	<li dir="ltr" style="list-style-type:decimal">
	Hepatitis B Surface Antigen (HBsAg) And Antibody (HBsAb):&nbsp;Antigens are proteins found within the hepatitis B virus framework, while antibodies are proteins made by the immune cells responsible for resisting and fighting off infections. They appear in the blood somewhere in the range of 1 and 10 weeks after exposure to the virus. If the individual successfully recuperates, they disappear in the following weeks or within 6 months. If the antibodies persist and are still present for half a year, the stage of the condition is labeled as chronic and dealt with accordingly<a href="#accordion">[11]</a>. To summarize, the presence of HBsAg indicates that the person is infectious while the presence of HBsAb indicates recovery and immunity from HBV infection or successful immunization against HBV. 
	&nbsp;
	</li>
	<li dir="ltr" style="list-style-type:decimal">
	Hepatitis B Surface Antibody (Anti-HBs):&nbsp;The presence of these antibodies indicates lifelong immunity and is also considered as the best initial screening test for hepatitis B infection. 
	&nbsp;
	</li>
	<li dir="ltr" style="list-style-type:decimal">
	HBV DNA:&nbsp;Sometimes may be the only marker present in early infections 
	&nbsp;
	</li>
	<li dir="ltr" style="list-style-type:decimal">
	Hepatitis B Core Antibody (HBcAb): HBcAb appears at the onset of acute HBV infection, but may also indicate chronic HBV infection 
	&nbsp;
	</li>
</ol>

If the illness becomes chronic, the doctors or specialists in charge of the case could take a tissue from the liver, called a biopsy. This will help them understand the progression of the disease. A liver ultrasound can further help in assessing liver damage.&nbsp; Other non-invasive procedures could also be advised e.g. magnetic resonance elastography (MRE) or transient elastography, which use magnetic resonance and sound waves respectively to visualize the extent of damage to the liver<a href="#accordion">[11]</a>. Doctors may rely on one or more of the following tests to decide the most efficient treatment: 
&nbsp;

<ol>
	<li>Magnetic Resonance Elastography (MRE): A painless and noninvasive option to a liver biopsy, MRE joins magnetic resonance imaging innovation with designs framed by sound waves skipping off the liver to make a visual guide showing gradients of firmness all through the liver. Firm liver tissue shows the presence of scarring of the liver (fibrosis). 
	&nbsp;</li>
	<li>Transient Elastography: Because of the preference for minimally invasive or completely noninvasive procedures within the medical fraternity, this is another non-invasive test. Transient elastography is a sort of ultrasound that allows vibrations into the liver and measures the speed of their dispersal through liver tissue to gauge its stiffness.</li>
</ol>

&nbsp;

Treatment

If an individual is under suspicion of being in contact to the infection, it is necessary the individual reaches out to a specialist without any delay to get tested. Like in most medical scenarios, time is of essence. Therefore, the sooner one is diagnosed and follows recommended treatment, the better. First course of action, would be to offer the patient an immunization and a shot of the registered hepatitis B immune globulin. This protein supports the body by keeping it safe from external pathogens and assisting it in fending off the infection<a href="#accordion">[11]</a>. If even after taking the precautionary steps, one does become ill, their primary care physician might put them on bed rest to provide the body with a break and avoid exertion. Acute hepatitis B does not have a particular clinical treatment; therefore, it is crucial to not engage in activities that could exhaust the infected individual and make them more susceptible to other diseases.

To build up immunity and regain primal strength, the patient would have to make certain lifestyle changes. Without any contemplation they will need to sacrifice use of substances and chemicals which may deteriorate the liver scarring. In fact, they will need to avoid consumption of alcoholic beverages or liquor in any form as the breakdown of alcohol decreases liver functionality.&nbsp;

They will also need to steer clear of over-the-counter medications and painkillers such as acetaminophen. Prior to ingesting any medicated drug, homeopathic concoction, herbal remedy, or supplement it would be best to check with their doctor. Most of these substances have an unregulated imbalance of chemicals which could directly affect the normal functioning of the liver.

