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Hepatitis B

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Synonyms of Hepatitis B

Disorder Subdivisions

General Discussion

Hepatitis B is a contagious liver disease caused by the hepatitis B virus (HBV), one of three viral agents that cause inflammation of the liver known as hepatitis or diffuse hepatocellular inflammatory disease. Hepatitis B is characterized by fever, nausea, vomiting, and yellow discoloration of the skin, eyes and mucous membranes (jaundice). In its most serious form, if left untreated, hepatitis B can become a chronic infection leading to chronic liver disease and potentially increasing the risk of developing liver cancer. The hepatitis B virus can be passed from mother to unborn child, and is highly contagious through bodily fluids such as blood, semen and possibly saliva. It is often spread from person to person through intravenous drug use or sexual contact.

Symptoms

Hepatitis B virus usually has a one to six week incubation period during which a certain antigen (immune response agent) circulates in the blood before symptoms of the illness develop. Hepatitis B may initially appear as influenza symptoms (fever, headache, eye-ear-nose-throat involvement, chills, tiredness, itchy rash, etc.), followed by nausea, vomiting and yellow discoloration of skin, eyes, and mucous membranes (jaundice). Affected individuals may also experience loss of appetite and abnormal tenderness of the upper right portion of the stomach. Because similar symptoms also occur with other diseases such as mononucleosis or chronic liver disease, hepatitis B may be difficult to diagnose.

In some cases, hepatitis B may eventually lead to damage and scarring of the liver (cirrhosis). Some affected individuals may develop chronic liver disease. In most cases, hepatitis B usually runs its course in four to eight weeks, except in some variations of the disease. For information on these, please see the Related Disorders section of this report.

Causes

Hepatitis B is a form of acute viral hepatitis. It is caused by infection with the hepatitis B virus. It is usually transmitted by injection (parenterally). Transfusion of contaminated blood or blood products to hospitalized patients is a typical source of the disorder. Sharing contaminated hypodermic needles by drug abusers often spreads the disease. An increased risk to patients and personnel working in renal dialysis units has also been identified.

The infection can also be spread through sexual activity. The infection can be passed from a mother to a baby during pregnancy or through breastfeeding. In rare cases, sharing a toothbrush or razor with an affected individual may lead to the development of hepatitis B.

In many cases the source of infection with hepatitis B virus is unknown.

Affected Populations

Hepatitis B virus is the second-leading sexually transmitted disease in the United States. More than one million Americans are chronic carriers of the virus. More than 300,000 new cases of hepatitis B infection occur in the United States each year. While sixty-five percent of the cases of hepatitis B are reported in the twenty to thirty-nine year age group, the male-to- female ratio remains 2:1. Hepatitis B affects approximately 350 million individuals worldwide.

High rates of hepatitis B have been found in South East Asia, sub-Saharan, Africa and parts of South America. The World Health Organization (WHO) estimates that over two billion individuals worldwide have been affected by acute hepatitis B. It is further estimated that 350 million of those individuals are chronic carriers of the virus. It is believed that over one million children are born with hepatitis B. Approximately four million cases of acute hepatitis B are recorded to the WHO every year.

Related Disorders

There are three major types of hepatitis: hepatitis A, hepatitis B, and Non- A, Non-B hepatitis (hepatitis C).

Hepatitis A virus infection is the most common form of hepatitis. It is spread primarily through fecal-oral contact, although improperly cooked contaminated shell fish, blood infusion or possibly sexual activity may spread the infection. Water and food-borne epidemics of hepatitis A are common, especially in underdeveloped countries. Symptoms are much the same as hepatitis B infection (influenza-like symptoms, nausea, vomiting, weakness, yellow skin discoloration or jaundice). Hepatitis A seems to be remarkably widespread in some countries where over three-fourths of the adult population appears to have been exposed. Hepatitis A virus can quickly spread through institutions and day care facilities where personal hygiene is less than adequate, particularly when mentally disabled individuals may not regularly wash their hands after using toilet facilities.

Non-A, Non-B hepatitis (hepatitis C) virus infection is a little known infectious agent which can cause liver disease. Increasing evidence points to at least two separate viruses. In general, symptoms of this disease appear similar to hepatitis B. It is usually spread through blood transfusions.

Neonatal hepatitis is a disorder in which the bile ducts inside the liver are closed and liver cells are of varied size; some are giant cells with multiple nuclei. Infants of both sexes may be affected by this form of hepatitis.

Anicteric hepatitis is an acute viral form of hepatitis which usually causes minor flu-like symptoms without jaundice. This type of hepatitis may be far more prevalent than other types of Hepatitis, but the diagnosis is usually overlooked.

Recrudescent hepatitis is a recurrent form of acute viral hepatitis that occurs in a minority of patients during their recovery phase from other hepatitis infections. The outlook remains good and chronic hepatitis rarely follows.

The symptoms of cholestatic hepatitis may include jaundice, elevated alkaline phosphatase, and itching (pruritis). Complete recovery is usual with this form of acute viral hepatitis.

