Hepatitis B

Date Updated: 09/04/2020

Overview

Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). For some people, hepatitis B infection becomes chronic, meaning it lasts more than six months. Having chronic hepatitis B increases your risk of developing liver failure, liver cancer or cirrhosis — a condition that permanently scars of the liver.

Most adults with hepatitis B recover fully, even if their signs and symptoms are severe. Infants and children are more likely to develop a chronic (long-lasting) hepatitis B infection.

A vaccine can prevent hepatitis B, but there's no cure if you have the condition. If you're infected, taking certain precautions can help prevent spreading the virus to others.

Symptoms

Signs and symptoms of hepatitis B range from mild to severe. They usually appear about one to four months after you've been infected, although you could see them as early as two weeks post-infection. Some people, usually young children, may not have any symptoms.

Hepatitis B signs and symptoms may include:

Abdominal pain
Dark urine
Fever
Joint pain
Loss of appetite
Nausea and vomiting
Weakness and fatigue
Yellowing of your skin and the whites of your eyes (jaundice)

When to see a doctor

If you know you've been exposed to hepatitis B, contact your doctor immediately. A preventive treatment may reduce your risk of infection if you receive the treatment within 24 hours of exposure to the virus.

If you think you have signs or symptoms of hepatitis B, contact your doctor.

Causes

Hepatitis B infection is caused by the hepatitis B virus (HBV). The virus is passed from person to person through blood, semen or other body fluids. It does not spread by sneezing or coughing.

Common ways that HBV can spread are:

Sexual contact. You may get hepatitis B if you have unprotected sex with someone who is infected. The virus can pass to you if the person's blood, saliva, semen or vaginal secretions enter your body.
Sharing of needles. HBV easily spreads through needles and syringes contaminated with infected blood. Sharing IV drug paraphernalia puts you at high risk of hepatitis B.
Accidental needle sticks. Hepatitis B is a concern for health care workers and anyone else who comes in contact with human blood.
Mother to child. Pregnant women infected with HBV can pass the virus to their babies during childbirth. However, the newborn can be vaccinated to avoid getting infected in almost all cases. Talk to your doctor about being tested for hepatitis B if you are pregnant or want to become pregnant.

Acute vs. chronic hepatitis B

Hepatitis B infection may be either short-lived (acute) or long lasting (chronic).

Acute hepatitis B infection lasts less than six months. Your immune system likely can clear acute hepatitis B from your body, and you should recover completely within a few months. Most people who get hepatitis B as adults have an acute infection, but it can lead to chronic infection.
Chronic hepatitis B infection lasts six months or longer. It lingers because your immune system can't fight off the infection. Chronic hepatitis B infection may last a lifetime, possibly leading to serious illnesses such as cirrhosis and liver cancer.

The younger you are when you get hepatitis B — particularly newborns or children younger than 5 — the higher your risk of the infection becoming chronic. Chronic infection may go undetected for decades until a person becomes seriously ill from liver disease.

Risk factors

Hepatitis B spreads through contact with blood, semen or other body fluids from an infected person. Your risk of hepatitis B infection increases if you:

Have unprotected sex with multiple sex partners or with someone who's infected with HBV
Share needles during IV drug use
Are a man who has sex with other men
Live with someone who has a chronic HBV infection
Are an infant born to an infected mother
Have a job that exposes you to human blood
Travel to regions with high infection rates of HBV, such as Asia, the Pacific Islands, Africa and Eastern Europe

Complications

Having a chronic HBV infection can lead to serious complications, such as:

Scarring of the liver (cirrhosis). The inflammation associated with a hepatitis B infection can lead to extensive liver scarring (cirrhosis), which may impair the liver's ability to function.
Liver cancer. People with chronic hepatitis B infection have an increased risk of liver cancer.
Liver failure. Acute liver failure is a condition in which the vital functions of the liver shut down. When that occurs, a liver transplant is necessary to sustain life.
Other conditions. People with chronic hepatitis B may develop kidney disease or inflammation of blood vessels.

