What is Chronic Hepatitis B? Symptoms and Treatment

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Hepatitis B virus (HBV) is one of the most common infectious microorganisms. It is estimated that 400 million people in the world have HBV infection and more than 750,000 people die annually due to complications related to HBV infection.

Chronic HBV infection not only causes chronic liver failure and cirrhosis, but also increases the risk of developing liver cancer (HCC- Hepatocellular carcinoma) 100 times. For this reason, early diagnosis and treatment of the disease are important.

HBV is 100 times more contagious than HIV (Human Immuno Deficiency Virus), which causes AIDS (Acquired Immuno Deficiency Syndrome) in humans. Hepatitis B Although it is common in the world, the frequency of HBV virus carrier varies according to regions;

There are 4 serotypes (adr, adw, ayr and ayw) determined according to the antigenic structure of the surface antigen (HBsAg) of the Hepatitis Bvirus and 8 genotypes (A-H) determined according to the nucleotide structure.

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How HBV Is Transmitted and How Can It Be Prevented?

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HBV is transmitted through the blood and body fluids of people infected with this virus. HBV can survive for 7-10 days in dry environments outside the human body. The mode of transmission varies by region.

For example, in parts of China, Southeast Asia, the Middle East and Africa, and South America, transmission is mostly mother-to-child transmission (Vertical transmission), while in parts of Western Europe, North America, Australia and South America, parenteral transmission (contaminated needle and other medical injections and other interventions with materials, blood transfusion, unprotected sexual intercourse, etc.) transmission is more common (Horizontal transmission).

Since HBV is a highly contagious virus, some special precautions must be taken to prevent its spread. The vaccine developed against HBV is still in use and provides lifetime protection if repeated at regular intervals.

Vaccination of infants, children and unvaccinated youth and people in the above-mentioned risk group is an appropriate approach. Today, Hepatitis B vaccine is routinely administered to newborns.

Unvaccinated people who have encountered HBV can be injected with hepatitis B immune globulin within the first two weeks (passive immunization). This application provides protection that can last up to 3-6 months. Pregnant women should have the necessary tests for HBV before delivery.

In order to prevent transmission and spread, people infected with HBV should maintain a safe sex life (like using a condom), not donate blood, organs, sperm, eggs, and should not share their belongings such as toothbrushes and shaving razors in their daily lives.

Plates, spoons, forks, etc. It is unnecessary to use the items separately, provided that they are well cleaned. Practically, 1/10 diluted bleach can be used for cleaning surfaces and materials that are thought to be contaminated with HBV.

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Course of HBV Infection

After HBV enters the body by any means, it reaches the liver, settles there and begins to multiply in the liver cells. The body’s response to HBV varies according to the age at which the virus was acquired. Symptoms of the disease in adults usually appear 2-6 months after exposure to the virus.

In 60% of adults infected with HBV, the disease is silent without causing symptoms or is usually passed as a mild flu-like infection or a period of fatigue and weakness. In another part of the patients, it may manifest itself as a disease that lasts for 1-2 weeks, may require bed rest and progress with jaundice.

During this time, liver enzymes (AST / ALT) are found to be high. The signs of the disease are less pronounced in children than in adults, and there are almost never any symptoms in infancy. In a very small part of the patients (1%), the disease may occur as a serious picture called fulminant hepatitis and 80% of these patients die.

In most of the adults (90-95%) infected with HBV, recovery is achieved by clearing the virus from the body thanks to the immune system, and the rate of chronicity in adults is around 5-10%. In the majority of patients with chronic hepatitis B, the disease is silent and there is no previous history of jaundice. Despite this, the disease becomes chronic in the majority of patients (90% and 10-30%, respectively) after HBV removal in newborns and childhood (<5 years).

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Chronic Hepatitis B

Chronic HBV infection is mentioned when HBV is not cleared from the body within 6 months in people infected with HBV. Mostly, at this stage, the disease is silent and almost all of the patients pass into this period without being aware of it.

When liver damage increases and liver functions begin to deteriorate, symptoms such as weakness, joint and muscle pain, nausea, yellowing of the whites of the eyes and skin, swelling in the feet and abdomen occur, it is understood that they are infected with HBV as a result of a blood test performed for another reason.

Chronic HBV infection may progress with different clinical pictures such as asymptomatic HBV carrier, chronic active hepatitis that may end with liver cirrhosis, or development of liver cancer. In 15-25% of patients with chronic liver disease, the cause of death is hepatitis B virus related liver diseases (See, liver cirrhosis).

hepatit bHBV When it enters the body and settles in the liver, it does not directly cause damage to the liver. As a result of the body’s immune response to the virus (the immune system’s response to the virus), liver cells are damaged. As the virus multiplies inside the liver cell, more immune response occurs, which means more liver cells are damaged.

Over time, connective tissue begins to form in place of damaged cells (fibrosis), and liver cirrhosis is the result of widespread connective tissue formation in the liver. Active replication of the virus in the liver is an important risk factor for liver damage. Liver damage is more serious in patients with high levels of virus in the blood.

