HEPATITIS B

I. INTRODUCTION
o The liver is such an important organ that we can survive only one or two days if it
completely shuts down - if the liver fails, your body will fail, too.
o Hepatitis B is the most common serious liver infection in the world. It is caused by
the hepatitis B virus that attacks and injures the liver. 
o Hepatitis B is a “silent epidemic” because most people do not have symptoms
when they are newly infected or chronically infected. Thus, they can unknowingly
spread the virus to others and continue the silent spread of hepatitis B. For people
who are chronically infected but don’t have any symptoms, their liver is still being
silently damaged which can develop into serious liver disease such as cirrhosis or
liver cancer.
o The virus is most commonly transmitted from mother to child during birth and
delivery, as well as through contact with blood or other body fluids.
o Hepatitis B can be prevented by vaccines that are safe, available and effective.

II. DEFINITION OF TERMS

HEPATITIS

 Hepato (liver) + itis (inflammation)= Hepatitis

 Inflammation of the tissue of the liver.
 Most common cause of this disease is by viral infection, however, the disease can
also occur secondary to heavy alcohol intake, certain medications, toxins, and other
infectious diseases.

HEPATITIS B

 An inflammation of the liver caused by the hepatitis B virus (HBV).

 Most serious type of viral hepatitis.
 The virus can cause both acute and chronic infection.
Acute – it lasts less than 6 months.  It is a short-term illness that can lead to
chronic infection.
Chronic – if it lasts more than six months.  It is a “silent” disease because often no
symptoms appear until your liver is severely damaged.
  A potentially life-threatening liver infection. It can cause scarring of the organ,
liver failure, and cancer. It can be fatal if it isn’t treated.
 III. How can one get Hepatitis B? 
Hepatitis B is spread thru blood, semen, or other body fluids with the hepatitis B virus. A
person may acquire the infection thru the following activities:

 Birth (spread from a hepatitis B positive mother to her baby)

 Sex with an infected partner
 Sharing needles, syringes, or other drug-injection equipment with an infected person
 Direct contact with the blood or open wounds of an infected person
 Exposure to blood from needle sticks or other sharp instruments
 Sharing razors, nail clippers/manicure or pedicure paraphernalia or toothbrushes with
an infected person

Who are considered to be at risk for hepatitis B infection? 

Since the Philippines is considered a hyper endemic area for hepatitis B, almost everyone without
the antibody or vaccine can become infected. Some people, however are at greater risk, such as
the following:

 Infants born to infected mothers

 People who have sex with an infected partner
 People who have multiple sex partners
 People who have a sexually transmitted disease
 Men who have sexual contact with other men
 People who inject drugs or share needles, syringes, or other drug equipment
 People who live in the household of one with chronic Hepatitis B
 Those who work in occupations where they may be exposed to blood and infected
body fluid

IV. HEPATITIS B VIRUS

The hepatitis B virus is a small DNA virus that belongs to the “Hepadnaviridae” family.
Structure of the Hepatitis B Virus
The hepatitis B virus contains an outer envelope and an inner core.

 The outer envelope of the virus is composed of a surface protein called the hepatitis B
surface antigen or "HBsAg". The HBsAg can be detected by a simple blood test and a
positive test result indicates a person is infected with the hepatitis B virus.
 The inner core of the virus is a protein shell referred to as the hepatitis B core antigen or
"HBcAg," which contains the hepatitis B virus DNA and enzymes used in viral replication.

Life Cycle of the Hepatitis B Virus

 During the first stage of infection, the HBV virion (virus particle) attaches to a liver cell
and is transported into the nucleus of the liver cell.
 Once inside the nucleus, the viral DNA is transformed into a covalently closed circular
DNA (cccDNA), which serves as a template for viral replication (creation of new hepatitis
B virus).
 The virus makes copies of itself in a process that lacks “proof reading ability” which
allows the virus to mutate.
 The newly formed HBV virions are released into the bloodstream from where they
invade other hepatocytes and repeat the replication process.
 It is thought that HBV causes inflammation and progressive fibrosis in the infected liver
by triggering the immune system to attack the hepatocytes.
V. PATHOPHYSIOLOGY

VI. EPIDEMIOLOGY

 Hepatitis B is a major public health problem in the Philippines.

 An estimated 7.3 million adult Filipinos (16.7% of the adult population) are
chronically infected with the hepatitis B virus (HBV) making our country
hyperenedemic for hepatitis B. This rate is extremely high in comparison to other
countries and is more than double the 8% average prevalence of HBV infection in
the Western Pacific region.
VII. CLINICAL MANIFESTATION

ACUTE HEPATITIS B
 When a person is first infected with the hepatitis B virus, it is called an " acute
infection" (or a new infection). 
 may last up to six months (with or without symptoms) and infected persons are
able to pass the virus to others during this time. 
 More severe than HAV.
 Although most people do not experience symptoms, they can appear 60-150
days after infection, with the average being 90 days or 3 months. 