Along with things to evade, infected individuals should concentrate on a healthy balanced diet constituting of vegetables, fruits, lean proteins, low-fat and nondairy options, and healthy fats such as avocados and nuts which would boost their immunity<a href="#accordion">[11]</a>.&nbsp;

The doctor will monitor the progress of the disease. After a while, if the infection disappears, the specialist will let the patient know that they now are an inactive carrier. That implies there&#39;s no more infection in the body, and the antibody tests will be a testament to the fact that they have recovered successfully.

However, if the infection persists and remains active for longer than a half year, the primary care physician will let the infected individual know that they have transitioned to chronic active hepatitis B. This stage may require more specific clinical treatment to prevent any unexpected and inconvenient complications&nbsp;<a href="#accordion">[11]</a>. The course of treatment may include: 
&nbsp;

<ol>
	<li dir="ltr" style="list-style-type:decimal">
	Adefovir Dipivoxil (Hepsera):&nbsp;This medication, which the patient can take as a tablet, functions admirably for individuals who show resistance to lamivudine (mentioned later). High dosages can cause kidney problems. 
	&nbsp;
	</li>
	<li dir="ltr" style="list-style-type:decimal">
	Entecavir (Baraclude):&nbsp;This is required once per day with few secondary effects. It is viewed as the front edge treatment. 
	&nbsp;
	</li>
	<li dir="ltr" style="list-style-type:decimal">
	Interferon Alfa (Intron A, Roferon A, Sylatron):&nbsp;This medication supports the insusceptible immune system. It can be taken as a shot for around six months. However, while it has both immunomodulatory and antiviral activity against HBV, currently its usage is infrequent in hepatitis B, due to the development of oral nucleoside analogs, which have potent activity against HBV and fewer side effects. 
	&nbsp;
	</li>
	<li dir="ltr" style="list-style-type:decimal">
	Lamivudine (3tc, Epivir A/F, Epivir HBV, Heptovir):&nbsp;It comes as a fluid or tablet that the infected individual is required to take one time per day. It is a suitable option for most, however, there is a possibility of becoming resistant to it. 
	&nbsp;
	</li>
	<li dir="ltr" style="list-style-type:decimal">
	Pegylated Interferon (Pegasys):&nbsp;Long-acting interferon is given by infusion once seven days as a rule for a considerable length of time to a year. Yet, this medication can cause the individual to feel droopy and depressed or discouraged, and it can suppress the appetite. It likewise brings down the white platelet count, which makes it harder to fend off infection. 
	&nbsp;
	</li>
</ol>

If an individual has been in contact with the virus, then they should schedule an appointment with a doctor or a licensed health care professional immediately, rather than self-treating as HBV infection could deteriorate and cause complications. 
&nbsp;

Since infected individuals may be asymptomatic, hepatitis B can last for decades before being identified and treated. Untreated hepatitis B has repercussions which the body is forced to endure and ward off. Some of these complications may include: 
&nbsp;

