Hepatitis B

Topic Overview

What is hepatitis B?

Hepatitis B is a virus that infects the liver. Most adults who get hepatitis B have it for a short time and then get better. This is called acute hepatitis B.

You can have hepatitis B and not know it. You may not have symptoms. If you do, they can make you feel like you have the flu. But as long as you have the virus, you can spread it to others.

Sometimes the virus causes a long-term infection, called chronic hepatitis B. Over time, it can damage your liver. Babies and young children infected with the virus are more likely to get chronic hepatitis B.

What causes hepatitis B?

Hepatitis B is caused by the hepatitis B virus. It is spread through contact with the blood and body fluids of an infected person.

You may get hepatitis B if you:

• Have sex with an infected person without using a condom.
• Share needles (used for injecting drugs) with an infected person.
• Get a tattoo or piercing with tools that were not cleaned well.
• Share personal items like razors or toothbrushes with an infected person.

A mother who has the virus can pass it to her baby during delivery. If you are pregnant and think you may have been exposed to hepatitis B, get tested. If you have the virus, your baby can get shots to help prevent infection with the virus.

You cannot get hepatitis B from casual contact such as hugging, kissing, sneezing, coughing, or sharing food or drinks.

What are the symptoms?

Many people with hepatitis B do not know they have it, because they do not have symptoms. If you do have symptoms, you may just feel like you have the flu. Symptoms include:

• Feeling very tired.
• Mild fever.
• Headache.
• Not wanting to eat.
• Feeling sick to your stomach or vomiting.
• Belly pain.
• Diarrhea or constipation.
• Muscle aches and joint pain.
• Skin rash.
• Yellowish eyes and skin (jaundice). Jaundice usually appears only after other symptoms have started to go away.

Most people with chronic hepatitis B have no symptoms.

How is hepatitis B diagnosed?

A simple blood test can tell your doctor if you have the hepatitis B virus now or if you had it in the past. Your doctor also may be able to tell if you have had the vaccine to prevent the virus.

If your doctor thinks you may have liver damage from hepatitis B, he or she may use a needle to take a tiny sample of your liver for testing. This is called a liver biopsy.

How is it treated?

In most cases, hepatitis B goes away on its own. You can relieve your symptoms at home by resting, eating healthy foods, drinking plenty of water, and avoiding alcohol and drugs. Also, find out from your doctor what medicines and herbal products to avoid, because some can make liver damage caused by hepatitis B worse.

Treatment for chronic hepatitis B depends on whether your infection is getting worse and whether you have liver damage. Most people with chronic hepatitis B can live active, full lives by taking good care of themselves and getting regular checkups. There are medicines for chronic hepatitis B, but they may not be right for everyone. Work with your doctor to decide whether medicine is the right treatment for you.

Sometimes, chronic hepatitis B can lead to severe liver damage. If this happens, you may need a liver transplant.

Can hepatitis B be prevented?

The hepatitis B vaccine is the best way to prevent infection. The vaccine is a series of 3 or 4 shots. Adults at risk and all babies, children, and teenagers should be vaccinated.

A combination vaccine (Twinrix) that protects against both hepatitis B and hepatitis A also is available.

To avoid getting or spreading the virus to others:

• Use a condom when you have sex.
• Do not share needles.
• Wear latex or plastic gloves if you have to touch blood.
• Do not share toothbrushes or razors.

Frequently Asked Questions

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Cause

Hepatitis B is a liver disease caused by infection with the hepatitis B virus (HBV). Hepatitis B is one of the most common forms of viral hepatitis, which includes hepatitis A, B, C, D, and E. But hepatitis has many other causes, including some medicines, long-term alcohol use, fatty deposits in the liver, and exposure to certain industrial chemicals.

