Hepatitis B is a liver disease that is caused by a DNA virus in the family Hepadnavirus. Like AIDS, hepatitis B is considered by the World Health Organisation (WHO) as a major public health problem.
Around the world, around 257 million people are reportedly suffering from this chronic infection and it is reportedly causing about 887 deaths a year worldwide.
Causes and risk factors for hepatitis B
Hepatitis B virus is transmitted mainly through sexual or blood. Indeed, the only secretions or body fluids that enable the virus to be transmitted are blood, sperm, vaginal secretions, saliva and wound fluids. For transmission, so one of these fluids in the patient needs to pass into a healthy person’s blood. Mother to child transmission is also possible but early immunoglobulin treatment followed by vaccination prevent the disease.
Some countries pose more risks than others due to the difficulties in enforcing the rules of prevention and lack of capacity. Africa, Asia, and South America are the most affected countries.
The virus can survive outside the body for at least 7 days and it is highly contagious. Precautions to avoid transmission are a routine use of condoms during sexual intercourse and avoid the exchange of used syringes. Awareness and education measures are often carried out among at-risk populations (injection drug addicts, etc.). ).).).).
In the patient’s surroundings, the exchange of materials in contact with the blood should be avoided (toothbrushes, razors, nail scissors, hair removal materials, etc. ).).).).
Hepatitis B: signs of disease
Hepatitis B infection begins with a silent incubation period of about 2 months but up to 6. As with hepatitis A, after incubation, the acute phase of the disease is asymptomatic in 90 % of cases. For others, the signs that appear may be:
Anorexia;
Liver pain;
Nausea, vomiting;
Extreme fatigue;
Dark urine colouring;
A jaundice (jaundice) of the skin and eyes. The latter can last longer than a month.
In rare cases, acute hepatitis can degenerate: it’s called fulminant hepatitis. This is an emergency because it is deadly in 90 % of cases. So it often requires liver transplantation (liver transplant).
The diagnosis of hepatitis B
Based on the symptoms described above, the doctor will palpate your liver to verify that it is the organ reaches. The observation will direct his diagnosis towards hepatitis.
After questioning the patient, he may consider what type of hepatitis it is: viral, medication, alcoholic, etc. But he’ll have to prescribe a blood check to make sure it’s the only way to check that hepatitis B is.
Additional hepatitis B examinations and analyses
The first tests requested by the doctor will be a study of markers that sign a liver damage: transaminases and bilirubine.
Also, he will prescribe serology that is a blood research for the presence of specific antibodies of major hepatitis. These antibodies are one of the body’s means of defending the virus, they are only present in case of infection. In the case of acute hepatitis B, the (Ac) desired antibodies are anti-HBc Ac, that is, antibodies directed towards a particular protein. Next, more biological tests may be required to know the history of hepatitis: Anti-HBs, Antigen (Ag) HBs, and DNA-HBB. Learn more about hepatitis B serology.
In case of chronic hepatitis, PBH (liver biopsy puncture) is practiced to know the condition of the liver tissue: fibrosis, cirrhosis or cancer.
The reliability of non-invasive methods advocated by scholarly societies to assess liver fibrosis (fibrotest, fibroscan…) is not recognized by the High Health Authority (HAS).
Evolution of hepatitis B
Hepatitis B virus infection can evolve into chronicity in 10 % of cases. This means that the patient will carry the virus all his life (but not necessarily sick). In the remaining 90 % it spontaneously evolves towards healing. This evolution is not influenced by whether the acute phase was symptoms or not.
Chronic carriers have approximately 2 out of 3 chances of experiencing active chronic hepatitis (the other third remaining asymptomatic and safe for their whole life). Once out of 2, this active chronic hepatitis will evolve into cirrhosis. Ultimately, cirrhosis that comes from hepatitis B can evolve into liver cancer.
Hepatitis B treatment
Only active chronic hepatitis B is treated with specific medications. At the beginning of hepatitis, at the acute phase, resting, stopping certain medicines (e.g. oral contraceptives), stopping all alcoholic beverages and balanced diet are the only steps to take.
In case of documented active chronic hepatitis (i.e. proven by biological examinations and or biopsy), the treatment is based on prescribing nucleoside analogues (tenofovir, entecavir…) which are drugs that block certain mechanisms of virus replication. Another option is the administration of interferons: interferon alpha 2 a or alpha 2 b, most often associated with an antiviral, lamivudine.
Hepatitis B: an effective vaccine
Hepatitis B vaccines exist. These are effective and ensure lasting immunity. A reminder must be completed every 10 years. Currently, vaccination is mostly recommended in people at risk (it is mandatory in all health workers) and in children. In the latter case, the goal is to eradicate the disease.
France has embarked on a vaccination programme following World Health Organisation recommendations in 1991. According to WHO, this vaccine is 95 % effective in preventing infection and developing a chronic hepatitis and liver cancer due to illness.
A controversy over a possible link between this vaccination and the occurrence of multiple sclerosis has made great noise. Yet, as Inserm points out, no scientific study has demonstrated this risk and therefore the recommendations have not changed since then even though monitoring has stepped up.
Living with hepatitis B
In case of hepatitis B, it is important to change your lifestyle to preserve your liver, but also to protect your surroundings.
Preserving your liver
Stop all alcohol use;
Stop smoking;
Lose weight if necessary;
Maintain a normal blood sugar and fat;
Follow her treatment correctly.
Protecting your surroundings
To limit the risk of contamination among its surroundings, here are some simple principles to respect:
Screening the disease;
Getting vaccinated;
Do not share everyday items like toothbrush or nail scissors (see above);
Wearing a condom during sex.
Medical tracking
The efficiency of medical treatment if you have one depends on how regular you take it. Also a regular medical follow-up should be carried out:
Respect the pace of scheduled consultation with your attending doctor and / or a specialist;
Don’t take medication without a medical notice;
Contact your doctor: report any adverse reactions or unusual symptoms, they will guide you.
Professional life
If the side effects of medication are too high, a stoppage of work may be considered with the consent of the doctor. In addition, a work life adaptation (half-time therapeutic, job adaptation) is often necessary.