The hepatitis B virus is still one of the most prevalent and serious infections both in the United States and across the world. The estimate is that, globally, between 350 and 400 million people are chronically infected with hepatitis B virus, and more than 500,000 deaths occur each year from liver failure, cirrhosis and liver cancer.
With the insurance population reaching out well into other continents, some 85 percent of the world’s population lives where the prevalence of chronic hepatitis B infection (chronic HBV) is more than 2 percent, according to the Centers for Disease Control. The prevalence in the United States is 0.4 percent, with more than a million people chronically infected.
Hepatitis B is transmitted through contaminated secretions, such as sweat, saliva, vaginal secretions and semen, as well as contaminated blood. Besides using a contaminated syringe from an infected person, medical procedures, occupational exposure in the health care field, transmission from mother to child at childbirth, and even tattoos and body piercing are becoming common sources.
Most people have no idea they are infected until a routine blood test for something else is done (a physical exam, for instance, a general health check, or even a screen prior to donating blood) and confirms the virus.
Active infection with hepatitis B shows the usual signs of hepatitis: jaundice, yellowed skin and conjunctiva, fever, abdominal pain, nausea, vomiting, weight loss and a tender liver.
After the acute phase passes, the body either clears the virus or the virus remains to produce a chronic infected state. About 95 percent of people clear the virus normally, and their blood tests show they have produced immunity to the disease. The others will go on to generally become one of three infected statuses.
The healthy chronic carrier of the disease is generally not infectious to others and lives a very close to normal life expectancy. They have a slightly elevated risk of cirrhosis and liver failure, but their real risk is that the virus will become reactivated and aggressive if other disease states develop (such as cancer) or immune system suppressants like steroids are given for another cause.
The chronic infectious type is highly infectious to others, and even though they have few if any symptoms until late in the disease, this is progressive.
A third type referred to as a chronic mutant type is one where treatment is difficult because the virus is more resistant to conventional treatment.
When liver function tests are elevated and sometimes as a routine part of insurance testing, serology testing is carried out. This includes tests such as HBsAg (surface antigen), anti-HBc (core antibody) and anti-HBs (surface antibody). Without explaining the biology behind each of the tests, negative testing for all three shows no active infection, but a susceptibility to catching the disease (no immunity).
When the HBs and HBc are positive, the patient has probably been infected sometime in his life and is now immune, since his body has made antibodies. This is a common form now found in health care professionals as well as children going through the school system who have received hepatitis B vaccination—isolated positive anti-HBs, which also show immunity. When antigen and both antibodies are positive, a patient is acutely infected. When antigen and core antibody are positive but surface antigen is negative, there is probably chronic infection.
In chronic infections where liver blood tests are elevated and show active inflammation, a biopsy of the liver is the most accurate gauge of how much damage has been done and how aggressive the process has become. It helps to guide treatment both in type and duration.
The goal of therapy of chronic hepatitis B infection is to reduce inflammation of the liver and to prevent liver failure, cirrhosis and liver cancer. Antiviral medication is given, as well as a medication called interferon. Depending on the results of the blood testing along the way, medication is given for 6 to 12 months continuously. Oral antiviral agents are used as well, but generally the duration of treatment is longer. Relapse is a common feature and leads to antiviral resistance.
Thankfully, most testing of abnormal liver function reveals a non-infectious feature. When testing for hepatitis B occurs, the outcomes are favorable if past infection is shown and the body has created its own immunity to the disease—just as with other childhood diseases.
Hepatitis B is becoming less prevalent in the United States, as vaccination of school children is conferring immunity before the disease can be acquired. Those cases that show chronic infection and progression represent the worst outcome and least favorable action for insurance.