How HBV is spread

HBV is spread when blood, semen, or vaginal fluids (including menstrual blood) from an infected person enter another person's body, usually in one of the following ways:

• Sexual contact. The hepatitis B virus can enter the body through a break in the lining of the rectum, vagina, urethra, or mouth. Sexual contact is the most important risk factor for the spread of HBV in North America.
• Sharing needles. People who share needles and other equipment (such as cotton, spoons, and water) used for injecting illegal drugs may inject HBV-infected blood into their veins.
• Work-related exposure. People who handle blood or instruments used to draw blood may become infected with the virus. Health care workers are at risk of becoming infected with the virus if they are accidentally stuck with a used needle or other sharp instrument contaminated with an infected person's blood. Infection also can occur if blood splashes onto an exposed surface, such as the eyes, mouth, or a cut in the skin.
• Childbirth. A newborn baby can get the virus from his or her mother during delivery when the baby comes in contact with the mother's body fluids in the birth canal (perinatal transmission). But breast-feeding does not transmit the virus from a woman with HBV to her child.
• Body piercings and tattoos. HBV may be spread when needles used for body piercing or tattooing are not properly cleaned (sterilized) and HBV-infected blood enters a person's skin.
• Toiletries. Grooming items such as razors and toothbrushes can spread HBV if they carry blood from a person who is infected with the virus.

In the past, blood transfusions were a common means of spreading HBV. Organ transplants could also spread the disease. Today, all donated blood and organs in the United States are screened for the virus, so it is extremely unlikely that you could become infected with the virus from a blood transfusion or organ transplant.

Contagious and incubation periods

Symptoms appear an average of 60 to 90 days (although they can appear 45 to 180 days) after you have contact with the hepatitis B virus (incubation period). Blood, semen, and vaginal fluids (including menstrual blood), whether fresh or dried, are highly contagious (HBV can be easily spread) during this period and for several weeks after the onset of symptoms.

• Blood contains the highest quantities of the hepatitis B virus.
• Blood and other body fluids that contain the virus can remain contagious for at least a week and possibly much longer, even if they are dried.

If you have a short-term HBV (acute) infection, you usually cannot spread the virus after antibodies against the surface antigen of HBV appear. This generally takes several weeks. If you have a long-term (chronic) HBV infection, you are able to spread the virus as long as you have an active infection.

Symptoms

Less than half of those with short-term (acute) hepatitis B infections have symptoms. Symptoms include:

• Jaundice (the skin and whites of the eyes appear yellow). Although jaundice is a major sign of liver damage, it does not occur in most people who have hepatitis B. Jaundice usually appears after other symptoms have started to go away.
• Extreme tiredness (fatigue).
• Mild fever.
• Headache.
• Loss of appetite, nausea, and vomiting.
• Constant discomfort on the right side of the abdomen under the rib cage, where the liver is located. In most people, the discomfort is made worse when their bodies are jarred or if they overwork themselves.
• Diarrhea or constipation.
• Muscle aches or joint pain.
• Skin rash.

Most people with chronic HBV have no symptoms.

You may get infected with HBV without knowing it. You may not find out that you have an HBV infection until you have a routine blood test or donate blood. Finding out a family member or someone you live with is infected also may cause you to be tested. Some people never know they have hepatitis B until a doctor finds that they have cirrhosis or liver cancer (hepatocellular carcinoma). But this is uncommon.

What Happens

Symptoms of infection with hepatitis B virus (HBV), if they appear at all, usually begin 60 to 90 days (although they can appear from 45 to 180 days) after the virus enters the body.

Most people have acute (short-term) HBV infection. In this infection:

• Most people start to feel better after 2 to 3 weeks and recover completely after 4 to 8 weeks. They develop antibodies against a type of HBV antigen that provide lifelong protection against future infection.
• Only a few people (particularly older adults) have long-lasting symptoms.
• A small number of people have symptoms that last for months. They may have signs of abnormal liver function before they completely recover from the acute infection.

About 1 or 2 out of 10 people with acute HBV infection develop joint pain and rashes.¹ In rare cases, HBV causes hives; swelling of the lips, tongue, or other tissue; swelling of the voice box (larynx); or pain in the abdomen.

If you remain infected with HBV for 6 months or longer, you have chronic hepatitis B. The risk of developing chronic HBV infection is related to the age at which you first become infected with the virus.²

• Up to 90% of children who are infected at birth develop chronic HBV infection.
• About 30% of children who are infected after birth between the ages of 1 and 5 develop chronic infection.
• About 6% of infected older children, adolescents, and adults develop chronic infection.

