According to frightening statistics, more than a quarter of the world's population is infected with the hepatitis B virus. Today, the disease is considered one of the most dangerous liver diseases with unpredictable consequences. Any of its outcomes is an imprint for life. The result of an accidental encounter with the hepatitis B virus can result in either simple virus carriage or cancerous damage to the liver, the main digestive gland.
Hepatitis B - what is it and how is it transmitted? What are the symptoms of hepatitis B, what is its treatment and preventive measures? What are the possible consequences and complications?
What is hepatitis B
The hepatitis B virus can be easily detected in the most remote corners of the globe. And this is not surprising. It is resistant to high temperatures and many solutions. It is difficult to destroy using conventional methods, while only 0.0005 ml of the patient’s blood is needed to infect a person.
What are the characteristics of the hepatitis B virus?
- The virus can easily withstand heating up to 100 ºC for several minutes; resistance to temperature increases if the pathogen is in the blood serum.
- Repeated freezing does not affect its properties; after thawing it will still be infectious.
- The virus cannot be cultured in a laboratory, making it difficult to study.
- The microorganism is found in all human biological fluids, and its infectiousness is a hundred times higher than even HIV.
How is hepatitis B transmitted?
The main route of infection is parenteral, through the blood. For infection, it is enough that a small amount of blood or other biological fluid (saliva, urine, semen, secretion of the glands of the genital organs) gets onto the wound surface - an abrasion, a cut. Where can you get hepatitis B?
The modes of transmission of hepatitis B also include transplacental - from a pregnant woman healthy child- during childbirth, the baby can come into contact with the virus while passing through the mother’s birth canal. Breastfeeding mothers can also infect their children.
Risk groups for viral hepatitis B
Why is hepatitis B dangerous for them? These populations have the highest risk of contracting this viral infection. Therefore, they are recommended to receive hepatitis B vaccinations and regular monitoring.
Forms of hepatitis B
These are different types of diseases that promote the circulation of the virus. These include:
The disease is most difficult in young people and children. The younger the patient is, the higher the likelihood of chronicity of the disease.
Symptoms of acute viral hepatitis B
After entering the body, the virus invades liver cells and multiplies. Then, after the microorganism leaves the cells, hepatocytes die. After some time, autoimmune lesions are observed when the body’s own cells begin to react to their own.
Several months often pass from the moment of infection to typical clinical manifestations of the disease. This incubation period hepatitis B and it can last up to six months. In the case of a fulminant course of the disease, the incubation period takes only two weeks, but on average its duration is about three months. Then comes the moment of classic manifestations. The most indicative is the acute form of the disease, in which there are:
- prodromal period;
- height;
- Exodus.
During all these periods, a person is bothered by the following symptoms.
The reason for the increase in hepatitis B disease is a sluggish and anicteric mild form of the disease. In most cases, typical clinical manifestations are not observed; the person suffers the disease “on his feet”, does not take medications and infects the people around him, which contributes to the rapid spread of the disease.
Diagnosis of hepatitis B
The difficulty of diagnosis lies in the long incubation period of the disease and the erased clinical forms. The diagnosis is made based on typical clinical symptoms and laboratory research methods.
The main method for determining the presence of hepatitis B is to identify markers of the virus. The diagnosis is made when the markers HbsAg, HBeAg and Anti-HBc IgM are detected in the blood serum of viral DNA. These are indicators of the presence of the hepatitis B virus in the acute phase of the disease.
Additionally, a biochemical blood test is taken to determine the activity of liver enzymes.
Treatment
Acute infection is treated only in a hospital. Treatment of hepatitis B depends on the form and course of the disease.
Can hepatitis B be completely cured? - yes, there are such cases, even without residual effects. But for this it is necessary to identify the disease in a timely manner and undergo full course treatment. An important role in healing belongs to the patient’s immunity.