Fulminant hepatitis is a rare acute viral hepatitis usually seen in intravenous drug abusers. Rapid physical deterioration with the onset of liver degeneration may be initial symptoms. There is massive liver cell death, and a decrease in liver size ("acute yellow atrophy"). Bleeding is common, resulting from functional liver (parenchymal) failure, and widely distributed blood vessel clotting (disseminated intravascular coagulation). Kidney failure may also develop. Massive doses of corticosteroids or exchange transfusions have not proven to be effective treatment. Patients may recover completely with no permanent liver damage in some cases, but the majority of cases become very serious with little hope of full recovery. Fulminant hepatitis may also be caused by excessive use of the sustained- release form of the vitamin, niacin. Use of this form of the vitamin is usually very well tolerated but on occasion may cause liver toxicity.

Bridging necrosis is an uncommon variant of acute viral hepatitis. This variation may be indistinguishable from ordinary viral hepatitis, but differs through a slow rather than sudden onset. Fluid retention or mild degenerative brain disease (encephalopathy) usually develops. Most patients with bridging necrosis do recover fully, although chronic active hepatitis may occur in this subgroup of patients.

Chronic hepatitis is a group of disorders that merge into acute hepatitis or liver disease (cirrhosis). Most of these cases can be classified into chronic persistent or chronic active forms. The chronic persistent is usually a mild form of hepatitis which may persist for years. Eventual recovery usually will occur. The chronic active (aggressive) form of hepatitis may result in liver failure and/or cirrhosis. It is regarded as a group of closely related conditions rather than a single disease. With adequate therapy, patients usually live several years, although liver diseases eventually develop in most cases.

Delta hepatitis, a longstanding infection seen in patients in the Los Angeles area, has caused fulminant hepatitis and progressive liver disease in both intravenous drug users and male homosexuals.

Hepatitis which is induced by long-term alcoholism is marked by abdominal swelling, distress, (anorexia) loss of appetite, nausea with or without vomiting, weight loss, and a general feeling of discomfort. Other symptoms of hepatitis usually occur including jaundice and weakness. Abstinence from alcohol will usually bring about great improvement with liver function possibly returning to normal. With continued drinking, the hepatitis may evolve into serious liver disease (cirrhosis).

Toxic, drug, or chemically induced hepatitis may be caused by inhalation, ingestion, or skin-penetration of chemical agents or industrial toxins such as carbon tetrachloride, yellow phosphorus, toxic cyclic peptides of mushroom "Amanita Phallorides" or drugs used in medical therapy. Typical symptoms of this form of hepatitis may include anorexia, nausea, vomiting and/or diarrhea. Timely withdrawal of the substance causing it is important in treating this disorder. If left untreated, this form of hepatitis could cause serious liver damage.

Standard Therapies

Diagnosis
Individuals affected by hepatitis B may not show symptoms until six weeks to six months after exposure to the virus. A diagnosis may be suspected, based upon a thorough clinical evaluation, a detailed patient history, and identification of characteristic symptoms. A diagnosis may be confirmed through blood tests.

Treatment
The best treatment of hepatitis B infection is prevention.

The Food and Drug Administration (FDA) has approved the anti-viral drug adefovir dipivoxil (Hepsera) for the treatment of Hepatitis B. This pharmaceutical is manufactured by:

Gilead Sciences
333 Lakeside Drive
Foster City, CA 94404
Phone: (650) 574-3000
Fax: (650) 578-9264
Toll Free: 1-800-GILEAD-5

The first genetically engineered hepatitis vaccine was approved by the FDA during the mid-1980s. The new vaccine, called Recombivax HB (like the less effective plasma-derived vaccine developed in 1981), is produced by Merck, Sharp & Dohme, West Point, PA.

The FDA urges that the new vaccine be used by individuals who are at high risk of becoming infected with hepatitis B, including dental and medical workers, homosexuals, drug users, and personnel who work with mentally disabled individuals in institutional or day care settings.

Because the vaccine can be given to newborns, passage of hepatitis from infected mothers to their offspring can be prevented. Pregnant women from high-risk groups can be tested to determine if they are carriers. Then their infants can be protected by early vaccination. Three injections are recommended for high-risk individuals, including infants of infected mothers.

The FDA has also approved the antiviral agent lamivudine (Epivir-HBV) for the treatment of adults with infection with the hepatitis B virus. Lamivudine appears to be an inhibitor of the hepatitis B virus (HBV). During clinical trials, the drug was well tolerated by affected individuals. However, research suggested that, in some cases, treatment of individuals with hepatitis B with lamivudine led to the hepatitis B virus developing a resistance to the drug. Researchers suggested using lamivudine in conjunction with other drugs, such as famciclovir. However, clinical trials investigating the safety and effectiveness of these drugs for hepatitis B are still ongoing. The drug is manufactured by GlaxoWellcome.

An appropriate formulation of the new vaccine for kidney patients on dialysis is not yet available.