About 1.2 million Americans have chronic HBV infection.² Most people with chronic infection have no symptoms. But they can spread the virus to others (especially to people who live with them and to their sex partners) unless they receive treatment that cures the infection.

Although many people with chronic hepatitis B will not develop complications, about 15% to 25% of people with chronic HBV infection will die of cirrhosis or liver cancer.³ Having a lot of virus in the body (a high viral load) increases the risk of developing cirrhosis and liver cancer.

• You are more likely to develop cirrhosis if you carry a specific hepatitis B antigen (called the HBe antigen), are older than 40, and have elevated liver enzymes. For more information on cirrhosis, see the topic Cirrhosis.
• Risk factors for developing liver cancer after chronic HBV infection include being male, having a family history of liver cancer, being over 40 years old, having cirrhosis, and also having hepatitis C.

Other problems that can develop in relation to HBV infection but are uncommon include:

• Hepatitis D (delta) virus infection, which only occurs in those with hepatitis B and may make the HBV infection more severe. Infection with hepatitis D is rare in the United States.
• Fulminant hepatitis, which causes sudden and severe liver failure. Hospitalization is necessary.
• Inflammation of the blood vessels (vasculitis), which may result in kidney disease, arthritis, abdominal pain, inflammation of a nerve (mononeuritis), and Raynaud's phenomenon.
• Inflammation and disruption of the kidney (membranoproliferative glomerulonephritis).

People with hepatitis B who engage in high-risk behavior (such as having multiple sex partners or injecting illegal drugs) are at increased risk for hepatitis C and HIV, the virus that causes AIDS.

What Increases Your Risk

People who practice certain behaviors or have certain jobs are at high risk for becoming infected with hepatitis B virus (HBV). If you are a member of a high-risk group, you should receive the hepatitis B vaccine (What is a PDF document?).²

Risk factors for hepatitis B that you can control include:

• Being sexually active, including having unprotected sex with someone who is infected with the virus or whose sexual history is unknown to you.
• Having more than one sex partner. (Your risk for HBV infection is higher if you have another sexually transmitted disease such as chlamydia.)
• Sharing needles or other equipment (such as cotton, spoons, and water) to inject illegal drugs.

Job and lifestyle risk factors for hepatitis B include:

• Handling blood or body fluids as a routine part of your job. This includes health care workers, such as doctors, dentists, nurses, and blood and laboratory technicians, and students in these occupations. It also includes morticians and embalmers.
• Being an employee or resident of an institution for the developmentally disabled.
• Being an employee or inmate of a long-term prison.
• Spending more than 6 months in parts of the world where hepatitis B is common or where a large number of people have been infected for a long time with HBV. Such areas include Southeast and Central Asia, the islands of the South Pacific, the Amazon River basin, the Middle East, Africa, Eastern Europe, and China.
• Being a sexually active homosexual or bisexual man.
• Living with someone who has long-term (chronic) HBV infection.
• Getting body piercings and tattoos from a tattoo artist who uses poor infection-control practices.

Risk factors for hepatitis B that you cannot control include:

• Being born to a woman who is infected with HBV (if the newborn doesn't promptly receive the hepatitis B vaccine and hepatitis B immune globulin). But breast-feeding does not transmit the virus from a woman who has HBV to her child.
• Having at some time lived in a part of the world where hepatitis B is common.
• Having a blood-clotting disorder, such as hemophilia, that requires you to receive clotting factors from human donors.
• Having severe kidney disease that requires you to have your blood filtered through a machine (hemodialysis).
• Having a weakened immune system caused by HIV infection or other condition.
• Having a liver disease with an unknown cause.
• Being bitten by a person who is infected with HBV. (Note: HBV is not spread by kissing.)

Most people in the United States who have hepatitis are in one of the high-risk groups. But some people do not know how they became infected.

People with hepatitis B who engage in high-risk behavior (such as having multiple sex partners or injecting illegal drugs) are at increased risk for hepatitis C and HIV, the virus that causes AIDS.