Consequences of hepatitis B
According to statistics, up to 90% of people, after suffering an infection, get rid of the disease almost forever. But their “complete” recovery is considered relative, since it is most often accompanied by residual effects in the form of:
How many years do people live with hepatitis B? - if it is uncomplicated, then even in the case of a chronic course, hepatitis B does not affect life expectancy. The quality of life may deteriorate if there are residual effects. The prognosis depends on the person’s behavior and complications. They significantly complicate the patient’s life, since bleeding or other difficulties may appear at any moment.
Complications
What complications of hepatitis B are dangerous?
Prevention of hepatitis B
General methods of prevention at the source of infection include identifying the source of infection, annual observation of a person who has had hepatitis B, and examination of everyone in contact with him.
In addition, there are methods of active and passive prevention.
Active prevention involves the use of vaccines. Given the prevalence of the virus and the severity of symptoms, the first hepatitis B vaccine is given to newborns within the first 12 hours of their life. This provides almost 100% protection against the virus. The next administration of the vaccine should be every month, then every six months with revaccination at 5 years.
Adults are vaccinated against hepatitis B according to indications if they belong to risk categories or travel abroad (not previously vaccinated). There are several immunization options. Vaccinated on the first day, then a month later and 5 months after the last vaccination. In emergency cases, they are vaccinated on the first day, on the seventh and 21st days, with revaccination a year later.
Passive prevention is the administration of interferon to a person in contact with a sick person.
Vaccination against hepatitis B in Russia is carried out with the following vaccines:
Viral hepatitis B spreads among people at a high rate. Severe, varied symptoms, difficulty in treatment and dangerous complications can await a person infected with this type of hepatitis. The disease is a predisposing factor in the development of irreversible diseases - liver cirrhosis and cancer. Therefore, the attention of infectious disease specialists is focused on hepatitis B. Correct prevention, which is carried out not only for children, but also for adults, will help to avoid all these difficulties.
Hepatitis B is a viral liver disease accompanied by fever, weakness, general malaise, jaundice and an increase in the size of the liver and spleen.
Hepatitis B virus
Hepatitis B is caused by DNA virus(HBV), which belongs to the hepadnavirus family (from the words hepar - liver, DNA - DNA, i.e. DNA-containing viruses that infect the liver). Hepatitis B virus is one of the smallest and most variable DNA enveloped viruses. More than 60 mutant strains and 8 genotypes, designated in Latin letters from A to G, have been registered. The relationship of a certain genotype and subtype of HBV with the severity of acute and chronic hepatitis, the development of severe forms with high mortality, and the effectiveness of the therapy used has been proven.
This virus is highly infectious and quite resistant to environment. When boiled, it retains its activity for up to 30 minutes; when treated with dry heat (+ 160C) it is destroyed within 1 hour. The virus persists at a temperature of +30C for 6 months, and when frozen to -30 degrees it remains viable for up to 15 years. The virus is not killed by the action of many disinfectants.
Routes of transmission of hepatitis B virus
The main source of infection is a sick person. Hepatitis B virus (HBV) can be transmitted in a variety of ways through blood, semen, vaginal secretions, or saliva.
- Sexual path. Most often, the virus is transmitted sexually through semen or vaginal discharge.
- Perinatal route. HBV is transmitted from mother to child through breastfeeding during childbirth and after childbirth. Transmission of the virus occurs through mother's milk or during the process of delivery, when a newborn comes into contact with infected people. amniotic fluid, vaginal secretion. Special meaning has transmission of HBV to the fetus through the placenta (transplacental transmission of the virus).
- Hemocontact (parenteral) route. During blood transfusion, injection of medication in case of violation of the rules for sterilization of medical instruments, during gynecological examination in mirrors (if the mirror is not disposable), treatment at the dentist, during surgical interventions.
- Contact and household path through microtrauma of the skin and mucous membranes, which occurs through close contact with contaminated blood, open lesions and wounds. The virus can be transmitted, for example, when receiving hairdressing services through razors and scissors contaminated with blood. Infection with HBV is also possible through everyday contact with a patient or virus carrier, through direct contact with a source of infection, or through sharing various household and personal hygiene items.
