The Digestive Disease Hepatitis B

A Deadly Hepatic Infection

Hepatitis B (Hep B or HBV) is an inflammation of the liver that can lead to liver scarring, liver failure, malignant tumor within the liver and death. Hepatitis B infection is a result of HBV (hepatitis B virus) invasion within the body and it is estimated that over 300 million people are infected worldwide. 

The CDC reveals that the number of individuals getting infected with hepatitis B virus per year has decreased significantly to 43,000 on an average in 2007 from about 200,000 during the 1980s. The rate of infection has been found highest in the range of 20 to 49-year-old persons. The infection can be transmitted through bodily fluids such as vaginal secretions, semen, open sores or blood.

3D illustration of the Hepatitis B virus

BSIP / UIG / Getty Images

How Can this Disease Lead to Liver Injury?

Hep B reproduces in liver cells, but the virus alone is not the problem--the immune system is. The response triggered by the virus causes inflammation and serious injuries to the liver as the immune system attempts to get rid of the virus. In most cases, there are limited damages and the human body is capable of fighting the infection off within a few months. After you're infected with HBV, your body produces antibodies that will last a lifetime so you won’t be infected with it again.

Despite the good fight put up by our organs, there are cases where the body is unable to uproot the infection, and even if you don’t show any symptoms, the virus is still there. In this situation, you remain a carrier and your blood and bodily fluids can infect other people that come into contact with you through unprotected sex, open sores, or any other avenue. Right now, there are roughly 1.25 million carriers in the U.S.

If you are a carrier, then your disease can follow two main routes: either it goes away after a while (medicine hasn’t figured out why yet) or it evolves into chronic hepatitis. If hepatitis becomes chronic, then the situation is pretty bad for the liver, as it can lead to cirrhosis and liver cancer, both deadly conditions.

It has been observed that about 5% to 10% of infected individuals who may be adults or children above the age of 5 years can develop a chronic infection. Another disappointing finding is that these rates are significantly elevated (25% to 50%) in children less than 5 years as well as those infants who caught the infection as they were born (90%).

How Does the Hepatitis B Infection Exhibit Itself?

Only 30% to 50% of people infected with HBV show symptoms from the beginning. Early symptoms can be confused with those of the flu: fever and joint pains. The symptoms that are most specific to Hepatitis B are as follows:

  • Yellow skin and yellowing of the white part of the eyes
  • Brown or orange color of the urine
  • Unexplained fatigue that lasts for a long period of time
  • Loss of appetite, nausea, vomiting
  • Abdominal pain
  • Fever

Still, for many people, none of these symptoms show and the disease is discovered only through a blood test. The first stage of an HBV infection is called acute hepatitis and rarely, it can be fatal for the liver. There were cases of acute hepatitis when the liver was damaged so badly that the patient went into a coma due to liver failure. This condition is called “fulminant hepatitis” and patients having it should be evaluated for liver transplantation.

What Determines the Level of Liver Injury?

The major determinant of the liver situation is our own immune system. People who develop a strong immune response are more likely to eliminate the virus and recover but they are also more likely to develop severe liver injury and strong symptoms. A weaker immune response may protect the liver for the moment and develop fewer symptoms, but there's also a higher risk to develop chronic hepatitis. Hence, eat healthily and live in a hygienic way to keep such infections at bay.

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  • Chen Y, Wei H, Sun R, Dong Z, Zhang J, Tian Z. Increased susceptibility to liver injury in hepatitis B virus transgenic mice involves NKG2D-ligand interaction and natural killer cells. Hepatology. 2007 Sep;46(3):706-15.
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By Naheed Ali, MD
Naheed Ali, MD, PhD, is the author of "Understanding Hepatitis: An Introduction for Patients and Caregivers."