Should I be tested for hepatitis B and C?

When To Call a Doctor

Contact a doctor immediately if you have been diagnosed with hepatitis B and develop severe dehydration (caused by vomiting and an inability to hold down fluids) or any of the following signs of rapidly developing liver failure:

• Extreme irritability (greater than would be expected in a person who is feeling ill).
• Impaired ability to think or reason clearly.
• Extreme drowsiness.
• Swelling of the arms, legs, hands, feet, abdomen, and/or face (edema).
• Heavy bleeding from the nose, mouth, or rectum (including blood in the stool), or under the skin.

If you witness a person with hepatitis B become unconscious, call 911 or other emergency services.

Call to make an appointment if:

• You have any of the hepatitis B risk factors listed in the What Increases Your Risk section of this topic, and you think you need to be tested for hepatitis B virus (HBV) infection or receive the hepatitis B vaccine.
• You develop any symptoms of hepatitis B (see the Symptoms section of this topic).
• Someone in your household has been diagnosed with hepatitis B.
• Your sex partner has been diagnosed with hepatitis B.
• You have been bitten by or exposed to the blood or body fluids (such as semen or vaginal fluids, including menstrual blood) of someone who has hepatitis B.

Watchful Waiting

Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. Because of the need to prevent the spread of hepatitis B, watchful waiting is not recommended if you have symptoms of hepatitis B or if you think you have come in contact with the hepatitis B virus (HBV). Because all forms of viral hepatitis have similar symptoms, it is important to see a doctor for a blood test when symptoms arise, so that he or she can rule out other forms of the illness. A doctor also can advise you about how to prevent the spread of the virus.

Who To See

Hepatitis B virus (HBV) infection usually can be diagnosed by:

• Family medicine doctors.
• Pediatricians.
• Internists.
• Physician assistants.
• Nurse practitioners.

The following specialists may work with your doctor to plan treatment:

• Gastroenterologist
• Hepatologist
• Infectious disease specialist

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Your doctor will diagnose hepatitis B virus (HBV) infection based on a physical examination, your medical history, and blood tests. You will be asked questions about risk factors for hepatitis B (such as about your job or sexual activity) and about factors that could make the disease worse (such as your alcohol use or family history of liver cancer).

If your doctor thinks you may be infected with the virus, you will need tests to find out more about your condition.

Blood tests done to help diagnose hepatitis B include:

• Hepatitis B antigens and antibodies, which help tell whether you are or were infected with HBV, whether you have been immunized, and whether you have long-term (chronic) HBV infection. You also may get tested for hepatitis B viral DNA (HBV DNA), which detects genetic material (DNA) from the hepatitis B virus. HBV DNA indicates that the virus is multiplying in your body (active) and that you can pass the virus to others. For more information, see the topic Hepatitis B Virus Tests.
• Tests that determine whether the hepatitis A, hepatitis C, or Epstein-Barr (which causes infectious mononucleosis, or "mono") viruses are causing your hepatitis if the results of your tests show that HBV is not multiplying in your body.
• Tests that determine the cause of liver inflammation if it is not a viral cause.
• Tests that determine whether you are infected with hepatitis D along with hepatitis B.

Hepatitis B and C: Should I be tested?

Blood tests done to help determine if your liver has been damaged include:

• Bilirubin, albumin, and prothrombin time, which help determine how well your liver is functioning. Cholesterol testing also may be done.
• Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, and lactic dehydrogenase (LDH), which help determine whether your liver is damaged or inflamed. These tests measure enzymes produced by the liver. But these tests alone are not a reliable way to confirm a diagnosis of hepatitis B. Additional tests usually are needed.

Tests may be done if you have chronic HBV infection and are considering antiviral treatment. These tests also may be used to determine whether treatment has been helpful in controlling liver damage caused by chronic HBV infection. They include:

• Diagnostic imaging.
  • Abdominal ultrasound
  • CT scan
  • MRI (may be used in rare cases)
• Removing a tissue sample from the liver (liver biopsy).