Mechanisms of occurrence and course of hepatitis B
Having penetrated the human body, the hepatitis B virus from the blood enters the liver tissue and attaches to the surface of the liver cell (hepatocyte). After the destruction of the outer shell of the hepatocyte, the virus penetrates deep into the target cell, reaching its nucleus. A complex mechanism of viral DNA replication takes place inside the hepatocyte. The death of the hepatocyte occurs due to the fact that the cells of the immune system, namely T-helper cells, perceive the hepatocyte containing the virus as foreign and strive to destroy it.
In addition to liver cells, HBV can replicate in kidney, pancreatic, bone marrow and lymphocyte cells, but with less intensity. As a result of the multiplication of the virus in hepatocytes, the mechanism of a complex pathological process in the liver is triggered. Inflammation of the organ develops with the appearance of certain signs of the disease in the patient: jaundice occurs, the liver enlarges, bilirubin in the blood increases, and the activity of aspartic (AST) and alanine (ALT) transaminases increases. In severe cases, massive liver necrosis is possible, while regeneration of the liver tissue does not occur or develops slowly. With a favorable course of hepatitis, the body is freed from viruses and immunity is formed.
Symptoms of Hepatitis B
The first symptoms of hepatitis do not appear immediately. Mostly, incubation period without any manifestations of the disease (latent) is from 2 to 4 months. Sometimes the latent period can be up to 6 months from the moment the virus enters the body.
Onset of the disease proceeds gradually. Patients complain of weakness, malaise, fatigue, change in skin color (jaundice), increased body temperature, dark urine. Possible nausea, sometimes vomiting, bitterness in the mouth, pain in large joints, sleep disturbance. Viral hepatitis B is characterized by increased clinical manifestations of the disease as jaundice increases - this is an important diagnostic sign!
With the onset of jaundice The patients’ well-being deteriorates: weakness increases, appetite decreases, up to anorexia. Constant nausea, dryness and bitterness in the mouth, often headache and dizziness, etc. are noted, but arthralgia (joint pain) stops and body temperature normalizes. During this period, the liver usually enlarges: it is soft and sensitive to palpation. When examining the patient, an enlarged size of not only the liver, but also the spleen is diagnosed. The duration of the icteric period varies from several days to several months, most often from 2 to 6 weeks.
HBV can occur in mild, moderate or severe form:
- At mild form of HBV intoxication is not observed or it is slightly expressed, the intensity of jaundice is low.
- At moderate form of HBV intoxication is manifested by moderate weakness, intermittent headache, decreased appetite, nausea; jaundice is bright and persistent.
- Severe form of HBV characterized by severe intoxication: weakness, lack of appetite, constant nausea, frequent vomiting. Severe muscle weakness, dizziness, flashing spots before the eyes, tachycardia, pain in the liver area, nosebleeds and bruises at the injection sites appear. In severe forms of HBV, complications leading to death are possible.
In addition to the icteric form, HBV can occur in an atypical form - anicteric, erased or innaparent (asymptomatic).
Diagnosis of hepatitis B
General inspection.
General research methods:
1 general blood and urine test;
2 blood test for bilirubin.
3 determinations of enzyme levels in the blood - AST and ALT.
Specific diagnostic methods viral hepatitis B are carried out by identifying specific markers of acute HBV infection:
- HBsAg an antigen that appears in the patient’s blood already 3-5 weeks after infection, i.e. still in the incubation period;
- Anti-HBs antibodies that appear 3-4 months from the onset of infection and persist for a long time (up to 5 years). Detection of anti-HBs indicates recovery and formation of immunity;
- anti-HBc IgM, which appear at the end of the incubation period and persist throughout the entire period of clinical manifestations. A high titer of anti-HBc IgM indicates acute viral hepatitis, and persistence of anti-HBc IgM in a low titer indicates chronic course illness;
- anti-HBc IgG(persist for life), which appear during the recovery stage, in the 4th–6th month from the onset of the disease after the disappearance of anti-HBC IgM;
- HBeAg an antigen that appears simultaneously with the HBsAg antigen and indicates the degree of infection of the body. Moreover, if the HBeAg antigen is detected in sufficient titer in the blood 10 weeks after infection, then we can talk about a chronic disease process.