<ul>
	<li>Scarring Of The Liver: In the beginning phases of hepatitis B, the liver has an adequate number of cells to perform its numerous responsibilities. But with prolonged infection more cells begin to decline in productivity. At this point, cirrhosis might appear. Cirrhosis has extreme and harsh consequences on the body which can be observed in multiple parts such as abdominal swelling, enlarged veins and spleen, insulin resistance, and lower immunity. Moreover, cirrhosis can aggravate the buildup of toxins which can affect neurological processes and actions such as thinking and memory, this can increase the possibility of the individual entering a coma. Therefore, your doctor should be informed of all side effects and complications<a href="#accordion">[11]</a>.&nbsp;&nbsp; 
	&nbsp;</li>
	<li>Cancer: <a href="https://merisehat.pk/disease/cirrhosis" style="vertical-align: baseline;" target="_blank">Cirrhosis </a>if left untreated can develop into liver cancer, which is the growth of a malignant tumor due to increased inflammation and scarring<a href="#accordion">[11]</a>. 
	&nbsp;</li>
	<li>Liver Failure: In an ongoing sickness, for example, hepatitis B there is excessive and rapid production of the collagen matrix produces but it is not disintegrated at the same rate. This leads to the development of scar tissue around cells. Liver cells lose fundamental access to the blood conveying supplements and oxygen and, as a consequence, they die<a href="#accordion">[11]</a>. 
	&nbsp;</li>
	<li>Kidney Disease: The hepatitis B virus (HBV) has an intricate relationship to kidney illnesses, which is not fully understood and conflicting evidence has made it difficult to reach a conclusive verdict.&nbsp; However, it has been observed that chronic HBV infection is an etiologic component in secondary glomerular diseases and renal complications. Furthermore, HBV carrier status negatively affects kidney transplantation. This adverse effect is also seen in HBV carrier patients with renal illnesses receiving immunosuppressive medications<a href="#accordion">[7]</a>. 
	&nbsp;</li>
	<li>Blood Vessel Complications: Vasculitis refers to the inflammation of blood vessels which may be due to a minor allergic reaction or something more serious such as a chronic kidney or heart disease. Vasculitis appears as an unexpected extrahepatic inconvenience of hepatitis B virus (HBV) infection<a href="#accordion">[14]</a>. 
	&nbsp;</li>
</ul>

With hepatitis developing at an unprecedented rate, it is necessary for patients to be in constant correspondence with their doctors to inform them of any sudden changes and complications. 
&nbsp;

<ul>
	<li>There are several modifiable preventive measures that range from ensuring blood transfusions are carried out in registered clinics by licensed lab technicians, to sexually active adults engaging in safe sexual activities and getting vaccinated<a href="#accordion">[1]</a>.&nbsp;</li>
	<li>Avoid booking appointments at salons with questionable equipment and health code violations. Furthermore, ensuring good sterilization techniques in hospitals should be an utmost priority<a href="#accordion">[5]</a>.</li>
	<li>Moreover, blood banks that hold blood donation drives should ensure that the donated blood is screened for <a href="https://merisehat.pk/disease/hiv" target="_blank">HIV</a>, <a href="https://merisehat.pk/disease/hepatitis-c-114" target="_blank">Hepatitis C</a> and Hepatitis B<a href="#accordion">[2]</a>.&nbsp;</li>
	<li>All patients requiring a medical procedure must be tested and evaluated for viral hepatitis<a href="#accordion">[9]</a>.</li>
	<li>Likewise, the socially acceptable practice of reusing razors in many hair parlors that might spread hepatitis in a significant number of people should be deterred. 
	&nbsp;</li>
</ul>

Researchers at UCLA have discovered another immunotherapy to battle hepatitis B virus (HBV), the most widely recognized reason for liver disease on the planet. Every year, internationally, chronic HBV causes 880,000 deaths from prolonged cell deterioration and complications such as liver cirrhosis and hepatocellular carcinoma/liver cancer (HCC). The innovative breakthrough concentrates on utilizing immune cells segregated directly from the source i.e., the infected patient&#39;s liver and cancer tissue.&nbsp;

The study shows that acyl-CoA: cholesterol acyltransferase (ACAT), was exceptionally powerful at helping immune reactions to fight off against infections<a href="#accordion">[15]</a>. 
&nbsp;

Key Points

<ul>
	<li>Hepatitis B is a curable infection, with a universally accepted vaccine and advanced medication that has helped decrease complications and prevent&nbsp;the infection from transitioning to irreversible damage.</li>
	<li>Hepatitis B can be left undiagnosed as infected individuals may be asymptomatic.</li>
	<li>Hepatitis B surface antibody (anti-HBs) is the best screening test for Hepatitis B.</li>
	<li>Hepatitis B is tested through the Hepatitis B surface antigen(HBsAg) and antibody (HBsAb).</li>
	<li>There is no recommended course of action for acute Hepatitis B&nbsp;but, for chronic hepatitis, the doctor may prescribe antiviral medication.</li>
	<li>Hepatitis B is transmitted through blood transfusions, unsanitary needles, HIV-positive mothers, and unprotected sex.</li>
	<li>Infected individuals should maintain a healthy diet, participate in physical activity, and avoid alcohol consumption to prevent severe liver damage.</li>
	<li>Hepatitis B is a notification priority disease in Pakistan and any presenting cases should be notified to the concerned authorities immediately. 
	&nbsp;</li>
</ul>