In March of 2005, the FDA approved the use of entecavir (Baraclude) for the treatment of chronic hepatitis B in adults. Entecavir slows the progression of the disorder by interfering with viral reproduction. For more information on this drug, contact:

Bristol-Myers Squibb
345 Park Avenue
New York, New York, USA 10154-0037
212-546-4000
www.bms.com

Other treatment of hepatitis B is symptomatic and supportive. There are no effective antibiotics to treat hepatitis, but Schering-Plough's Intron A (Interferon-alpha 2a-2b) has been shown to be a safe and effective treatment for hepatitis B and C (Non-A, Non-B). In general, extended rest and a light diet seem to be of benefit. Avoiding alcohol is also recommended for individuals with hepatitis B.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com.

Scientists are studying all forms of hepatitis to learn how it can better be prevented, diagnosed, and treated. A new drug, thymosin alpha-1 or thymalfasin (Zadaxin), is being developed by SciClone Pharmaceuticals, Inc. for the treatment of chronic active hepatitis B. Initial studies have demonstrated that the drug produces a sustained response in individuals with the immune tolerant phase of the disease. The drug is currently in phase III clinical trials in the United States.

Sandoz Pharmaceuticals Corp., 59 Route 10, East Hanover, NJ, 07936, has developed a new biologic to help prevent hepatitis B reinfection of individuals who are receiving liver transplants as a result of end-stage liver damage from chronic hepatitis B infection. The biologic is human monoclonal antibody against hepatitis B virus.

The National Institutes of Health is conducting a study to determine the effect of the use of interferon and famiclovir in combination as a treatment for hepatitis B. They are also conducting a study to determine the effect of lamivudine for the treatment of hepatitis B. More studies are needed to determine the long-term safety and effectiveness of these treatments. Individuals who are interested in participating in this study should contact:

Robin McKenzie
Liver Diseases Section
NIH/National Institute of Allergy and Infectious Diseases
Building 10 Room 11N222
9000 Rockville Pike
Bethesda, MD 20892
(301) 496-1721

Researchers are studying the anti-viral drug tenofovir (Viread) for the treatment of hepatitis B. Initial studies show that tenofovir is effective in treating individuals with hepatitis B. One current study seeks to determine the effectiveness of tenofovir versus adefovir for the treatment of HBeAg negative chronic hepatitis B. More research is necessary to determine the long-term safety and effectiveness of this drug for individuals with hepatitis B. For more information, contact:

Gilead Sciences
333 Lakeside Drive
Foster City, CA 94404
Phone: (650) 574-3000
Fax: (650) 578-9264
Toll Free: 1-800-GILEAD-5

Organizations related to Hepatitis B

References

JOURNAL ARTICLES
Schildgen O, sirma H, Funk A, et al., Variant of hepatitis B virus with primary resistance to adefovir. N Engl J Med. 2006;354:1807-12.

Tanikawa K. Recent advances in antiviral agents: antiviral drug discovery for hepatitis viruses. Curr Pharm Des. 2006;12:1371-7.

Dienstag JL. Looking to the future: new agents for chronic hepatitis B. Am J Gastroenterol. 2006;101:S19-25.

Zoulin F. Entecavir: a new treatment option for chronic hepatitis B. J Clin Virol. 2006;36:8-12.

Rivkina A, Rybalov S. Chronic hepatitis B: current and future treatment options. Pharmacotherapy. 2002;22:721-37.

Pramoolsinsup C. Management of viral hepatitis. B J Gastroenterol Hepatol. 2002;17 Suppl 1:125-45.

Rizzetto M, Lagget M. Hepatitis B: therapeutic perspectives. Forum (Genova). 2001;11:137-50.

Reshef R, et al. Lamivudine in the treatment of acute hepatitis B. N Engl J Med. 2000;343:1123-24.

Mutimer D, et al. Selection of multiresistant hepatitis B virus during sequential nucleoside-analogue therapy. J Infect Dis. 2000;181:713-16.

Mutimer D, et al. Hepatitis B virus antiviral drug resistance: from the laboratory to the patient. Antivir Ther. 1998;3:243-46.

Lai C, et al. A one-year trial of lamivudine for chronic hepatitis B. N Engl J Med. 1998;339:61-68.

Omata M. Treatment of chronic hepatitis B infection. N Engl J Med. 1998;339:114-15.

Hoofnagle JH, et al. The treatment of chronic viral hepatitis. N Engl J Med. 1997;336:347-56.

Lee WM, et al. Hepatitis B virus infection. N Engl J Med. 1997;337:1733-45.

Niederau C, et al. Long-term follow-up of HBeAg-positive patients treated with interferon alfa for chronic hepatitis B. N Engl J Med. 1996;344:1422-27.

Dienstag JL. A preliminary trial of lamivudine for chronic hepatitis B infection. N Engl J Med. 1995;333:1657-61.

Dooley S, et al. Pilot study of recombinant human alpha-interferon for chronic type B hepatitis. Gastroenterology. 1986;90:150-57.

Report last updated: 2008/04/05 00:00:00 GMT+0