Hepatitis B: causes, symptoms, diagnosis /hepatitis b treatment
Hepatitis B is a viral infection which attacks the liver. The virus is spread through contact with the blood or during sexual intercourse. More than 250 million people suffer from chronic infection with the hepatitis B virus. Disease signs, diagnosis, treatment, vaccine, Doctissimo reviews hepatitis B.
What is hepatitis B?
Hepatitis B is a liver disease that is caused by a DNA virus of the Hepadnavirus family. Around 257 million people worldwide are reported to be chronically infected, with an estimated 780,000 deaths a year. In France, 3.2 million people have been in contact with the hepatitis B virus (HBV) and more than 280,000 have a chronic form of infection.
Causes and risk factors of hepatitis B
Hepatitis B virus is transmitted primarily through sexual or blood transmission. In fact, the only secretions or body fluids that transmit the virus are blood, sperm, vaginal secretions, saliva and fluids from a wound. So that there is transmission, it is necessary that one of these liquids in the patient passes in the blood of a healthy person. Transmission from mother to child is also possible, but early treatment with immunoglobulins followed by vaccination prevents the disease.
Some countries are more risky than others because of the difficulties in enforcing prevention rules and lack of resources.
The virus can survive outside the body for at least 7 days and is highly contagious. Precautions to avoid transmission are consistent use of condoms during sex and avoid the exchange of used syringes. Sensitization and education measures are often carried out in at-risk populations (injecting drug users, etc.).
In the entourage of the patient, it is necessary to avoid the exchange of materials in contact with the blood (toothbrushes, razors, nail scissors, hair removal equipment, etc.).
Hepatitis B: the signs of the disease
Infection with the hepatitis B virus begins with a silent incubation period of about 2 months but up to 6. As for hepatitis A, after incubation, the acute phase of the disease is asymptomatic in 90% of cases. For others, the signs that appear can be:
a dark coloring of the urine
Jaundice (jaundice) of the skin and eyes. This last can last more than one month.
In rare cases, acute hepatitis can degenerate: it is called fulminant hepatitis. It is an emergency because it is fatal in 90% of cases. It therefore 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 affected organ. The observation will guide his diagnosis to hepatitis. After questioning the patient, he can consider what type of hepatitis it is: viral, drug, alcoholic, etc. But he will have to prescribe a blood test to make sure of it because it is the only way of checking that he is indeed a hepatitis B.
Additional tests and tests for hepatitis B
The first tests requested by the doctor will be a study of markers that signify the existence of liver damage: transaminases and bilirubin.
Also, he will prescribe a serology that is to say a search in the blood of the presence of antibodies specific for the main hepatitis. These antibodies are a defense of the body against the virus, they are present only in case of infection. In the case of acute hepatitis B, the antibodies (Ac) sought are anti-HBc Ab, that is antibodies directed towards a particular protein. Then, other biological tests can be prescribed to know the history of the hepatitis: Ab anti-HBs, antigen (Ag) HBs and HBV-DNA. To learn more, read our article on the serology of hepatitis B.
In case of chronic hepatitis, a PBH (liver biopsy puncture) is practiced to know the state of liver tissue: fibrosis, cirrhosis or cancer. The reliability of non-invasive methods advocated by learned societies to evaluate liver fibrosis (fibrotest, fibroscan …) is not recognized by the High Health Authority (HAS)
Evolution of hepatitis B
Infection with the hepatitis B virus can progress to 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%, she spontaneously evolves towards healing. This evolution is not influenced by the fact that the acute phase was symptomatic or not.
Chronic carriers are about 2 in 3 likely to have active chronic hepatitis (the remaining third is asymptomatic and out of danger for life). Once in 2, this chronic active hepatitis will evolve into cirrhosis. Ultimately, cirrhosis that stems from hepatitis B can develop into liver cancer.
hepatitis b treatment
Only chronic active hepatitis B is treated with specific drugs. In early hepatitis, the acute phase, rest, discontinuation of certain drugs (oral contraceptives for example), stopping all alcoholic beverages and balanced diet are the only measures to take.
In case of chronic active hepatitis documented (that is to say proven by biological examinations and / or biopsy), the treatment is based on the prescription of nucleoside analogues (tenofovir, entecavir …) which are drugs that block some mechanisms of replication of the virus. Another option is the administration of interferons: interferon alpha 2a or alpha 2b, most often associated with an antiviral, lamivudine.
Hepatitis B: an effective vaccine
There are vaccines against hepatitis B. These are effective and provide lasting immunity. A reminder must be done every 10 years. Currently, vaccination is especially recommended for people at risk (it is mandatory for all health personnel) and for children. In the latter case, the goal is the eradication of the disease. France has embarked on an immunization program following the recommendations of the World Health Organization in 1991. According to the WHO, this vaccine is 95% effective in the prevention of infection and the development of chronic hepatitis and liver cancer due to the disease.
A controversy over a possible link between this vaccination and the occurrence of multiple sclerosis has caused a stir. Yet, as Inserm recalls, no scientific study has demonstrated this risk and recommendations have not changed since; even though surveillance has increased.
Living with hepatitis B
In case of hepatitis B, it is important to change your lifestyle to preserve your liver, but also to protect those around you.
PRESERVING YOUR LIVER
Stop all alcohol consumption
Lose weight if necessary
Maintain a normal rate of sugar and fat in the blood;
Follow your treatment correctly.
PROTECT YOUR ENTOURAGE
To limit the risks of contamination of those around you, here are some simple principles to respect:
To detect the disease;
To get vaccinated ;
Do not share everyday objects such as toothbrushes or nail scissors (see above);
Wearing a condom during sex.
The effectiveness of medical treatment if you have one depends on how regularly you take it. Also a regular medical follow-up must be operated:
Respect the rhythm of the consultations planned with your doctor and / or specialist;
Do not take medication without medical advice;
Contact your doctor: tell him about any adverse reactions or any unusual symptoms, he will guide you.
If the side effects of the medications are too important, a work stoppage can be considered with the doctor’s agreement. In addition, an adaptation of the professional life (half-time therapeutic, adaptation of the post) is often necessary.