Chronic hepatitis B

Hepatitis B is a virus that causes inflammation of your liver. Chronic hepatitis B is when you test positive for the hepatitis B virus for more than 6 months after your first blood test result.

Key points

  1. Most adults who get hepatitis B recover fully. This is called acute hepatitis B
  2. If you get diagnosed with chronic hepatitis B, this means that your immune system was not able to get rid of the hepatitis B virus and it is still in your blood and liver.
  3. The risk of developing chronic hepatitis B is related to the age at which you first become exposed to the hepatitis B virus. Most babies or children who are infected with hepatitis B are unable to clear the virus from their liver and it stays there for the rest of their life.
  4. Chronic hepatitis B infection can cause significant damage such as cirrhosis, liver failure or liver cancer. In cirrhosis, your liver becomes small and hard and if untreated, loses its function, leading to bleeding from your gut and liver failure.
  5. Most people with chronic hepatitis B can expect to live a long and healthy life because there are medicines that can control and even stop the hepatitis B virus from further damaging your liver. 

Who is most at risk of developing chronic hepatitis B?

The risk of developing chronic hepatitis B is related to the age at which you first become exposed to the hepatitis B virus. Most babies or children who are infected with hepatitis B are unable to clear the virus from their liver and it stays there for the rest of their life:

  • infants who are infected at age less than 1 year: 9 out of every 10 infants will develop chronic hepatitis B infection
  • children who become infected at aged 1 to 4 years: 3 of every 10 children will develop chronic hepatitis B infection
  • adults who get hepatitis B: less than 5 out of every 100 adults will develop chronic hepatitis B infection.

Also at higher risk are:

  • people born in New Zealand prior to the introduction of national vaccination in 1988
  • immigrants from countries with limited access to vaccination
  • people of Māori, Pasifika, South-East Asian or Chinese ethnicity.

How is chronic hepatitis B diagnosed?

There are several blood tests available that can identify whether you are currently infected or have developed immunity to hepatitis B. Your sexual partners and people living in your household should also get tested. If you are diagnosed with chronic hepatitis B infection, you will require life-long blood and liver tests at least every 6 months to assess the condition of your liver.

Learning that you have chronic hepatitis B infection can be very upsetting. Because most people do not have symptoms and can be diagnosed decades after their initial exposure to the hepatitis B virus, it can be a shock and a surprise to be diagnosed with chronic hepatitis B. The good news is that most people with this condition can expect to live a long and healthy life because there are medicines that can control and even stop the hepatitis B virus from further damaging your liver.

If you have been diagnosed with chronic hepatitis B, contact The Hepatitis Foundation of New Zealand freephone 0800 332 010. They provide a free hepatitis B follow-up programme with information, support and regular blood tests. 

How is chronic hepatitis B treated?

Chronic hepatitis B is not curable and life-long treatment is usually required. Long-term treatment is well tolerated and will prolong your survival. The treatments aim to prevent the virus being active and multiplying in your liver and causing long-term liver damage and liver cancer. In New Zealand the main medicines to treat chronic hepatitis B are entecavir and tenofovir tablets. Pegylated interferon (Pegasys) injection is used for some people.
Entecavir tablets are taken once a day. Nearly everyone who takes entecavir achieves viral suppression (undetectable levels of hepatitis B) and improved liver blood tests. However, the virus is still present in your blood. Read more about entecavir.
Tenofovir tablets are also taken once a day. It is a suitable option for treatment of HIV infection and chronic hepatitis B and for pregnant women who have chronic hepatitis B. Read more about tenofovir.

What self care can I do with chronic hepatitis B?

Reduce alcohol intake

Regular and heavy alcohol intake will increase liver damage and your risk of cirrhosis and dying from a complication of hepatitis B. It is recommended you keep alcohol intake to a minimum to reduce the risk of developing hepatitis-related complications. Reducing your alcohol intake is the single most important lifestyle change you can make. Patients with cirrhosis are advised not to drink alcohol at all.

Reduce cannabis use

Heavy cannabis use is associated with increased liver scarring. By reducing or stopping cannabis use, you will slow the progression of liver damage.

Reduce the risk of fatty liver disease

Fatty liver is a condition where excess fat builds up inside the cells in your liver. Fatty liver may speed up the progression of scarring in people with chronic hepatitis B. Maintaining a healthy lifestyle will prevent this.

Avoid fatty liver by:

  • staying within a healthy weight range
  • avoiding foods and beverages containing a lot of fats and/or sugars
  • being active every day
  • eating a healthy, well-balanced diet
  • managing your diabetes well, if you have it
  • take steps to reduce your risk of developing diabetes by maintaining a healthy weight, being active every day and eating a healthy diet.

Support for people with hepatitis B

The Hepatitis Foundation of NZ provides a follow-up programme for people with hepatitis B. This is free and their community nurses help follow-up people in the community, through home visits, to provide education and support to individuals and families. 

Learn more

Hepatitis B The Hepatitis Foundation of New Zealand
Hepatitis B
The Immunisation Advisory Centre, NZ
Hepatitis B Ministry of Health, NZ 

References

  1. Hepatitis B: treatments now available for primary care BPAC, NZ, 2018
  2. Management of chronic hepatitis B: a guide for health professionals Hepatitis Foundation NZ
Credits: Health Navigator Editorial Team .