If you have chronic hepatitis B, the U.S. Centers for Disease Control and Prevention (CDC) recommends that you be vaccinated for hepatitis A if you have not been vaccinated or are not immune to this disease. For more information on Hepatitis A, see the topic Hepatitis A.

If you are at risk for liver cancer, an alpha-fetoprotein (AFP) test may be done. If the AFP level is elevated, it may indicate liver cancer.

If you have chronic HBV infection, you will need to visit your doctor regularly. He or she will do blood tests to monitor your liver function and the activity of the hepatitis B virus in your body. Some of the tests can tell your doctor whether HBV is actively multiplying in your liver, which increases your risk for chronic hepatitis. Chronic hepatitis can lead to cirrhosis or liver cancer (hepatocellular carcinoma).

Early Detection

The CDC recommends that all pregnant women have the hepatitis B surface antigen test. This test can tell if a woman has an active HBV infection. This test also may be repeated later in the pregnancy if a woman is at high risk for infection. For more information on risk factors, see the What Increases Your Risk section of this topic.

People who were exposed to the hepatitis B virus in the past, especially people who moved to the United States from a country where the virus is common, often develop lifelong protection (immunity) against HBV and do not need to be vaccinated. But people from countries where HBV infection is common may carry the virus and should be screened for the virus.

You can be tested for hepatitis B before getting vaccinated.

• Antibody testing will show if you have an active hepatitis B infection and need treatment.
• If testing shows you are already protected against hepatitis B, you will not need to get the hepatitis B vaccine (What is a PDF document?).
• You can receive the hepatitis B vaccine even if you already have antibodies against HBV in your blood, and no harm will result.

Treatment Overview

Treatment of hepatitis B viral (HBV) infection depends on how active the virus is and whether you are at risk for liver damage such as cirrhosis. Short-term (acute) hepatitis B usually goes away on its own. Home treatment is used to relieve symptoms and help prevent spread of the virus. In long-term (chronic) HBV infection, treatment includes monitoring the condition and using antiviral medicines to prevent liver damage. If hepatitis B has severely damaged your liver, a liver transplant may be considered.

The American Association for the Study of Liver Disease has made recommendations on who should receive antiviral treatment for chronic hepatitis B based on the presence of hepatitis B antigens, level of HBV DNA, and the levels of liver enzymes in your blood.⁴

Treatment of short-term (acute) hepatitis B infection

Initial treatment for hepatitis B infection depends on whether you:

• Have been recently infected with the hepatitis B virus (HBV).
• Have the symptoms of an acute HBV infection.
• Have chronic HBV infection.

If you believe you have recently been exposed to HBV, you should receive a shot of hepatitis B immune globulin (HBIG) and the first of three immunization shots of hepatitis B vaccine (What is a PDF document?). It is important to receive this treatment within 7 days after a needle stick and within 2 weeks after sexual contact that may have exposed you to the virus. The sooner you receive treatment after exposure, the more effective treatment is.

If you have the symptoms of acute hepatitis B, treatment with medicine is usually not needed. Home treatment usually will relieve your symptoms and help prevent the spread of the virus. To help relieve symptoms and prevent the spread of the infection:

• Slow down. Reduce your activity level to match your energy level. Don't go to work or school unless your workload can be lightened. Avoid strenuous exercise. As you start to feel better, go back to your regular activities gradually.
• Eat right. Even though food may not appeal to you, it is important to get adequate nutrition. For most people, nausea and loss of appetite become worse as the day goes on. Try eating a substantial (but not heavy) meal in the morning and lighter meals later in the day.
• Drink plenty of liquids to avoid dehydration. It is important that you keep your body well-hydrated when you have hepatitis B, especially if you have been vomiting. Drink plenty of water and, if you can tolerate them, drink fruit juices and broth to obtain additional calories. Rehydration drinks help replenish electrolytes.
• Avoid alcohol and drugs. Hepatitis B makes it difficult for your liver to process drugs and alcohol. If you take drugs (prescription or illegal) or drink alcohol when you have hepatitis, their effects may be more powerful and may last longer. In addition, alcohol and some drugs can make liver damage worse. You should avoid alcohol until your doctor feels that your liver is completely healed, which may take as long as 3 to 4 months. Tell your doctor about all of the prescription and over-the-counter medicines you are taking.
• Try to control itching. People with hepatitis B sometimes develop itchy skin. You might try nonprescription medicines, such as Benadryl or Chlor-Trimeton, to control itching. But talk to your doctor before taking any over-the-counter medicines.
• Prevent the spread of HBV by informing people you live with or sleep with about the illness, by not sharing personal toiletries (such as razors and toothbrushes), and by using a condom or abstaining from sex.