- Anti – HBe antibodies, the presence of which is a favorable sign regarding the course of the disease, foreshadowing a complete recovery. These antibodies persist for 2 years.
Antigens and antibodies to HBV are usually determined by ELISA. The most sensitive indicator of HBV virus replication is HBV DNA. HBV DNA is detected in blood serum, lymphocytes, and liver cells using the PCR method.
For severe, protracted, chronic forms perform additional blood and urine tests, x-rays, ultrasound abdominal cavity, consultation with a surgeon is necessary.
Hepatitis B treatment
Viral hepatitis B cannot be treated on your own!
With adequate treatment of viral hepatitis B, the virus can be completely eliminated from the human body. The result of inadequate treatment of hepatitis B is the formation of carrier state, the development of chronic hepatitis, cirrhosis of the liver, and malignant degeneration of the liver. After suffering from viral hepatitis B, persistent lifelong immunity is formed.
Hepatitis B is a viral inflammation of the liver caused by the hepatitis B virus. In most cases, the disease has a favorable prognosis. With an adequate response of the patient’s immune system, the pathology occurs in an acute form and is characterized by vivid symptoms. Within a month, the symptoms of the process disappear, then a complete cure occurs.
In 10% of cases the disease progresses to chronic form, initially characterized by a blurred clinical picture. It is this condition that is most dangerous for humans and requires early diagnosis and selection of a comprehensive treatment regimen. How to treat hepatitis B and what new hepatologists can offer to fully restore the patient’s body is discussed in the article.
What to do after infection?
The causative agent of hepatitis B is contained in the biological fluids of a carrier of the virus or a sick person. The largest amount is found in the blood, secretions of the salivary glands and seminal fluid. If you suddenly come into contact with an infected person, you must immediately contact a medical facility to prevent infection.
It should be remembered that the virus is transmitted in the following ways:
- Parenteral - during the transfusion of infected blood or its individual components, during manipulations with non-sterile instruments, during the use of one syringe by drug addicts.
- Vertical - from mother to baby during the last trimester of pregnancy, during the passage of the child through the birth canal.
- Sexual – in the presence of macerations and microcracks in the genital area, but subject to high aggressiveness of the virus.
If a person suddenly realizes that he has had contact with a sick person, he should contact a medical facility within the first 12 hours from the moment of the injection or sexual intercourse. In a hospital setting, a specific immunoglobulin will be administered, which will strengthen the body’s defense response, and then vaccination against hepatitis B will be carried out.
The first vaccination against hepatitis B is carried out on the first day of the baby’s life.
You should definitely monitor your own condition and monitor the appearance of hepatitis symptoms during the first 4 months after such an incident. Usually this period is enough for liver inflammation to make itself felt. In case the person was still infected. He will become weak headache, pain in muscles and joints, hyperthermia. Later, yellowness of the skin and sclera, skin rash, itching, soreness and heaviness in the right hypochondrium will appear.
Treatment for hepatitis B depends on the following factors:
- how aggressive the virus is in the patient’s body;
- how much of the pathogen penetrated;
- stage of the disease;
- the degree of damage to the liver and other organs;
- course of the disease.
Mild and moderate forms of hepatitis B can be treated at home. During the first week of therapy, doctors recommend bed rest. Further restrictions regarding motor activity depend on the general condition of the patient. Pediatric patients are advised to remain in semi-bed rest even after signs of intoxication have disappeared.
Any physical exercise During treatment, liver inflammation is prohibited. Children are exempt from attending physical education classes for six months, and when participating in professional sports - for a year. Increasing the level of physical activity should be dosed and individual. It is important to take into account the patient’s age, his laboratory parameters, and the body’s recovery rate.
