Hepatitis B: Symptoms, Causes & Treatment

Hepatitis B (HBV infection) is a viral infection that attacks the liver and can be acute or chronic. The virus spreads through contact with blood and body fluids, particularly via unprotected sexual contact, contaminated needles, blood transfusions, or from infected mother to child during childbirth.

Globally, approximately 296 million people have chronic hepatitis B, causing around 820,000 deaths annually. In the Middle East and North Africa region, including Jordan, the prevalence is moderate, ranging from 2-7% depending on the area. Most infected adults recover spontaneously within six months, but 5-10% develop chronic infection, which may progress to cirrhosis or hepatocellular carcinoma (HCC) if untreated.

Vaccination against hepatitis B provides effective protection of 95% or higher and is part of national immunization programs in most countries, including Jordan. For those with chronic infection, antiviral medications such as entecavir and tenofovir provide viral control and reduce disease progression risk.

Some infected individuals may experience no symptoms initially (especially children), but when symptoms appear, they typically develop 6-8 weeks after exposure. Symptoms may be mild or severe and vary depending on age and personal immunity. Children who contract the infection may show no symptoms, while adults typically develop more noticeable symptoms.

• Jaundice: Yellowing of skin and eyes due to bilirubin accumulation.
• Abdominal pain: Especially in the upper right abdomen where the liver is located.
• Fatigue and weakness: Feeling of exhaustion and severe tiredness.
• Fever: Elevated body temperature.
• Loss of appetite: Lack of desire to eat.
• Nausea and vomiting: Especially in early morning.
• Joint and muscle pain: General body aches.
• Dark urine: Urine color changes to dark or brown.
• Pale stools: Stool color changes to white or pale.
• Rash: Skin rash may appear in some cases.

• Mother-to-child transmission: Infection spreads from infected pregnant women to the fetus during pregnancy or childbirth, especially when the mother has high viral loads. This is the primary cause of chronic infection in children.
• Unprotected sexual contact: The virus transmits through body fluids during unprotected sex, particularly when genital sores or wounds are present.
• Contaminated needle use: Sharing injection equipment for illegal drugs or exposure to non-sterile needles in unreliable medical clinics.
• Transfusion of contaminated blood: May occur when receiving blood products that are unscreened or improperly processed.
• Unsafe medical procedures: Use of non-sterile instruments in dentistry, tattooing, body piercing, or shaving.
• Occupational exposure: Healthcare workers may be exposed when handling blood from infected patients.
• Accidents and injuries: Contact with infected blood through open wounds or cracked skin.

• Lack of vaccination: Unvaccinated individuals are at higher risk, especially healthcare workers or those with high-risk sexual practices.
• High-risk sexual practices: Multiple sexual partners, anal intercourse, or inconsistent condom use.
• Drug use: Injection drug use and needle sharing.
• Healthcare workers: Repeated exposure to patient blood.
• Service industry workers: Barbers, tattoo artists, and body piercers in unlicensed facilities.
• Prisoners: Higher rates of drug use and unsafe sexual practices.
• Household contacts with infected persons: Potential exposure through shared razors or toothbrushes.
• HIV-positive individuals: Immunocompromised status increases infection severity risk.
• Travelers and migrants: Those visiting high-prevalence areas without vaccination.

Hepatitis B is diagnosed through specialized blood tests that detect the virus or its antibodies. The doctor may also request liver function tests to assess liver health. In some cases, ultrasound or advanced imaging may be performed.

• HBsAg test (Hepatitis B surface antigen): The primary test detecting virus presence. A positive result indicates current infection (acute or chronic).
• Anti-HBc test (Hepatitis B core antibody): Indicates past or current virus exposure.
• HBeAg and anti-HBe tests: Measure viral activity and infectivity potential.
• HBV DNA test (Viral deoxyribonucleic acid): Quantifies viral load in blood. Normal values are less than 20 copies/mL; elevated values indicate active infection.
• Liver function tests: Include ALT, AST, bilirubin, and albumin analysis. Elevated ALT and AST levels suggest liver inflammation (normal value less than 40 units/liter).
• Cirrhosis assessment: FibroScan (transient elastography) may be performed to measure liver fibrosis degree non-invasively.

Medications

• Entecavir: An antiviral drug, one of the most effective and safe options. Taken orally once daily, it significantly reduces viral load. Used for chronic infection.
• Tenofovir: Another highly effective antiviral, taken orally once daily. Used for chronic infection and drug-resistant cases.
• Lamivudine: A relatively older drug, sometimes used alone or with other medications, but has a higher resistance development rate.
• Interferon-alpha: An injected drug that stimulates the immune system. Used in some cases, especially for non-responders to oral medications or those with cirrhosis.
• Acute infection only: Acute infections may not require medication, only supportive care and monitoring, as most adults recover spontaneously.

Procedures

• Regular monitoring: Periodic blood tests to monitor viral load and liver function.
• Ultrasound imaging: To detect signs of cirrhosis or liver cancer in chronic infection cases.
• Liver biopsy: Rarely performed to assess inflammation and fibrosis degree (now often replaced by non-invasive methods).
• Liver transplantation: In advanced cirrhosis or acute liver failure cases.

Lifestyle Changes

• Avoid alcohol: Alcohol accelerates cirrhosis development significantly; complete avoidance is recommended.
• Rest and sleep: Get adequate sleep to help your body recover.
• Healthy diet: Eat balanced meals rich in vitamins and proteins; avoid fatty and fried foods.
• Hydration: Drink sufficient water to maintain body hydration.
• Gentle exercise: Practice light activities like walking but avoid strenuous sports.
• Protection from secondary infection: Vaccinate against hepatitis A, as dual infection increases disease severity.

• Chronic Hepatitis: Occurs in 5-10% of infected adults, where the virus persists in the liver for more than 6 months. May lead to cirrhosis over time.
• Cirrhosis: Liver scarring from chronic inflammation, leading to liver function failure. Risk increases with alcohol consumption.
• Hepatocellular Carcinoma (HCC): May develop in 1-5% of chronically infected individuals, especially if untreated. Considered a serious malignancy.
• Acute Liver Failure: May occur weeks after acute infection onset, especially in elderly patients, requiring emergency hospitalization.
• Co-infection: Dual infection with other viruses like C or D significantly increases disease severity.
• Renal Failure: May occur as a rare complication in advanced cases.
• Hepatic Encephalopathy: A rare but very serious complication occurring with advanced liver failure, causing mental confusion and coma.

• Hepatitis B vaccination: The primary and most effective prevention method. Usually given in 3 doses (at birth or during childhood, and for unvaccinated adults). Protection typically lasts a lifetime.
• Condom use: Use condoms correctly and consistently during sexual contact.
• Avoid sharing personal items: Do not share toothbrushes, razors, or nail clippers with others, even if they show no symptoms.
• Sterile needle use: Avoid non-sterile needles in unreliable clinics or for drug use.
• Choose reliable medical centers: Ensure using licensed and reliable clinics and hospitals for any medical or dental procedure.
• Donor screening: Ensure blood and organ donors are tested.
• Partner education: If infected, inform sexual partners and encourage vaccination.
• Workplace precautions: Healthcare workers must strictly follow safety protocols, including glove and mask use.