HJ, a marketing officer, was about to voluntarily donate blood when pre-donation screening revealed that he had hepatitis B virus in his blood. He had been very fine. He was referred to a physician for evaluation.
Hepatitis describes a type of liver injury. Hepatitis simply means “inflammation of the liver”. Hepatitis B is a specific type of hepatitis that is caused by a virus with the same name. Others are Hepatitis A, C, D and E.
How is the virus transmitted to an individual?
1. Close contact — The virus can be spread through close personal contact with an infected person. This could happen if blood or other body fluids get into tiny cracks or breaks in your skin, mouth, or eyes.
2. Mother to baby— The virus can be passed from a mother to her baby during or shortly after delivery. Having a Caesarean delivery does not absolutely prevent the virus from spreading. Experts believe that breastfeeding is safe.
3. Use of hepatitis B virus contaminated needles.
4. Poorly screened blood and organs for transfusion and transplantation respectively.
5. Unprotected sex.
What complaints do infected individuals have?
Hepatitis B infection occurs in two forms. It could be acute if the infection is less than 6 months of duration or chronic if the individual has been harboring the virus for more than 6 months. Most infected patients do not have complaints, particularly if the infection occurs in children. However, following initial infection with hepatitis B, one can develop fever, abdominal pain, fatigue, decreased appetite, nausea, and in some cases yellowness of the skin and eyes (jaundice). In Nigeria and other sub-Saharan countries, this is usually diagnosed as malaria.
In the most severe cases, liver failure can develop. Not having complaints does not necessarily mean that the infection is under control. Most people have no complaints until their liver disease is at a late stage. The most common early symptom is feeling tired. Everyone with chronic hepatitis B is at increased risk of developing complications, including liver scarring (called cirrhosis when the scarring is severe) and liver cancer. The risk of developing complications (such as cirrhosis, liver failure, or liver cancer) depends on how rapidly the virus multiplies and how well the immune system controls the infection. Drinking alcohol, having chronic hepatitis C or D or having HIV infection further increases the risk of developing these complications.
How is diagnosis of hepatitis B made?
The doctor would request for a number of tests to diagnose and monitor hepatitis B infection. Most of these tests are blood investigations and ultrasound scan.
How is hepatitis B infection treated?
Should everyone be treated? — Specific treatment for acute hepatitis B is usually not needed since in most adults, the immune system controls the infection and gets rid of the virus within about six months.
In people who develop chronic hepatitis, an antiviral medication might be recommended to reduce or reverse liver damage and to prevent long-term complications of hepatitis B. However, not all people with hepatitis B need immediate treatment. If you do not need to start treatment immediately, you will be monitored over time to know when hepatitis becomes more active (at that point you may begin antiviral treatment).
Once on treatment (with oral medication or injectable medication), the individual will have regular blood tests to see how well the treatment is working and to detect side effects or drug resistance. Regular scans to assess the liver and look out for masses are done. Monitoring will continue even after treatment is completed to determine if the infection has recurred.
Liver transplantation — Liver transplantation may be the only option for people who have developed advanced cirrhosis.
How can hepatitis B infection be prevented?
1. Preventing infection of close contacts — Acute and chronic hepatitis B infections are contagious. Thus, people with hepatitis B should discuss measures to reduce the risk of infecting close contacts. These include the following:
●Discuss the infection with any sexual partner and use a latex condom with every sexual encounter.
●Do not share razors, toothbrushes, or anything that has blood on it.
●Cover open sores and cuts with a bandage.
●Do not donate blood, body organs, other tissues, or sperm.
●Immediate family and household members should be tested for hepatitis B. Anyone who is at risk of hepatitis B infection should be vaccinated.
●Do not share any injection drug equipment (needles, syringes).
●Clean blood spills with a mixture of 1-part household bleach to 9 parts water.
Hepatitis B cannot be spread by:
●Hugging or kissing
●Sharing eating utensils or cups
●Sneezing or coughing
2. Preventing infection from mother to child — If a woman tests positive for hepatitis B surface antigen, every pregnancy must be registered in a center where certain steps can be taken to decrease the risk of transmitting the virus to the baby.
How can an individual with hepatitis B infection maintain a healthy liver?
Vaccinations — Everyone with chronic hepatitis B should be vaccinated against hepatitis A unless they are known to be immune. Influenza vaccination is recommended in environments where it is available.
Liver cancer screening — Among those with chronic hepatitis B infection, regular screening for liver cancer is recommended, particularly for older individuals, those with cirrhosis, and patients with a family history of liver cancer. This is done by liver scan every six months.
Diet — Against popular belief, no specific diet has been shown to improve the outcome in people with hepatitis B. Eating a healthy and balanced diet is essential.
Alcohol — Alcohol should be avoided since it can worsen liver damage. All types of alcoholic drinks, even in small quantity, can cause further damage to the liver.
Use of medications — Many medications are broken down by the liver. Thus, an infected individual should always consult health personnel before taking medications.
Herbal medications — No herbal treatment has been proven to improve outcomes in patients with hepatitis B, and some can cause serious liver toxicity.
Groundnuts— Some poorly stored groundnuts have been found to contain high levels of aflatoxins which can cause liver cancer. Therefore, chronic hepatitis B infected individuals are advised to avoid groundnuts and the by-products.
Key recommendation: Everyone should go for hepatitis B screening.
Opeyemi O. Owoseni is a Gastroenterologist and Hepatologist. She is a Fellow of the Medical College of Physicians, Nigeria. She is a member of the Society for Gastroenterology and Hepatology in Nigeria (SOGHIN) and that of the American Society for Gastrointestinal Endoscopy (ASGE). She currently consults for several hospitals and performs liver biopsies, fibroscans, diagnostic and therapeutic endoscopies. She can be reached on firstname.lastname@example.org