Hepatitis B

Information, Symptoms, Treatments and Resources

HepB Introduction & Welcome Page

Authors: stevenNYer & ZellyF

Modified by: bram, Sharp7

updated by stef2011 sept 2011

Important forum dates / milestones:

February 14, 2008 – Hepatitis B forum was born.
February 20, 2008 – ZellyF joined this community.
March 2, 2008 – Forum posting exceeded page 1.

March 7, 2008 – cajim joined this community.
March 8, 2008 – Hepatitis B Introduction Health page was born.

April 4, 2008 – HR (Hepatitis Researcher) joined this community & 1st HR post.

Posting suggestions:

* Remember that this is strictly a patient-to-patient forum.  It is for sharing and learning from a common experience.  Actual treatment decisions should always be discussed with your doctor.   

Please introduce yourself.  Tell us who you are (aliases are fine), your ethnicity, age, and age of infection.  With background information, you'll get better feedback.  Provide information on your account's, "About Me" entry.
* Never hijack a thread with your own questions.  Ask your own questions by opening a new thread.  
* Try to ask all questions on the forum and not via personal messages.  The goal is to build community and establish an information base on the forum so others can learn from it.  
* Be patient when waiting for feedback.  

* Private message "stevenNYer" to report inappropriate forum behavior.  "stevenNYer" is the Community Leader of this forum and is able to communicate with MedHelp directly for certain situations, such as deleting an inappropriate post.



Acute vs. Chronic Infection:

A new HepB infection is considered to be an “Acute” infection.


If infected as an adult, you will likely feel terrible with classic symptoms of hepatitis.  But the good news is that you will have a 90-95% chance of clearing the virus.


If infected as an adolescent, you will have about a 50% chance of clearing the virus.


If infected as an infant or at birth, you have only a 5% (or less) chance of clearing the virus.


If you cleared the virus, you are immune to HepB.

If you don’t clear the virus, meaning you remain surface antigen positive for over 6 months, then it usually means you have a chronic HepB infection.  Chronic HepB tends to be asymptomatic but this does not indicate that there is no viral activity.  Terms such as "healthy carrier" or "inactive carrier" are misleading as there is no such thing as inactive chronic HepB.  Even at undetectable viral levels there does remain low level activity which is why it is important to continue to monitor your condition even though you are feeling well. 

There is currently no cure.  Spontaneous clearance of a chronic infection is possible but the odds are very low  at about 1% per year.


If you are chronically infected, the following markers are important to understand the status of the disease:  

hbsag quantity in iu/ml: S antigen is used by virus to suppress our imune response so it is of maximum importance to have a monitoring of this antigen, after all when this reaches zero we are cured....

the various levels can help understand disease status, especially when hbvdna is undetactable, ast/alt normal and liver healthy without fibrosis, infact a level of hbsag less than 500iu/ml on genotype D can confirm inactive hbv.a level less/equal than 1500iu/ml has the highest chances of hbv clearance on interferon

HBeAg: E antigen is the second soluble antigen of HepB.  If this is positive, you will likely have a high viral load and are very infectious to others who are not immune.

HBeAb: is the antibody that neutralizes the E antigen.  If this E antibody is positive, the E antigen is likely negative.Hbeag negative has lower hbvdna and hbsag quantity on most patients and no correlation with disease activity 

HBV DNA:  tells the level of virus in your blood.  Can be expressed as copies/ml, IU (international units)/ml or logs.today hbvdna alone is not enough to understand disease status so hbsag quantity measured by abbott architect in iu/ml (and a few other machines) is absolutely necessary.the quantity of hbsag can predict eradication of hbv infection.

ALT (also known as SGPT): is an enzyme in liver cells.  If liver cell is damaged, these enzymes leak into your blood.  Thus, elevated ALT is not good a normal alt doesn t mean no damage, fibroscans is the main toll to monitor liver damage today

AST (also known as SGOT): is also an enzyme in liver cells.  Same concept as the ALT but usually its level is not as high as the ALT.

Lab Basics:




Neither infected nor immune. 
Get vaccinated



Immune via clearance of past infection



Immune via vaccination

IgM anti-HBc


Acutely infected

IgM anti-HBc


Chronically infected


In addition to the above, a chronically infected person is advised to undergo one or more of the following tests:

Ultrasound (also known as ultrasonogram)non-invasive scan to detect liver cancer, it is important to make US every 6 months because liver cancer is so fast that after 6 months from development it may be not treatable.US can detect only advanced cirrhosis when it is too late to regress the damage so it is not a tool to monitor liver damage anymore

Liver biopsy: invasive test to cut out a piece of the liver for further analysis. May require hospitalization for a day and not used anymore in europe unless unclear results of fibroscan and general tests

Fibroscannon-invasive scan to quantify hepatic fibrosis, it can detect very early cirrhosis but less efficent on very low fibrosis but this is not important since a very low level of fibrosis has no clinical relevance. 

Importance of building a support community for those infected with HepB:

It is estimated that 400 million people worldwide have HepB, including 1.25 million chronic carriers in the United States.  Hepatitis B is endemic in Southeast Asia, China, and Africa.  