Prevention

The hepatitis B vaccine is typically given as three or four injections over six months. You can't get hepatitis B from the vaccine.

The hepatitis B vaccine is recommended for:

Newborns
Children and adolescents not vaccinated at birth
Those who work or live in a center for people who are developmentally disabled
People who live with someone who has hepatitis B
Health care workers, emergency workers and other people who come into contact with blood
Anyone who has a sexually transmitted infection, including HIV
Men who have sex with men
People who have multiple sexual partners
Sexual partners of someone who has hepatitis B
People who inject illegal drugs or share needles and syringes
People with chronic liver disease
People with end-stage kidney disease
Travelers planning to go to an area of the world with a high hepatitis B infection rate

Take precautions to avoid HBV

Other ways to reduce your risk of HBV include:

Know the HBV status of any sexual partner. Don't engage in unprotected sex unless you're absolutely certain your partner isn't infected with HBV or any other sexually transmitted infection.
Use a new latex or polyurethane condom every time you have sex if you don't know the health status of your partner. Remember that although condoms can reduce your risk of contracting HBV, they don't eliminate the risk.
Don't use illegal drugs. If you use illicit drugs, get help to stop. If you can't stop, use a sterile needle each time you inject illicit drugs. Never share needles.
Be cautious about body piercing and tattooing. If you get a piercing or tattoo, look for a reputable shop. Ask about how the equipment is cleaned. Make sure the employees use sterile needles. If you can't get answers, look for another shop.
Ask about the hepatitis B vaccine before you travel. If you're traveling to a region where hepatitis B is common, ask your doctor about the hepatitis B vaccine in advance. It's usually given in a series of three injections over a six-month period.

Diagnosis

Your doctor will examine you and look for signs of liver damage, such as yellowing skin or belly pain. Tests that can help diagnose hepatitis B or its complications are:

Blood tests. Blood tests can detect signs of the hepatitis B virus in your body and tell your doctor whether it's acute or chronic. A simple blood test can also determine if you're immune to the condition.
Liver ultrasound. A special ultrasound called transient elastography can show the amount of liver damage.
Liver biopsy. Your doctor might remove a small sample of your liver for testing (liver biopsy) to check for liver damage. During this test, your doctor inserts a thin needle through your skin and into your liver and removes a tissue sample for laboratory analysis.

Screening healthy people for hepatitis B

Doctors sometimes test certain healthy people for hepatitis B infection because the virus can damage the liver before causing signs and symptoms. Talk to your doctor about screening for hepatitis B infection if you:

Are pregnant
Live with someone who has hepatitis B
Have had many sexual partners
Have had sex with someone who has hepatitis B
Are a man who has sex with men
Have a history of a sexually transmitted illness
Have HIV or hepatitis C
Have a liver enzyme test with unexplained abnormal results
Receive kidney dialysis
Take medications that suppress the immune system, such as those used to prevent rejection after an organ transplant
Use illegal injected drugs
Are in prison
Were born in a country where hepatitis B is common, including Asia, the Pacific Islands, Africa and Eastern Europe
Have parents or adopted children from places where hepatitis B is common, including Asia, the Pacific Islands, Africa and Eastern Europe

Treatment

Treatment to prevent hepatitis B infection after exposure

If you know you've been exposed to the hepatitis B virus and aren't sure if you've been vaccinated, call your doctor immediately. An injection of immunoglobulin (an antibody) given within 12 hours of exposure to the virus may help protect you from getting sick with hepatitis B. Because this treatment only provides short-term protection, you also should get the hepatitis B vaccine at the same time, if you never received it.

Treatment for acute hepatitis B infection

If your doctor determines your hepatitis B infection is acute — meaning it is short-lived and will go away on its own — you may not need treatment. Instead, your doctor might recommend rest, proper nutrition and plenty of fluids while your body fights the infection. In severe cases, antiviral drugs or a hospital stay is needed to prevent complications.

