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What is hepatitis B?

Hepatitis B is an infection caused by the hepatitis B virus.

Hepatitis B is a DNA virus. It goes into the cell, incorporates into the DNA and takes residence. Once you¡¯re infected with hepatitis B, the virus stays in the body¡¯s liver cells. Hepatitis B can cause liver inflammation. Over time, that inflammation can lead to liver damage.

Hepatitis B can be either acute or chronic, depending on how long you have had the infection.

Here¡¯s how the describes the difference:

• Acute hepatitis B is a short-term illness in the first 6 months after someone is exposed to hepatitis B.
• Chronic hepatitis B is a lifelong infection.

How does hepatitis B increase cancer risk?

Having chronic hepatitis B increases your liver cancer risk. This includes risk for the most common type of liver cancer: hepatocellular cancer.

Liver inflammation caused by hepatitis B infection can lead to liver damage. This includes:

• Fibrosis, or liver stiffening, which can be reversed
• Cirrhosis, or liver scarring or hardening, which is often permanent
• Other changes in the liver cells

Over time, this liver damage can lead to the development of liver cancer. However, hepatitis B infection can sometimes lead to liver cancer without first causing fibrosis or cirrhosis.

Hepatitis B infection has also been indirectly linked to other cancer types, including pancreatic cancer and non-Hodgkin lymphoma. This means people with a history of hepatitis B or chronic hepatitis B have been observed to develop these cancers. The evidence for these links is weaker than for liver cancer, however.

What are the symptoms of hepatitis B?

Not everyone with hepatitis B has symptoms. When a hepatitis B infection causes symptoms, they may be mild symptoms that are easily ignored. These symptoms can be very general and may include:

• Fatigue
• Appetite loss
• Nausea
• Vomiting
• Abdominal pain
• Dark urine

These symptoms are more common in adults with serious cases of acute hepatitis B infection. People with chronic hepatitis B often have no symptoms.

How does hepatitis B spread?

Hepatitis B is spread through contact with infected blood and bodily fluids, such as semen.

For instance, it may be passed from mother to child in the birthing process, or through sexual relations or IV drug use.

You cannot get hepatitis B through casual contact like kissing, hugging or sharing utensils. It is not spread through food or by coughing or sneezing.

Although the risk of transmission is high among people with chronic hepatitis B infection, those with past hepatitis B infections are not infectious to their family members or their loved ones.

How is hepatitis B diagnosed?

The screening exam for hepatitis B is a blood test. There are three hepatitis B tests used in bloodwork. During screening, your health care team may perform one or more of the following:

• Hepatitis B surface antigen: If this is positive, it means you have an active hepatitis B infection. If it stays positive for more than six months, it usually means you have chronic hepatitis B, which can increase your risk for liver disease and liver cancer.
• Hepatitis B core antibody: A positive result means you had hepatitis B in the past.
• Hepatitis B surface antibody: This shows you are protected from hepatitis B, either because you recovered from a past infection or got vaccinated.

Getting all three of these together is also called a triple panel test.

Who should be screened for hepatitis B?

The CDC recommends that all adults get screened for hepatitis B with the triple panel test we describe above at least once in their lives.

Ask your health care provider to screen you for hepatitis B if you haven¡¯t been screened.

Who is at risk for hepatitis B?

There are some known risk factors for hepatitis B, listed below. However, sometimes people with hepatitis B do not have obvious risk factors. As a result, hepatitis B testing is recommended for all adults.

You have a risk factor for hepatitis B if you:

• Were born to a mother with hepatitis B
• Were born outside the United States in a region with a high infection rate
• Have sexual contact with a person with hepatitis B
• Share items such as razors or toothbrushes with an infected person
• Have ever used IV drugs
• Have multiple sexual partners or a history of sexually transmitted disease
• Are a man who has had sex with another man
• Are exposed to blood on the job
• Had an organ transplant or blood transfusion prior to 1992
• Received clotting factor concentrates produced before 1987
• Have a history of chronic liver disease, diabetes, HIV or AIDS
• Are undergoing renal dialysis

Pregnant women should be screened for hepatitis B infection to prevent infecting their baby.

How is hepatitis B treated?

Hepatitis B can be treated with daily oral medications that control the amount of virus in your body. Managing your infection will help lower your risk for liver damage and liver cancer.

Not everyone with hepatitis B needs treatment, but they do need close monitoring. If you have hepatitis B infection, it¡¯s important that you have close follow-up care with your medical providers.

How is hepatitis B managed during cancer treatment?

At MD Anderson, we recommend that all of our patients with cancer get screened for hepatitis B. This allows our providers to identify and treat hepatitis B infections that could impact your health and cancer care.

Certain cancer therapies ¡ª such as chemotherapy, immunotherapy, bone marrow transplantation and some targeted therapies ¡ª weaken the immune system. While a healthy immune system can usually keep viral levels low, immunosuppression caused by some cancer treatments can impact the body's natural ability to keep the virus in check.

If you were to have a hepatitis B infection during cancer therapy, this could allow the hepatitis B virus to replicate unchecked and lead to hepatitis B reactivation. This could pause or delay your ability to get cancer treatment and could also lead to liver damage, liver failure or even death.

If screening reveals you have a current or past hepatitis B infection, your care team will design a personalized treatment plan. This may mean taking daily oral antiviral therapy to prevent hepatitis B reactivation during treatment or close monitoring of your lab results over time.

Because hepatitis B can lead to liver cancer, it¡¯s important for cancer patients with hepatitis B to establish a long-term relationship with their care team. This allows them to get the follow-up care and testing needed to reduce that risk.

What do you want someone diagnosed with hepatitis B to know?

First, know that hepatitis B is common. It isn¡¯t always clear how someone gets hepatitis B; it could have been caused by environmental factors and be something you¡¯ve had since you were young. The good news is that now that we know you have hepatitis B, we can do something about it.

If you have hepatitis B, follow your doctor¡¯s treatment recommendations to reduce your risk of developing liver damage and liver cancer. Here are some tips.

• Take any medication prescribed to help control your hepatitis B infection.
• Get regular check-ups so your doctor can monitor the amount of virus in your body and the condition of your liver.
• Talk to your doctor about any over-the-counter medications you take. Some over-the-counter medications, such as acetaminophen and some nutritional supplements, can hurt your liver.
• Let your loved ones know you have hepatitis B so they can be screened and take appropriate precautions, including vaccination.
• If you have chronic hepatitis B, practice safe sex and use a condom.
• Eat healthy foods.
• Avoid alcohol.
• Avoid smoking cigarettes and using tobacco.

How can you prevent hepatitis B?

The best way to protect yourself from hepatitis B is vaccination. The hepatitis B vaccine is the first anti-cancer vaccine. It can be given to infants, children and adults.

The that all people up to age 59 who haven¡¯t already been vaccinated for hepatitis B get vaccinated. Adults age 60 and older with hepatitis B risk factors should also be vaccinated.

The CDC writes that, depending on the brand of hepatitis vaccine, you will get either two shots about a month apart or three shots over a 6-month period.

If you haven't been screened for hepatitis B, get screened. If your tests show that you don't have hepatitis B and you've never been vaccinated, please get vaccinated.

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