For more information on treating the symptoms of acute HBV infection, see the Home Treatment section of this topic.

You may be given medicine to treat an acute hepatitis B infection if:

• Tests continue to detect a certain antigen (HBeAg) after 12 weeks.
• Your liver enzyme levels are higher than normal, indicating that you may have some liver damage.
• The amount of hepatitis B virus DNA is high, which means there is a lot of virus in the body (high viral load).

Treatment of long-term (chronic) hepatitis B infection

If you have chronic HBV infection, treatment depends on how active the virus is in your body and the potential for liver damage. The goal of treatment is to stop liver damage by preventing the virus from multiplying.

Antiviral medicine is used if the virus is active and you are at risk for liver damage. Medicine slows the ability of the virus to multiply. Antiviral medicine for hepatitis B includes:

• Interferons such as interferon alfa-2b and pegylated interferon alfa-2a.
• Nucleoside reverse transcriptase inhibitors (NRTIs) such as adefovir, entecavir, lamivudine, and telbivudine.

Antiviral therapy is not recommended for everyone who has a chronic hepatitis B viral infection. Your doctor may recommend antivirals if you have or are likely to develop liver damage, such as cirrhosis. For more information, see:

Hepatitis B: Should I take antiviral medicine for chronic hepatitis B?

Whether or not you are taking medicine, you will need to visit your doctor regularly. He or she will do blood tests to monitor your liver function and the activity of the hepatitis B virus (HBV) in your body. Some of the tests can determine whether HBV is actively multiplying in your liver, which increases your risk of liver damage, such as cirrhosis or liver cancer. If you develop advanced liver damage because of hepatitis and your condition becomes life-threatening, you may need a liver transplant. But not everyone is a good candidate for a liver transplant.

Prevention

You can protect yourself from hepatitis B virus (HBV) infection by avoiding contact with the body fluids of someone whose health and sexual history are not known to you. To prevent infection:

• Use a condom when you have sex.
• Do not share needles.
• Do not share toothbrushes or razors.
• Wear latex or plastic gloves if you have to touch blood.

The hepatitis B vaccine (What is a PDF document?) is the most effective way to prevent infection with HBV. The vaccine is up to 95% effective against HBV infection if you receive all the shots in the vaccination series (3 or 4 shots given at different times).⁵ The vaccine provides protection against HBV infection for at least 20 years.⁶ A combination vaccine for hepatitis A and B also is available. Vaccination is recommended for:

• All newborn babies.
• Anyone 18 years old or younger who has not previously received the vaccine.
• People who inject illegal drugs.
• People who have had more than one sex partner in the past 6 months or who have a history of sexually transmitted diseases.
• Men who have sex with men.
• Household contacts and sex partners of people who have hepatitis B.
• People who have blood-clotting disorders, such as hemophilia, and have received clotting factors from human donors.
• People who have a severe kidney disease that requires them to have their blood filtered through a machine (hemodialysis).
• People who have liver disease or are infected with HIV.
• Health care workers and public safety workers who are likely to be exposed to blood.
• Staff and residents of prisons or institutions for the developmentally disabled.
• People who will spend more than 6 months in parts of the world where hepatitis B is common or where a large number of people have chronic HBV infection. To find the countries where hepatitis B is common, go to wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/hepatitis-b.aspx.

It is important that you discuss vaccination with your doctor even if you are not in one of the above categories. In the United States, about 15 out of 100 of those who become infected do not know how they got infected.¹

In some cases, a doctor will order postvaccination testing to make sure you have developed immunity to the hepatitis B virus. People who need this testing include those who have an impaired immune system or those who are health care workers or sex partners of people who have long-term (chronic) HBV infection.

