Hepatitis B: symptoms, causes and treatment of HBV

By Cristiano Antonino On May 4, 2023

Hepatitis B is an infection of the liver caused, as its name suggests, by the hepatitis B virus, HBV

It is less common than in the past, but should by no means be underestimated because it is potentially life-threatening: it can cause chronic infections and increase the risk of cirrhosis and liver cancer.

Even today, it still represents a serious global health problem.

The good news is that a safe and effective vaccine is available that offers 98% to 100% protection against hepatitis B.

HBV, what it is

Hepatitis B is an inflammation and infection of liver cells, caused by the B virus (HBV – Hepatitis B Virus).

It is one of the most infectious viruses in the world, so much so that it is significantly more contagious (50-100 times) than HCV (the virus that triggers hepatitis C) and HIV.

According to data from the World Health Organisation (WHO), the disease is most prevalent in the Western Pacific and African regions, where 116 million and 81 million people, respectively, are chronically infected.

In third place in this particular ranking is the Eastern Mediterranean region, with 60 million infected. In Europe, an estimated 14 million people are infected.

Hepatitis B symptoms

Initially, HBV usually causes an acute form, which in most cases is asymptomatic or manifests itself with mild, uncharacteristic symptoms, such as fatigue, joint pain, abdominal pain.

Only a small percentage of people experience symptoms lasting several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme tiredness, nausea, vomiting and abdominal pain.

Typically, these complaints develop two to six months after infection.

In more than 90-95% of healthy adults with a functioning immune system, the HBV virus is spontaneously eliminated from the body within about six months.

The remaining approximately 10% of infected persons are unable to completely eradicate the virus and thus undergo chronic infection.

Chronic infection occurs most frequently when acquired in infancy (90% of cases) or childhood (50% of cases).

People with hepatitis B can also contract the Delta virus (HDV), a so-called ‘defective’ virus as it needs the simultaneous presence of the B virus in order to reproduce.

Transmission occurs mainly through contact with infected blood.

Chronic hepatitis B

Chronic hepatitis B is not necessarily dangerous.

Sometimes, chronic infection is characterised by low virus replication and does not lead to liver damage.

In this case, one speaks of inactive HBV infection: in practice, the person is a ‘healthy carrier’ and does not require antiviral treatment.

The disease only needs to be monitored over time, through regular blood tests to ensure that the liver is not suffering, that transaminases are normal and that virus replication remains low.

However, the situation is not always so rosy.

In some cases, the chronic form is dangerous because liver tests, in particular transaminases, are elevated, virus levels in the blood are high and inflammation (hepatitis) with histological lesions develops in the liver.

In these situations, acute liver failure can develop, a serious problem that can even lead to death.

Long-term complications of HBV infections include advanced liver disease such as cirrhosis and hepatocellular carcinoma, which cause high morbidity and mortality.

Hepatitis B transmission

In highly endemic areas, hepatitis B is most commonly transmitted from mother to child at birth (perinatal transmission) or by horizontal transmission, i.e. through exposure to infected blood, particularly from an infected child to an uninfected child during the first five years of life.

The development of chronic infection is common in both mother-infected children and children under five years of age.

Hepatitis B is also transmitted through needle injuries, tattoos, piercings and exposure to infected blood and body fluids, such as saliva and menstrual, vaginal and seminal fluids.

Virus transmission can also occur through the re-use of contaminated needles and syringes or sharp objects, including in healthcare settings.

Sexual transmission is more common in unvaccinated persons who have multiple sexual partners

As mentioned, hepatitis B infection acquired in adulthood leads to chronic hepatitis in less than 5% of cases, while infection in childhood leads to chronic hepatitis in about 95% of cases.

This is why it is essential to vaccinate infants and children.

The hepatitis B virus can survive outside the body for at least seven days.

During this period, the virus can cause infection if it enters the body of a person not protected by the vaccine.

The incubation period of the hepatitis B virus varies from 30 to 180 days.

The virus can be detected within 30-60 days of infection.

Risk factors

People who are at greatest risk of contracting hepatitis B, and who should therefore undergo screening, are those who

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have promiscuous sex without using a condom;
share razors and toothbrushes;
have a history of sexually transmitted infections;
exchange or have exchanged infected syringes;
live with HBV-infected individuals;
were born to HBV-infected mothers;
have HBV-infected persons as sexual partners;
are undergoing haemodialysis;
require transfusions;
travel in areas with high HBV endemicity;
are detained in prevention and punishment institutes;
work in healthcare settings in contact with infected blood or material;
have been exposed to blood or body secretions in the workplace (emergency workers, firefighters, undertakers, embalmers are at risk).

Hepatitis B treatment

There is no specific treatment for acute hepatitis B: it is advisable to rest as much as possible; drink a lot, so as to supplement any liquids lost due to vomiting and diarrhoea; follow a light diet, low in fat.

It is also essential to avoid unnecessary medication, including acetaminophen, paracetamol and drugs against vomiting, as the liver’s metabolic capacity is reduced during acute hepatitis.

No specific therapy exists for the inactive form either: only in cases of reactivation will the doctor consider antiviral therapy.

In this case, however, the situation must be monitored over time to see how it develops.

Chronic hepatitis B infection can be treated pharmacologically, in particular with orally administered antiviral agents (entecavir, tenofovir), which reduce HBV viremia to zero and prevent disease progression, thereby reducing the risk of cirrhosis and the risk of hepatocarcinoma.

Most people who begin treatment for chronic hepatitis B must continue it for life.

Hepatitis B vaccine

Hepatitis is preventable by means of a specific vaccine, which in Italy is given to children in three doses: usually at the third, fifth and eleventh month of life.

The vaccine currently in use has proven to be safe and effective and provides long-lasting immunity (probably for life).

In addition to childhood vaccination, WHO recommends the use of antiviral prophylaxis in pregnant women to prevent mother-to-child transmission of hepatitis B.

Other prevention rules

To reduce the risk of being infected with the hepatitis B virus, it is good to

avoid sexual intercourse with high-risk persons or casual partners. On such occasions, always use a condom;
use only your own toothbrush;
use only razor blades or disposable razors for shaving;
do not exchange syringes;
avoid, as far as possible, contact with blood of unknown or high-risk persons.

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