CHRONIC HEPATITIS B
 greater than 6 months
 It lingers because your immune system can't fight off the infection. It still
remains in the blood and liver.
 Chronic hepatitis B infection may last a lifetime, possibly leading to serious
illnesses such as cirrhosis and liver cancer.

 The risk of developing a chronic hepatitis B infection is also directly related to

the age at which one first becomes exposed to the hepatitis B virus:
 90% of infected newborns and babies will develop a chronic hepatitis B
infection
 Up to 50% of infected children (1-5 years) will develop a chronic
hepatitis B infection
 5-10% of infected adults will develop a chronic hepatitis B infection
 Complications
Having a chronic HBV infection can lead to serious complications, such as:
 Scarring of the liver (cirrhosis). The inflammation associated with a hepatitis B
infection can lead to extensive liver scarring (cirrhosis), which may impair the
liver's ability to function.
 Liver cancer. People with chronic hepatitis B infection have an increased risk of
liver cancer.
 Liver failure. Acute liver failure is a condition in which the vital functions of the
liver shut down. When that occurs, a liver transplant is necessary to sustain life.

VIII. SIGNS AND SYMPTOMS

Sign and symptoms usually appear about one to four months after one has been
infected, although one may experience them as early as two weeks post-infection.
Not everyone develop symptoms after infected by HBV.
 Sudden nausea and vomiting
 Abdominal pain or discomfort, especially on the upper right side beneath the
lower ribs (by the liver)
 Clay-colored bowel stools and dark urine
 Loss of appetite and fatigue
 Low-grade fever and joint pain
 Yellowing of the skin and the whites of the eyes (Jaundice)
 Intense itching

IX. DIAGNOSIS

 Liver ultrasound. A special ultrasound called transient elastography can show the
amount of liver damage.
 Liver biopsy. Your doctor might remove a small sample of your liver for testing (liver
biopsy) to check for liver damage. During this test, your doctor inserts a thin needle
through your skin and into your liver and removes a tissue sample for laboratory
analysis.

 Laboratory evaluation of Hepatitis B disease generally consists of liver enzyme test.

These include the levels of:
  Alanine aminotransferase (ALT)
- When liver cells are damaged, they release ALT into the bloodstream.
- High levels of ALT in the blood can indicate a liver problem, even
before you have signs of liver disease
- Also called SGPT (Serum Glutamic-Pyruvic Transaminase)
 Aspartate aminotransferase (AST)
- an enzyme that is found mostly in the liver, but also in muscles.
- When your liver is damaged, it releases AST into your bloodstream. 
- When your liver is damaged, it puts more AST into your blood, and
your levels rise.
- A high AST level is a sign of liver damage, but it can also mean you
have damage to another organ that makes it, like your heart or kidneys.
- Also called SGOT (serum glutamic-oxaloacetic transaminase).

There are many different blood tests that your doctor can order to diagnose hepatitis B. They
can be ordered as a single test or as a battery of tests. Below are some of the common tests and
what they usually mean. It is important that you ask your doctor on the proper interpretation of
your test results.

TESTS INTERPRETATION

Hepatitis B Surface Antigen- POSITIVE- A person may have acute or chronic

It is a protein on the surface of the Hepatitis B Hepatitis B infection and may transmit the
Virus. It can be detected in the blood of those disease to others
who carry the virus. NEGATIVE- A person does not have Hepatitis B in
his or her blood

AntiHBs- POSITIVE
Protective antibody to the Hepatitis B Virus
 person has received successful
vaccination against Hepatitis B
 Person has recovered from Hepatitis B
infection and is protected from future
infection

AntiHBc IgM- (IgM Antibody to Hepatitis B Core POSITIVE 

Antigen) This may mean that a person was infected with
Hepatitis B within the past 6 months

AntiHBcIgG- (IgG Antibody to Hepatitis B Core POSITIVE 

Antigen) This may indicate exposure to the Hepatitis B
virus and that a patient either has chronic
Hepatitis B, or recovered from Hepatitis B
  HBeAg POSITIVE
This may indicate high levels of the Hepatitis B
Virus in the blood, which can mean that a person
can more easily spread the virus to others

HBV DNA Indicates the levels of virus in the blood. This test
is used to determine the need for treatment of
Hepatitis B with drugs as well as the effectiveness
of drug treatment.

Note: A positive or negative test for any of the markers above (except HBVDNA) is reported as
REACTIVE or NON-REACTIVE, respectively in most reports from different laboratories.