Treatment for chronic hepatitis B infection

Most people diagnosed with chronic hepatitis B infection need treatment for the rest of their lives. Treatment helps reduce the risk of liver disease and prevents you from passing the infection to others. Treatment for chronic hepatitis B may include:

Antiviral medications. Several antiviral medications — including entecavir (Baraclude), tenofovir (Viread), lamivudine (Epivir), adefovir (Hepsera) and telbivudine (Tyzeka) — can help fight the virus and slow its ability to damage your liver. These drugs are taken by mouth. Talk to your doctor about which medication might be right for you.
Interferon injections. Interferon alfa-2b (Intron A) is a man-made version of a substance produced by the body to fight infection. It's used mainly for young people with hepatitis B who wish to avoid long-term treatment or women who might want to get pregnant within a few years, after completing a finite course of therapy. Interferon should not be used during pregnancy. Side effects may include nausea, vomiting, difficulty breathing and depression.
Liver transplant. If your liver has been severely damaged, a liver transplant may be an option. During a liver transplant, the surgeon removes your damaged liver and replaces it with a healthy liver. Most transplanted livers come from deceased donors, though a small number come from living donors who donate a portion of their livers.

Other drugs to treat hepatitis B are being developed.

Lifestyle and home remedies

If you've been infected with hepatitis B, take steps to protect others from the virus.

Make sex safer. If you're sexually active, tell your partner you have HBV and talk about the risk of transmitting it to him or her. Use a new latex condom every time you have sex, but remember that condoms reduce but don't eliminate the risk.
Tell your sexual partner to get tested. Anyone with whom you've had sex needs to be tested for the virus. Your partners also need to know their HBV status so that they don't infect others.
Don't share personal care items. If you use IV drugs, never share needles and syringes. And don't share razor blades or toothbrushes, which may carry traces of infected blood.

Coping and support

If you've been diagnosed with hepatitis B infection, the following suggestions might help you cope:

Learn about hepatitis B. The Centers for Disease Control and Prevention is a good place to start.
Stay connected to friends and family. You can't spread hepatitis B through casual contact, so don't cut yourself off from people who can offer support.
Take care of yourself. Eat a healthy diet full of fruits and vegetables, exercise regularly, and get enough sleep.
Take care of your liver. Don't drink alcohol or take prescription or over-the-counter drugs without consulting your doctor. Get tested for hepatitis A and C. Get vaccinated for hepatitis A if you haven't been exposed.

Preparing for an appointment

You're likely to start by seeing your family doctor or a general practitioner. However, in some cases, you may be referred immediately to a specialist. Doctors who specialize in treating hepatitis B include:

Doctors who treat digestive diseases (gastroenterologists)
Doctors who treat liver diseases (hepatologists)
Doctors who treat infectious diseases

What you can do

Here's some information to help you get ready for your appointment.

Be aware of pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
Write down your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
Write down key personal information, including major stresses or recent life changes.
Make a list of all medications, vitamins and supplements you take.
Consider taking a family member or friend along. Someone who accompanies you may help you remember the information you receive.
Write down questions to ask your doctor.

Listing questions for your doctor can help you make the most of your time together. For hepatitis B infection, some basic questions to ask your doctor include:

What is likely causing my symptoms or condition?
Other than the most likely cause, what are other possible causes for my symptoms or condition?
What tests do I need?
Is my condition likely temporary or chronic?
Has hepatitis B damaged my liver or caused other complications, such as kidney problems?
What is the best course of action?
What are the alternatives to the primary approach you're suggesting?
I have other health conditions. How can I best manage them together?
Are there restrictions that I need to follow?
Should I see a specialist?
Should my family be tested for hepatitis B?
How can I protect people around me from hepatitis B?
Is there a generic alternative to the medicine you're prescribing?
Are there brochures or other printed material I can have? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

When did your symptoms begin?
Have your symptoms been continuous or occasional?
How severe are your symptoms?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?
Have you ever had a blood transfusion?
Do you inject drugs?
Have you had unprotected sex?
How many sexual partners have you had?
Have you been diagnosed with hepatitis?