Experts say that the therapy is aimed at inhibiting the processes of viral DNA production, stopping the progression of the disease, achieving remission in relation to changes that occur in the liver at the cellular level, as well as preventing the development of oncological processes, cirrhosis and liver failure.
Diet
Treatment of hepatitis B is based on the correction of the patient’s individual menu. It is important to reduce the load on the hepatobiliary system and gastrointestinal tract. However, nutrition must be complete, high-calorie and fortified in order to maintain the body’s defenses at a high level. The ratio of proteins, lipids and carbohydrates is characterized by a ratio of 1:1:4.
Protein foods should be presented:
- lean meats - chicken, beef, veal, rabbit;
- fish - pike, cod, pike perch;
- fermented milk products of medium fat content;
- steamed omelette.
Steam chicken cutlets– an excellent dish option for a person with a diseased liver
Lipids can enter the body as part of various types vegetable oils (corn, olive, sunflower), as well as butter good quality. Carbohydrate products are represented by porridges (rice, buckwheat, oatmeal, wheat), day-old bread and crackers. It is important that the patient’s diet includes a sufficient amount of vegetables and fruits. They can be not only raw, but also stewed, boiled, or baked in the oven.
To completely cure hepatitis B, you should limit the patient’s intake of the following foods:
- lard;
- margarine and products based on it;
- spices;
- smoked meats;
- canned food;
- alcohol and soda;
- ice cream and jelly;
- fatty meats and fish;
- garlic;
- nuts, etc.
Important! The patient's menu should include at least 5 meals a day. It is important to drink plenty of liquid (pure water, herbal tea).
How to choose medications?
To recover from viral liver damage, you should determine what stage of the disease the patient has at this moment. The fact is that it is necessary to act on the virus at the moment of its reproduction. In such conditions, it will be possible to get rid of the disease forever. To clarify the stage of the disease, a number of laboratory and instrumental studies are carried out.
Mandatory are a biochemical blood test, determination of the presence of hepatitis B markers, PCR analysis to clarify the presence of pathogen DNA in the patient’s body, as well as an assessment of the viral load. At the same time, the condition of the liver is examined using ultrasound with Doppler sonography, and the degree of fibrotic changes is clarified using elastometry. If necessary, diagnostics of virus mutations and determination of its resistance to a number of drugs are prescribed.
Most patients are interested in how much a comprehensive examination costs, which is prescribed by the attending physician to select the correct treatment regimen. As a rule, the cost is in the range of 20-25 thousand rubles, if tests and instrumental diagnostics are done in private laboratories.
Treatment of the chronic form
The question of whether hepatitis B can be treated or not has received a clear answer. Yes, hepatitis can be cured and quite successfully. If we compare the prognosis for patients with liver damage by a B-type virus, they are much more comforting than for patients who encountered a C-type pathogen or combined infection.
The treatment regimen is selected only after receiving diagnostic results
Doctors have identified a number of criteria by which the effectiveness of the therapy is assessed:
- normalization of transaminase levels in the blood;
- absence of viral cell DNA, which is confirmed by real-time PCR;
- disappearance of HBeAg;
- stopping the progression of deterioration of the histological picture of the liver.
A decrease in transaminase levels to normal levels is a biochemical response to the treatment. A decrease in the amount of pathogen DNA and the disappearance of HBeAg indicates a virological response. Normalization of liver condition indicators at the level of hepatocytes – histological response. The combination of all responses is called a complete response to therapy.
Important! A persistent positive result of the treatment is the normalization of all of the above indicators and maintaining them at this level for 6-12 months from the end of therapy.
At this stage, two drugs are most often used for antiviral therapy: Interferon and Lamivudine.
Interferon
The group of interferons is characterized not only by its antiviral effect. These drugs are able to fight tumor cells and strengthen the body's immune system. Scientists have found that interferon alpha suppresses the reproduction process of the hepatitis B virus, which contributes to the development of remission of the disease. However, the drug is not prescribed to all patients, since there are certain restrictions regarding selection criteria for treatment.
