Among the different forms of Hepatitis, Hepatitis B seems to get less publicity than its counterpart, Hepatitis C. But for the millions of people in the United States and around the world impacted by Hepatitis B, it can certainly pose some challenges that are difficult to overcome. The Cleveland Clinic estimates that, each year, 200,000 to 300,000 people in the United States develop a Hepatitis B infection. And the number of people living with chronic Hepatitis B may be more than 1 million.
All about Hepatitis B
Perhaps the reason hepatitis B doesn’t get as much attention is that fewer cases of it become chronic when compared with hepatitis C. While 80 percent of people with hepatitis C go on to develop a chronic liver infection, that percentage is substantially lower among people with hepatitis B.
Still, hepatitis B can pose problems in its own right for those who have it. The symptoms can include stomach pain, fever, fatigue, achy joints, loss of appetite, dark-colored urine and a yellowing of the skin (jaundice) and eyes (scleral icterus). These symptoms of an acute, or short-lived, hepatitis B infection can last anywhere from a few weeks to several months.
If you’re an adult, it’s much less likely that your acute case of hepatitis B infection will become a chronic, or long-lasting, liver infection. The National Institutes of Health (NIH) estimates that only about 5 percent of adults with acute hepatitis B develop the chronic version of the disease. However, that number increases as the patient gets younger. The rate of chronic infection among hepatitis B patients is 25 to 50 percent in children 1 to 5 years old, and for babies with hepatitis B, the rate of chronic infection is 90 percent.
However, the U.S. Department of Health and Human Services (HHS) notes that direct-acting antiviral medications have improved outcomes for those with hepatitis B. Also, researchers continue to look for new and better ways to cure the disease.
How you get Hepatitis B
Much like the other forms of hepatitis, you can’t contract hepatitis B simply by getting sneezed on or drinking out of the same glass as someone. The disease requires contact with infected blood or other bodily fluid to be spread. Some common ways that hepatitis B can be passed between people include unprotected sex, sharing drug needles or items like razors or fingernail clippers, getting a tattoo with improperly sterilized equipment or being born to a mother with hepatitis B.
How you prevent Hepatitis B
Considering the manner in which it is spread, the good news about hepatitis B is it can be prevented in several ways. The best way to avoid getting hepatitis B, of course, is to steer clear of risky activities that might lead to its spread. This includes unprotected sex, illicit drug use, travel in parts of the world where hepatitis B is common and other risky activities.
Another way to prevent the spread of hepatitis B is through the hepatitis B vaccine. Available since the 1980s, the vaccination is given in three shots over the course of six months. The shot should be given to infants and children, but it also can be given to adults who may be at a greater risk for infection or who are traveling to countries where rates of hepatitis B are higher. The vaccine is one of the reasons why rates of hepatitis B infection are lower than those of hepatitis C, for which there is currently no vaccine.
How you treat Hepatitis B
In cases of acute, or short-term, hepatitis B infection, only supportive care is usually needed as the infection generally resolves on its own over time. However, hepatitis B that becomes chronic requires treatment to prevent complications such as cirrhosis (liver scarring), liver failure and liver cancer. This is especially concerning when you consider that chronic hepatitis B often doesn’t exhibit any symptoms before it damages the liver. For this reason, some at-risk individuals may get screened for the disease to ensure that they don’t have it.
In the past, treatments to reduce the amount of hepatitis B virus within the body included injectable medications such as peginterferon alfa-2a. These were often not very successful at managing hepatitis B, and they also caused many concerning side effects, including depression, anxiety, suicidal thoughts, hallucination, aggressive behavior, diarrhea, irregular heartbeat, weakness, loss of coordination, severe muscle or joint pain. The medication could also worsen a wide number of existing medical conditions, including heart problems, diabetes and mental health conditions.
However, this situation changed with the development of several new medications, known as direct-acting antivirals. They have significantly improved outcomes for people with hepatitis B and have reduced the side effects related to treatment. Some of these drugs include tenofovir alafenamide (Vemlidy), tenofovir disoproxil fumarate (Viread) telbivudine (Tyzeka) and entecavir (Baraclude).
Though these drugs have improved the situation for people with chronic hepatitis B, they have not had the same dramatic effect as they have for hepatitis C, where they yield cure rates close to 100 percent. For hepatitis B, these drugs do not provide a cure in most cases, but they do help people manage their condition more effectively. The reality, notes the HHS, is that most people will need to continue treatment for chronic hepatitis B for the rest of their lives.
In some cases, a liver transplant may be needed to successfully manage hepatitis B. This is particularly true if a person’s liver has been severely damaged as a result of their hepatitis B infection.
The high cost of Hepatitis B treatment
Considering that hepatitis B often requires lifelong treatment, this can often be a costly proposition for people who have the disease. Add to that the fact that the newer direct-acting antivirals are very expensive, and people with hepatitis B can find themselves in dire financial straits. What’s more, the Mayo Clinic notes that some insurers are hesitant to cover the drugs unless the patient is showing signs of liver damage, such as cirrhosis.
The key to successful treatment, the Mayo Clinic points out, is to work closely with a trusted doctor to get the treatment that you need. The NIH adds that some states, drug companies and nonprofit organizations offer assistance in helping pay for needed medications. Be sure to ask your doctor about options that might be available to you.
The bottom line on Hepatitis B treatments
When it comes to the outlook for hepatitis B, it’s certainly a case of good news and bad news. The good news is that the disease rarely results in a chronic infection, particularly in adults. It’s also good news that people can now receive a hepatitis B vaccine that protects against the infection.
However, there can be bad news about hepatitis B, as well, and that frequently occurs when a hepatitis B infection becomes chronic. In those situations, the harsh reality is that the treatments are not as effective as they are for some other forms of chronic hepatitis infection, like hepatitis C. As a result, the treatments may need to continue for life. In some cases, the liver damage that occurs due to chronic hepatitis B treatment may require a liver transplant.
- Hepatitis: Viral Hepatitis A, B, and C, Cleveland Clinic, 2019. https://my.clevelandclinic.org/health/diseases/4245-hepatitis-viral-hepatitis-a-b--c
- Hepatitis B, NIH, 2019, https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/hepatitis-b#treat
- Hepatitis B Basic Information, HHS.gov, 2019. https://www.hhs.gov/hepatitis/learn-about-viral-hepatitis/hepatitis-b-basics/index.html
- Hepatitis B, Mayo Clinic, 2019. https://www.mayoclinic.org/diseases-conditions/hepatitis-b/diagnosis-treatment/drc-20366821
- Most patients with HCV cured with new drugs — but at what price? Mayo Clinic, 2016. https://www.mayoclinic.org/medical-professionals/digestive-diseases/news/most-patients-with-hcv-cured-with-new-drugs-but-at-what-price/mac-20430491
- Hepatitis C, NIH, 2019. https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/hepatitis-c#vaccine
- Peginterferon Alfa-2a Injection, US National Library of Medicine, 2016. https://medlineplus.gov/druginfo/meds/a605029.html