If you are exposed to the virus before you have received all of the shots in the vaccination series, you may be given a dose of hepatitis B immune globulin (HBIG) soon afterward. In most cases, HBIG will prevent infection until the vaccine takes effect.

If you have had sex with someone who has hepatitis B and you have not received all doses of hepatitis B vaccine, you should receive a shot of HBIG—in addition to continuing the vaccine series—within 14 days of being exposed to HBV.

Hepatitis B is easily spread, so if you are already infected, there are many steps you can take to prevent the spread of HBV to others (such as not donating blood or not sharing razors or other toiletries). If you are not infected, there also are steps you can take to protect yourself against HBV infection (such as getting vaccinated or using condoms). For more information on preventing the spread of hepatitis B, see the topics Immunizations and Exposure to Sexually Transmitted Diseases.

Home Treatment

Home treatment is important for relieving symptoms and preventing the spread of hepatitis B virus (HBV).

While there is no specific medical treatment for short-term (acute) hepatitis B, there are some things you can do that may help you feel better while the illness is running its course.

Slow down

• Reduce your activity level to match your energy level. You don't have to stay in bed, but listen to your body and slow down when you become tired.
• Don't go to work or school unless your workload can be reduced to match your energy level.
• Avoid strenuous exercise.
• As you start to feel better, go back to your regular activities gradually. If you try to meet your regular pace too soon, you may get sick again.

Eat right

• Even though food may not appeal to you, it is important to get adequate nutrition. For most people, nausea and loss of appetite become worse as the day goes on. Try eating a substantial (but not heavy) meal in the morning and lighter meals later in the day.
• Doctors used to recommend a high-calorie, protein-rich diet to people who have hepatitis. This is no longer believed to be of any benefit, and such foods can be hard to eat when you feel nauseated. Try to maintain a balanced diet while eating foods that appeal to you.

Avoid dehydration

It is important that you keep your body well-hydrated when you have hepatitis B, especially if you have been vomiting.

• Drink plenty of water.
• If you can tolerate them, fruit juices and broth are other good choices, because they provide additional calories.
• Many of the "sports drinks" available in grocery stores can help replace essential minerals (electrolytes) that are lost during vomiting. You can also make your own rehydration drink.

Avoid alcohol and drugs

Hepatitis impairs your liver's ability to process drugs and alcohol. If you take drugs (prescription or illegal) or drink alcohol when you have hepatitis, their effects may be more powerful and may last longer. In addition, alcohol and some drugs can make liver damage worse.

• If you are taking prescription medicines, your doctor may instruct you to stop using them until your liver has had time to heal. Do not stop taking prescription medicines unless your doctor has told you to do so.
• Check with your doctor before taking any new medicines or continuing the use of nonprescription medicines, including herbal products and acetaminophen (such as Tylenol). Acetaminophen can make liver disease worse, especially if you continue to drink alcohol.
• You should avoid alcohol until your doctor feels that your liver is completely healed. This may take as long as 3 to 4 months.

Try to control itching

People with hepatitis sometimes develop itchy skin. You can control itching by keeping cool and out of the sun, wearing cotton clothing, or using nonprescription medicines such as Benadryl or Chlor-Trimeton. Talk to your doctor if you want to take nonprescription medicines.

Be sure to follow the instructions that are provided with the product, and stop using the product if you have any side effects.

See your doctor regularly if you have chronic HBV infection

If you have been diagnosed with long-term (chronic) HBV infection, your doctor will recommend that you be vaccinated for hepatitis A if you have not been vaccinated or are not immune to this disease. For more information on hepatitis A, see the topic Hepatitis A. You also will need to visit your doctor regularly. He or she will do blood tests to monitor your liver function and the activity of the hepatitis B virus (HBV) in your body. Some of the tests can tell your doctor whether HBV is actively multiplying in your liver, which increases your risk for chronic hepatitis. Chronic hepatitis can lead to liver disease such as cirrhosis or liver cancer (hepatocellular carcinoma).

