What is Hepatitis B? (2)
To determine whether somebody has been infected or exposed to the hepatitis B virus, some blood tests are done. Hepatitis B infection is diagnosed by detecting pieces of the virus in the blood called antigens. Because the virus is foreign to the body, the body does produce antibodies to it.
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The presence or otherwise of this antibody can be used to diagnose an infection with this virus. In addition, the DNA of the virus can also be detected and quantified, as a means of diagnosis, usually referred to as ‘viral load'.
The hepatitis B profile is then requested once a positive result is secured. This tests other antigens of the virus such as the core c-antigen and the e- antigen. These give an idea as to whether the organism is actively dividing or not. It also tells whether the body has produced antibodies against the organism or not.
Blood tests for hepatitis B virus are often done when routine blood work shows abnormal liver function test or when there is strong suspicion of the infection. It is also done for people who are at an increased risk for exposure such as health and social workers.
If a patient is diagnosed with chronic hepatitis B, they will need regular follow ups. Blood tests can help determine how active the infection is and whether there has been damage to the liver or not.
Blood tests alone may not be enough to guide treatment in chronic hepatitis B infection. Sometimes other tests such as scanning of the liver either by ultrasound or computerized tomography (CT scan) is used to detect the extent of liver damage.
It may also detect cancer of the liver caused by chronic hepatitis B. In some extreme cases, a biopsy of the liver - removal of a tiny piece of the liver by inserting a long needle into the liver and withdrawing the tissue, is examined under a microscope to detect changes in the liver.
A biopsy may be done to detect the extent of liver damage or to monitor treatment.
Treatment
By way of treatment, acute hepatitis B usually resolves on its own and does not require medical treatment. In very severe infections, symptoms such as vomiting or diarrhoea may be present. The affected person may then require treatment to restore fluids and electrolytes.
There are no medications to prevent acute hepatitis B from becoming chronic. Once diagnosed, there are basic self-care ways that can help to relieve symptoms and to prevent worsening of the disease.
These include; Drink plenty of fluids to prevent dehydration.
• Avoid taking any medications, especially those over-the-counter without discussing with the doctor. This is because some medications depend on the liver for its removal from the body, and liver damage may impair the body's ability to metabolize these drugs.
• Avoid drinking alcohol during the acute phase. Individuals with chronic HBV must avoid alcohol for the rest of their lives.
• Eating high caloric diet.
• Avoid prolonged, vigorous exercise until symptoms start to improve.
• Avoid any activity that may spread the infection to other people.
The medications used to treat are classified as antiviral drugs, because they try to stop the virus from multiplying. These are the best therapy known for chronic hepatitis B even though they do not work in all individuals with the disease.
Decision to start medications for treatment of hepatitis B is made by the patient and health care practitioner, often in consultation with a specialist in diseases of the digestive system or liver specialist because of the huge cost and erratic response.
The decision to treat is guided by results of liver function tests, Viral load tests, and, frequently, liver biopsies after a complete history and physical examination. Treatment is usually started when blood tests indicate that liver function is deteriorating and the amount of replicating Hepatitis B is rising. The good news is that many people never reach this point. For those who do, the interval between diagnosis and starting treatment is quite variable.
It is important to note that the various medications do not cure the infection. They only reduce the ability of the virus to reproduce in the liver, providing an opportunity for the liver to heal itself.
No herbs, supplements, or other alternative therapy is known to work. In fact no specific herb or herbal preparation is recommended because they put so much pressure on the already overstressed liver to metabolise these herbs.
In severe cases, when the liver is failing in its functions, the only remedy is to do liver transplant which is not available in Ghana at the moment.
There is a vaccine against the hepatitis B virus which helps to protect from the organism. It is safe and works well to prevent the disease. A total of 3 doses of the vaccine are given over several months. In Ghana, it is part of the pentavalent vaccine (five- in- one) given to children at age 6, 10 and 14 weeks of life.
For most of us born before the introduction of this vaccine in Ghana, we need to test to see if we are free from the virus and then vaccinate ourselves against this virus if we are negative.
In general though, all health care and public safety workers who may be exposed to blood, people who have sickle cell disease, haemophilia or other blood clotting disorders and receive transfusions of human clotting factors are at increased risk and need to get the vaccine at all cost.
Hepatitis B immune globulin is given along with the hepatitis B vaccine to unvaccinated people who have been exposed to hepatitis B. These include close contacts of people with HBV infection, health care workers who are exposed to hepatitis B-contaminated blood, and infants born to mothers infected with Hepatitis B.
Giving the immune globulin and the vaccine together in these situations prevents transmission of the disease in 80 to 90 per cent of cases.
In addition to the hepatitis B vaccine, other protective ways include practicing safe sex – use of condoms; avoid premarital sex, avoiding sharing needles and other sharp equipment, etc.