Hepatitis B

Diagnosis

Diagnosis involves the steps that your healthcare professional takes to find out if you have hepatitis B. Your healthcare professional gives you a physical exam and looks for symptoms of liver damage. These symptoms can include yellowing skin and stomach pain. Tests that can help diagnose hepatitis B or its complications are:

• Blood tests. Blood tests can detect the hepatitis B virus in your body. They also can tell your healthcare professional if the infection is acute or chronic. A simple blood test also can find out if you're immune to the condition.
• Liver ultrasound. A special ultrasound called transient elastography can show the amount of liver damage.
• Liver biopsy. Your healthcare professional might remove a small sample of your liver for testing to check for liver damage. This is called a liver biopsy. During this test, your healthcare professional inserts a thin needle through your skin and into your liver. The needle removes a tissue sample for the lab to check.

Screening healthy people for hepatitis B

Healthcare professionals sometimes test certain healthy people for hepatitis B. This is called screening. Screening is done because HBV can damage the liver before the infection causes symptoms. Talk with your healthcare professional about screening for hepatitis B if you:

• Are pregnant.
• Live with someone who has hepatitis B.
• Have had many sexual partners.
• Have had sex with someone who has hepatitis B.
• Were born male and have sex with men.
• Have a history of a sexually transmitted infection.
• Have HIV or hepatitis C.
• Have a liver enzyme test with irregular results that can't be explained.
• Receive kidney dialysis.
• Take medicines that suppress the immune system, such as those used to prevent rejection after an organ transplant.
• Use injected street drugs.
• Are in prison.
• Were born in a country where hepatitis B is common, including Asia, the Pacific Islands, Africa and Eastern Europe.
• Have parents or adopted children from places where hepatitis B is common, including Asia, the Pacific Islands, Africa and Eastern Europe.

Treatment

Treatment to prevent HBV infection after exposure

If you know you've been exposed to the hepatitis B virus, call a healthcare professional right away. It's important to know if you've been vaccinated for hepatitis B. A healthcare professional asks you when you were exposed and what kind of exposure you had.

Medicine called immunoglobulin may help protect you from getting sick with hepatitis B. You need to receive a shot of the medicine within 24 hours of exposure to the hepatitis B virus. This treatment only provides short-term protection. So you also should get the hepatitis B vaccine at the same time if you never received it.

Treatment for acute HBV infection

You might not need treatment for an acute hepatitis B virus infection. The infection is short lived and most often it goes away on its own. A healthcare professional might recommend:

• Rest.
• Proper nutrition.
• Plenty of fluids.
• Close monitoring while your body fights the infection.

If your symptoms are severe, you may need antiviral medicines or a hospital stay to prevent complications.

Treatment for chronic HBV infection

Most people with chronic hepatitis B virus infection need treatment for the rest of their lives. The decision to start treatment depends on many factors, including whether:

• The virus is causing inflammation or scarring of the liver, also called cirrhosis.
• You have other infections, such as hepatitis C or HIV.
• Your immune system is weakened by medicine or illness.

Treatment helps lower the risk of liver disease and prevents you from passing the infection to others.

Treatment for chronic hepatitis B may include:

• Antiviral medicines. Many antiviral medicines can help fight the virus and slow its ability to damage your liver. These medicines include entecavir (Baraclude), tenofovir (Viread), lamivudine (Epivir) and adefovir (Hepsera). You take them by mouth, most often for the long term. Your healthcare professional may recommend combining two of these medicines. Or the healthcare professional may have you take one of these medicines with interferon to improve treatment response.

• Interferon shots. Interferon is a lab-made version of a substance that the body makes to fight infection. This type of medicine includes peginterferon alfa-2a (Pegasys). One upside of interferon shots is that they're taken for a much shorter time than are oral antiviral medicines. But interferon has a high rate of side effects, such as upset stomach, vomiting, trouble breathing and depression.