[1] Ahmed, M. (2001). Hepatitis B surface antigen study in professional and volunteer blood donors. Ann Abbasi Shaheed Hosp Karachi Med Dent Coll, 6, 304-306.

[2] Ahmed, M. A., Zafar, T., Brahmbhatt, H., Imam, G., Bareta, J. C., & Strathdee, S. A. (2003). HIV/AIDS risk behaviors and correlates of injection drug use among drug users in Pakistan. Journal of Urban Health, 80(2), 321-329.

[3] Alam, M. M., Zaidi, S. Z., Malik, S. A., Naeem, A., Shaukat, S., Sharif, S., . . . Butt, J. A. (2007). Serology based disease status of Pakistani population infected with hepatitis B virus. BMC infectious diseases, 7, 64.

[4] Ali, M., Idrees, M., Ali, L., Hussain, A., Ur Rehman, I., Saleem, S., . . . Butt, S. (2011). Hepatitis B virus in Pakistan: a systematic review of prevalence, risk factors, awareness status and genotypes. Virology journal, 8, 102.

[5] Aziz, S., Memon, A., Tily, H. I., Rasheed, K., Jehangir, K., & Quraishy, M. S. (2002). Prevalence of HIV, hepatitis B and C amongst health workers of Civil Hospital Karachi. The Journal of the Pakistan Medical Association, 52(3), 92-94.

[6] CDC. (2022, February 16). Perinatal Transmission.

[7] Chan, T. M. (2010). Hepatitis B and Renal Disease. Current hepatitis reports, 9(2), 99-105.

[8] Hepatitis B Foundation. (2022). What is Hepatitis B?

[9] Khan, M. S., Jamil, M., Jan, S., Zardad, S., Sultan, S., & Sahibzada, A. S. (2007). Prevalence of hepatitis ‘B’and ‘C’in orthopaedics patients at Ayub Teaching Hospital Abbottabad. Journal of Ayub Medical College Abbottabad, 19(4), 82-84.

[10] Mayo Clinic. (2020, September 4). Hepatitis B.

[11] Nazario, B. (2020, September 8). Hepatitis B. Retrieved from WebMD.

[12] Noorali, S., Hakim, S. T., McLean, D., Kazmi, S. U., & Bagasra, O. (2008). Prevalence of Hepatitis B virus genotype D in females in Karachi, Pakistan. Journal of infection in developing countries, 2(5), 373–378.

[13] Qureshi, H., Arif, A., Riaz, K., Alam, S., Ahmed, W., & Mujeeb, S. (2009). Determination of risk factors for hepatitis B and C in male patients suffering from chronic hepatitis. BMC Research Notes, 2(1), 1-6.

[14] Singh, H., Tanwar, V. S., Sukhija, G., Kaur, P., & Govil, N. (2016). Vasculitis as a Presenting Manifestation of Chronic Hepatitis B Virus Infection: A Case Report. Journal of clinical and diagnostic research : JCDR, 10(2).

[15] University College London. (2021, May 14). New immunotherapy 'highly effective' against hepatitis B. Retrieved from ScienceDaily.

[16] Zhu, R., Zhang, H. P., Yu, H., Li, H., Ling, Y. Q., Hu, X. Q., & Zhu, H. G. (2008). Hepatitis B virus mutations associated with in situ expression of hepatitis B core antigen, viral load and prognosis in chronic hepatitis B patients. Pathology, research and practice, 204(10), 731–742.

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