Although the majority of individual with HepB will live long lives, some will die from complication (such as cirrhosis and liver cancer).  Although classified as a sexually transmitted disease, many individuals' primary risk factor is being born in a high risk area.  
Because, chronic hepatitis B is largely asymptomatic, many individuals with HepB don't know it.  Many will find out while they are feeling healthy and in the prime of their lives.  It's a shock and the panic sets in and information overload begins.  Unfortunately, the cases found online are frightening.  The individual cited usually dies from liver cancer.  There are fewer examples given of people who live normal life expectancies even though this is the most typical scenario.

 This is where community support comes in.  This is where balanced learning takes place.  From each other, at difference stages of the disease, we learn that we are okay.  We learn that the virus can't take our spirit.   We remind each other to monitor the disease and assess the need for treatment.  We adjust our lifestyles to be more liver friendly, such as cutting out alcohol and cigarettes.  We support each other and the newly diagnosed who stumbled upon our forum.


Concerns relating to HepB and pregnancy:
Many chronically infected women learn of their chronic status via routine blood tests done in early pregnancy.  In a typical pregnancy there is very little risk of transmitting hepatitis B to the fetus in utero.  There does, however, remain a high risk of transmission during the delivery itself.  This risk is largely negated if the newborn receives two shots within 12 hours of birth.  The first shot is a dose of immunoglobulin which boosts the newborn's immune system and allows neutralization of the hepatitis B virus.  The second shot is the first dose of the hepatitis B vaccine (a three-shot series).  You must follow up and complete the three-shot series on schedule.  Once the series has been completed the child should have a titer done to determine that they have responded to the vaccine and are indeed immune to infection.  

If you follow all of these steps your child has a greater than 95% chance of a life free from hepatitis B.  If you do not, then your child has a 90% chance of infection.  Don't hesitate to remind everyone in the delivery room that your child needs these shots within 12 hours of delivery.  If you or a birth partner can observe the shots being administered that's even better.

Most mothers infected with hepatitis B can safely nurse once the newborn shots have been administered.  The CDC specifically points out that hepatitis B is not transmitted via breast milk.  Check with your pediatrician and

Regarding treatment options:
Discuss this with your doctor.  There are
many individual factors to consider deciding on treatment (if needed).


Additional Treatment Information:


Antivirals are pills classified as Nucleoside / Nucleotide Analogues.  They are designed to interfere with the virus' DNA polymerase required for viral replication.  In other words, antivirals will hopefully cause a drop in viral replication which would be reflected in lower viral load levels (HBV DNA). The goal of antiviral therapy is an undetected (UND) viral load (Remember, UND doesn't mean ZERO replication.  It means low level replication).  Antivirals are usually very patient friendly.  They are easy to take and have minimal side effects.  The main concern with antivirals is resistance.  That is, the virus has the ability to make adjustments and adapt over time which means the virus can outsmart the antiviral.  This often results in viral loads climbing back up after a period of being successfully repressed by antiviral therapy.  Once resistance is developed, the particular antiviral being used will no longer be able to interfere with the virus' ability to replicate.  It is suggested that combo-therapy (treating with multiple antivirals) could cross-protect against a viral break-through by enhancing the resistance profile.  Listed below are antivirals used to treat HepB.  In bold are the generic names with equivalent abbreviations and in parenthesis are the brand name.  I suggest that generic names be used for forum purposes.


Currently approved antivirals: 

Entecavir = ETV (Baraclude) : FDA approved 2005 for adults.

Tenofovir = TDF (Viread) : FDA approved 2008 for adults.

Emtricitabine (FTC) : Phase 3 trials , expected to be FDA approved soon.

Previously approved, but no longer recommended:

Lamivudine = LAM (Epivir HBV, Zeffix, 3TC): FDA approved 1998 for children & adults.

Adefovir Dipivoxil = ADV (Hepsera): FDA approved 2002 for adults.

Telbivudine LdT (Tyzeka, Sebivo): FDA approved 2006 for adults.

These drugs were previously approved, but are no longer recommended for use with Hepatitis B, for various reasons. Some of them lead to resistance (the virus mutates and becomes immune to this and sometimes many other medicines) and some of them have too many dangerous side-effects. If your doctor recommends these, either be fully aware of what you are doing, or change doctors immediately.


The other common treatment option are interferons, classified as immunomodulators.  It’s designed to stimulate your immune system to help fight the virus.  Patients’ main concern for this treatment is that it’s less convenient since it’s an injection.  Also, flu-like side effects are common.   The main advantage to interferon is that there is no resistance issue.  Listed below are interferons used to treat HepB:


Interferon alfa-2b (Intron A) : several injections per week,  FDA approved 1991 for children & adults.

Peginterferon alfa-2a=PEG-IFN (Pegasys) : injection once per week,  FDA approved 2005 for adults.

PEG-IFN is effective with varying degrees against various genotypes of HBV. At best, it is effective in about 50% of people infected with Genotype A, and at worst 25% of the people infected with Genotype D.

Only PEG-IFN, ETV, and TDF are approved as first-line therapy. Recent data suggest ETV+TDF combo on severe liver damage or cirrhosis to prevent deadly flares, leading to resistance.

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