A good virological response to the use of interferon is observed in treated people with constant or periodic increased performance ALT in blood serum and the presence of HBeAg. If the ALT level is normal, response to treatment will be recorded in less than 10% of patients.
The effectiveness of therapy in pediatric patients is similar to that in adults. Clinical data have proven that the use of interferon alpha against the background of a chronic form of the disease, in which HBeAg is absent, is accompanied by a positive response to treatment, but is fraught with relapses of the disease within 5 years from the date of completion of treatment. Permanent cure is achieved in only a quarter of patients.
Interferon is not recommended for use in patients with liver cirrhosis, since when taking such drugs, the level of ALT in the blood serum increases sharply, which confirms the occurrence of a cytolytic crisis. The result may be the development of liver failure.
Adverse reactions to interferon therapy:
- weakness;
- decreased appetite;
- pain in joints and muscles;
- depression;
- decrease in the level of leukocytes in the blood;
- anxiety;
- hair loss.
Lamivudine
This drug stops the process of reproduction of the hepatitis virus by integrating the active substance into the growing DNA chains. Recommended for use in patients who have HBeAg-positive hepatitis. A persistent virological and histological response is observed in half of the patients. Children, as a rule, are not prescribed Lamivudine.
The drug is also recommended for those patients who do not have HBeAg. In such a case, the effectiveness of therapy over 5 months is 63%. Lamivudine is excellent for those patients who are resistant to interferon alpha. Also, a number of studies have proven that the medication can be used against the background of liver cirrhosis. Among the undesirable effects of taking the drug, a slight increase in the level of transaminases in the blood can be noted, but this is far from critical. Otherwise, the drug is tolerated quite well.
Other drugs
Famciclovir - clinical studies have proven that this medication has an antiviral effect, but is inferior in terms of activity to Lamivudine. Moreover, the medicine should be taken three times a day, so it is unlikely that it will be the drug of choice.
Adefovir dipivoxil - the drug cannot be used in high doses, as it becomes toxic to the kidneys. Able to reduce the amount of viral DNA in the patient’s body. Thymosin is a well-tolerated drug that stimulates the activity of T-cell immunity. In some cases, it is combined with other medications.
In the presence of severe intoxication, specialists prescribe detoxification therapy. It involves the introduction into a vein of a number of solutions (sodium chloride, rheosorbilact, hemodez, rheopolyglucin, glucose). In parallel, they introduce hormonal agents. Start with high doses, gradually reducing them.
Treatment of malignant form
Can malignant hepatitis be cured? The malignant form of the disease, which is more often observed in children, requires immediate correction of the body’s condition. Moreover, medications begin to be administered even at the moment of threat of its development.
Treatment regimen:
- glucocorticosteroids into a vein;
- administration of plasma, albumin, rheopolyglucin;
- diuretics to force diuresis (Mannitol, Lasix);
- heparin in case of development of disseminated intravascular coagulation syndrome;
- enterosorbents orally to accelerate the elimination of toxic substances;
- antibacterial drugs.
According to indications, hyperbaric oxygenation, plasmapheresis, hemosorption are performed
Dispensary registration
In case of treatment in a hospital setting, the patient is discharged 30-35 days from the start of therapy. At this time, body functions are restored, transaminase levels are slightly reduced. The doctor gives the patient a note. It describes how to eat properly and what the recommended regimen is.
The first examination after the patient’s discharge is carried out after 30 days, then after 3, 4, 5 months. They are removed from the dispensary register if the indicators of general clinical tests and biochemistry are within normal limits twice in a row, and HBsAg is absent.
Patients are interested in whether hepatitis can be treated with folk remedies. On websites devoted to the treatment of viral liver damage, you can find reviews that someone was treated / was treated with prescriptions traditional medicine. However, it should be remembered that replacing full drug treatment It won't work with these means. They can only be used as a supplement to support the functioning of liver cells and accelerate their regeneration.