Sometimes, HBV can acquire a different structure by undergoing some genetic changes during the reproduction period in the liver (viral mutation). This change may occur during the natural course of chronic HBV infection or may occur after the use of certain drugs for treatment.

This is a condition that can change the course of the liver disease and complicates the response to treatment. One of the most common mutations is the HBeAg (Hepatitis B early antigen-Hepatitis B e antigen) mutation. In non-mutated patients, HBeAg production is associated with active replication of the virus.

The formation of antibodies against HBeAg in the body (HBeAb or anti-HBe) (Hepatitis B e antibody) is accepted as an indication that the virus has stopped multiplying and the body has started to become immune to HBV, and this event is called ‘seroconversion’.

In this case, the level of HBV-DNA in the blood is low. In the presence of mutated HBV infection, although HBeAg cannot be detected in the blood and HBeAb is present, active virus proliferation continues and the HBV-DNA level in the blood is high. This condition occurs in 30 to 80% of chronic HBV infections in southeast Europe and Asia, and is usually associated with childhood HBV infection.

hepatit b tedavi sureciIn practice, it may be assumed that HBeAg-negative chronic HBV muscles have erroneously seroconverted (formed antibodies to HBeAg).

Patients with seroconversion are generally called inactive carriers and it is accepted that the inflammation in the liver slows down or stops in these patients.

In contrast, patients with HBeAg-negative (and HBeAb-positive) mutant chronic HBV infection persist, albeit at a low level, of viral replication and chronic inflammation in the liver progresses. These patients continue their lives as candidates for all kinds of damage that HBV may cause in the liver.

In 2/3 of patients with chronic HBV infection living in Asia, serious complications such as liver cirrhosis and liver cancer occur in the period after HBeAb formation.

By measuring the HBV-DNA level in the blood of HBeAg negative and HBeAb formed patients, it can be understood to some extent whether the event is an active mutant virus infection or an inactive disease with seroconversion.

Although high HBV-DNA levels are usually indicative of mutant HBV infection, this rule may not always be valid. Patients with HBeAg negative mutant HBV infection do not develop any disease-related symptoms for years, and the average time it takes for liver cirrhosis to appear in these patients is around 40 years.

After the appearance of signs of cirrhosis, 25% of patients enter the stage of end-stage liver disease within 10 years.

What Are The Symptoms Of Chronic Hepatitis B Disease?

Patients who develop suddenly, that is acute hepatitis b, usually apply to us as a flu infection. Patients have widespread body pain, weakness, fatigue, joint pain.

Patients who smoke have an aversion to cigarettes. Although this microbe is a jaundice microbe, very few of the patients have jaundice under the eyes in 1 in 3 patients.

Patients who survived this period do not have any complaints when the body’s immune system is still not able to remove hepatitis b from the body after the first 6 months.

The patients are not even aware of the presence of this microbe until they come to us at an advanced stage such as cirrhosis and liver cancer.

Can A Mother With Hepatitis B Give Birth?

There is no harm in giving birth to a mother with hepatitis B. Unfortunately, although there is a vaccine for hepatitis b, our society does not have this vaccine because it is not conscious of it.

So don’t worry about the pregnant mother going to give birth With protective serum and vaccine, you can give birth with peace of mind and never infect your child.

Can mothers who take medication for chronic hepatitis b by opening a parenthesis here give birth? yes, there is no harm in these mothers giving birth under the supervision of a doctor and getting pregnant.

Can A Mother With Hepatitis B Breastfeed Her Baby?

The vast majority of births today are performed in a hospital environment and under the control of a doctor. In all pregnancies under the control of a doctor, a hepatitis B test is definitely performed in the follow-up.

If a mother with hepatitis is giving birth, these babies are definitely taken under serum and vaccine treatment within 48 – 72 hours after birth. If your child has taken the serum treatment and vaccination program, there is no harm in breastfeeding.

However, when mothers have problems such as cracked sores and abscesses at the tip of their breasts during birth and breastfeeding, it may be healthier to protect the child if they do not give this milk to children during this period.

In this period, there is no harm in breastfeeding her child with peace of mind, without depriving her child of mother’s milk, which is very precious.

How İs Hepatitis B Disease Transmitted?

Hepatitis B is one of the germs of jaundice. It is a virus and causes liver inflammation. Classically, there are 4 contagious ways. The first contagious route is from pregnant mother to baby.

If Mother has hepatitis B, it can be transmitted to the child if it is not noticed during birth. The second mode of transmission is through blood.

When we say blood, a material that has been used in a hepatitis B disease surgically before is used in the next patient without being well sterilized, and the blood of a patient with hepatitis B may be transmitted to another patient with blood in the transition transport without knowing the blood of a patient with hepatitis B.

The third contagious route is through sexual contact. If it is present in one of the couples, it can be transmitted to the other over time through sexual contact. The fourth and final mode of transmission is domestic contact.

When we say domestic contact, especially the common use of blood-borne devices that come into contact with blood, they can also be transmitted by the common use of devices such as nail clippers, toothbrushes, razors, epilation devices.

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