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Karin Andersson, MD, MPH, director of the Massachusetts General Hospital Hepatitis B Clinic, answers common questions about the cause of and treatments for hepatitis B.
Hepatitis B is a virus transmitted through infected blood or bodily fluids that infects liver cells. The immune system recognizes and destroys liver cells infected with the hepatitis B virus. In the long term, this can cause liver damage or scarring and can lead to cirrhosis, or reduced liver function. The presence of hepatitis B in the liver is also carcinogenic, which means it increases the risk of liver cancer.
If you were born in an area where hepatitis B is very common such as Africa, Asia or the Pacific Islands, your doctor should test your blood for hepatitis B infection. Anyone who has come in contact with hepatitis B-infected blood or bodily fluid should also be tested, including people who have used intravenous or inhaled drugs, anyone who has had unprotected sexual contact with a hepatitis B-infected partner and individuals with regular blood exposure such as patients on hemodialysis.
Hepatitis B infection can exist in a variety of states over a person’s lifetime. In young children and adults, the virus is often very active but does not cause much liver damage. The virus may later enter a relatively quiet phase known as the “carrier state.” Treatment may not be necessary in this phase. In the Mass General Hepatitis B Clinic, we identify individuals with chronic active hepatitis and begin antiviral medication to reduce the risks of cirrhosis and liver cancer.
The best way to determine whether you should be treated is by having a thorough medical evaluation including blood work. Patients with hepatitis B often do not feel sick even when the disease is causing liver damage. Periodic monitoring is recommended for anyone with chronic hepatitis B so that treatment can be started as soon as it is needed.
Hepatitis B is diagnosed through blood tests. If you think you may be at risk for hepatitis B, please ask your doctor to do the appropriate screening tests.
People with chronic active hepatitis B infection can be treated with oral antiviral pills or an injected medication known as pegylated interferon. The antiviral medications used most often for chronic hepatitis B infection in our clinic include tenofovir and entecavir. These are potent medications with great long-term efficacy and very few side effects. Some people with chronic hepatitis B need treatment for a few years while others require lifelong treatment. For acute hepatitis B, treatment is not routinely recommended as most adults will recover fully.
Some individuals recover completely from hepatitis B infection over the long term, particularly those with acute hepatitis B. The goal of antiviral therapy is to control the virus and limit damage to the liver. Sometimes the hepatitis B infection goes away with antiviral treatment, but this occurs very rarely and is therefore not the primary goal of treatment.
If you have chronic hepatitis B infection, the vaccine is not helpful for you and is not recommended. However, members of your household and your sexual partners should be vaccinated to reduce the risk of transmission, if they do not have hepatitis B infection. In the United States, most infants born after 1991 have been vaccinated against the hepatitis B virus through the routine immunizations of childhood.
Cirrhosis develops in some patients with hepatitis B. This risk is related to how active the virus is and for how long it has been active. The risk of cirrhosis can be minimized by identifying and treating active hepatitis B infection early in its course.
Unfortunately, yes. Any person whose liver is chronically irritated or inflamed can develop cirrhosis even if he/she never drinks alcohol. You should not drink alcohol if you have hepatitis B infection.
Chronic hepatitis B infection is a risk factor for liver cancer, particularly if the virus is very active. The risk of liver cancer can be minimized by appropriate antiviral treatment. People with chronic hepatitis B should be screened for liver cancer to detect the cancer while it is limited and treatable. Screening typically involves periodic ultrasound examination and blood work.
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