  Interferon mainly is used for young people with hepatitis B who wish to not need long-term treatment. It's also used for women who might want to get pregnant within a few years. Women should use birth control during interferon treatment. Do not take interferon during pregnancy. Interferon also is not right for people with cirrhosis or acute liver failure.

• Liver transplant. If your liver has been badly damaged, a liver transplant may be an option. During a liver transplant, the surgeon removes your damaged liver and replaces it with a healthy liver. Most transplanted livers come from deceased donors. A small number come from living donors who donate a part of their livers.

Other medicines to treat hepatitis B are being developed.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

If you've been infected with the hepatitis B virus, take steps to protect others.

• Make sex safer. If you're sexually active, tell your partner you have HBV. Talk about the risk of your partner catching the virus from you. Use a new latex condom every time you have sex. Be aware that condoms lower the risk but don't get rid of the risk completely.
• Tell your sexual partner to get tested. Anyone with whom you've had sex needs to be tested for the virus. Your partners also need to know their HBV status so that they don't infect others. If tests show that they've been infected, they should get healthcare checkups to see if they need treatment.
• Don't share personal care items. If you use injected drugs, never share needles and syringes. And don't share razor blades or toothbrushes, because they may carry traces of infected blood.

Coping and support

If you have hepatitis B, the following tips might help you cope:

• Learn about hepatitis B. The Centers for Disease Control and Prevention is a good place to start.
• Stay connected to friends and family. You can't spread hepatitis B through casual contact, so don't cut yourself off from people who can offer support.
• Take care of yourself. Eat a healthy diet full of fruits and vegetables, exercise regularly, and get enough sleep.
• Take care of your liver. Don't drink alcohol or take new medicines without talking with your healthcare professional first. Get tested for hepatitis A and C. Get vaccinated for hepatitis A if you haven't been exposed.

Preparing for your appointment

You're likely to start by seeing your family healthcare professional. You may be referred to a specialist right away. Doctors who specialize in treating hepatitis B include:

• Doctors called gastroenterologists, who treat digestive diseases.
• Doctors called hepatologists, who treat liver diseases.
• Doctors who treat infectious diseases.

What you can do

Here's some information to help you get ready for your appointment.

• Be aware of any restrictions before your healthcare checkup. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
• Write down your symptoms, including any that may not seem related to the reason for which you made the appointment.
• Write down key personal information, including major stresses or recent life changes.
• Make a list of all medicines, vitamins and supplements you take. Include the doses.
• Take a family member or friend along if you can. Someone who joins you may help you remember the information that your healthcare team gives you.
• Write down questions to ask your healthcare professional.

For hepatitis B, some basic questions to ask include:

• What is likely causing my symptoms or condition?
• Other than the most likely cause, what are other possible causes for my symptoms or condition?
• What tests do I need?
• Is my condition likely short- or long-term?
• Has hepatitis B damaged my liver or caused other complications, such as kidney conditions?
• What is the best course of action?
• Are there other treatment choices aside from the main treatment that you've suggested?
• I have other health conditions. How can I best manage them together?
• Are there restrictions that I need to follow?
• Should I see a specialist?
• Should my family be tested for hepatitis B?
• How can I protect people around me from HBV?
• Is there a generic version of the medicine you're prescribing?
• Are there brochures or other printed material I can have? What websites do you recommend?

What to expect from your doctor

Your healthcare professional is likely to ask you questions such as:

• When did your symptoms start?
• Have you ever had jaundice symptoms, including yellowing of the eyes or clay-colored stool?
• Have you been vaccinated for hepatitis B?
• Do your symptoms happen all the time or once in a while?
• How bad are your symptoms?
• What, if anything, seems to make your symptoms better?
• What, if anything, appears to make your symptoms worse?
• Have you ever had a blood transfusion?
• Do you inject drugs?
• Have you had sex without a condom?
• How many sexual partners have you had?
• Have you been diagnosed with hepatitis?