Medications

For people with short-term (acute) hepatitis B infection (HBV), treatment with medicine is not usually recommended. Antiviral medicine may be used for long-term (chronic) HBV infection if the virus is multiplying or liver damage exists or may develop.

But antiviral therapy is not recommended for everyone who has chronic hepatitis B viral infection. It is an option for people who have or appear likely to develop liver damage such as cirrhosis. Antiviral therapy may not help if you already have severe liver damage.

The American Association for the Study of Liver Disease has made recommendations on who should receive antiviral treatment for long-term (chronic) hepatitis B based on the presence of hepatitis B antigens in your blood, the level of hepatitis B virus DNA (HBV DNA) in your blood, and the levels of your liver enzymes.⁴

Medication Choices

Interferons such as interferon alfa-2b and pegylated interferon alfa-2a

Nucleoside reverse transcriptase inhibitors (NRTIs) such as adefovir, entecavir, lamivudine, and telbivudine

Hepatitis B: Should I take antiviral medicine for chronic hepatitis B?

What To Think About

• It is important to weigh the benefits of treatment against the risks. Treatment for chronic hepatitis B does not cure the disease, but does suppress it.
• Interferons are given as shots. Adefovir, entecavir, lamivudine, and telbivudine are pills.
• Interferons have common side effects, including fever, headaches, and hair loss. They may also cause or aggravate mental problems. Adefovir, entecavir, lamivudine, and telbivudine have few side effects but generally need to be taken for a longer period of time.
• After you have taken lamivudine for 1 year or longer, you can become resistant to the drug. Drug resistance means the medicine no longer works very well. If you develop resistance to lamivudine, you can take adefovir.
• If you have cirrhosis, you cannot use interferons. But you can use adefovir, entecavir, lamivudine, and telbivudine.
• After any kind of treatment for hepatitis B, the virus may return (relapse).

Surgery

Hepatitis B is a viral infection that affects the liver. There is no surgical treatment for hepatitis B.

If you develop advanced liver damage because of hepatitis and your condition becomes life-threatening, you may need a liver transplant.

In rare cases, short-term (acute) hepatitis B progresses rapidly to liver failure, a life-threatening condition called fulminant hepatitis. For some people, liver transplantation offers the only hope for survival.

Other Treatment

Some people with short-term (acute) hepatitis B develop severe nausea and/or dehydration. If this happens, you might need to be hospitalized so you can receive additional fluids intravenously.

Other Places To Get Help

Organizations

References

Citations

1. Berenguer M, Wright TL (2006). Hepatitis B and D. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 2, pp. 1647–1679. Philadelphia: Saunders Elsevier.
2. Centers for Disease Control and Prevention (2009). Hepatitis B: Frequently asked questions for health professionals. Available online: http://www.cdc.gov/hepatitis/HBV/HBVfaq.htm.
3. American Public Health Association (2008). Viral hepatitis B. In Control of Communicable Diseases Manual, 19th ed., pp. 284–293. Washington, DC: American Public Health Association
4. Lok ASF, McMahon BJ (2007). Chronic hepatitis B. Hepatology, 45(2): 507–539.
5. American Academy of Pediatrics (2006). Hepatitis B. In LK Pickering, ed., Red Book: 2006 Report of the Committee on Infectious Diseases, 27th ed., pp. 335–355. Elk Grove, IL: American Academy of Pediatrics.
6. World Health Organization (2009). Hepatitis B fact sheet. Available online: http://www.who.int/mediacentre/factsheets/fs204/en/index.html.

Other Works Consulted

• Janssen, H (2005). Pegylated interferon alfa-2b alone or in combination with lamivudine for HBeAg-positive chronic hepatitis B: A randomised trial. Lancet, 365(9454): 123–129.
• Sorrell MF, et al. (2009). National Institutes of Health consensus development conference statement: Management of hepatitis B. Annals of Internal Medicine, 150(2): 104–110.
• Weinbaum CM, et al. (2008). Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR, 57(RR-08): 1–20. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5708a1.htm.

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