Living with Hepatitis B doesn’t have to mean constant worry. Importantly, by making smart lifestyle changes, following medical advice, and protecting your liver, you can live a full and vibrant life. This article provides information on diagnosis and treatments, as well as practical steps for managing hepatitis B, so you can focus on your health and peace of mind.

Managing hepatitis B: What is it?

Hepatitis B, caused by the hepatitis B virus (HBV), is a serious liver infection with varying outcomes. For most people, hepatitis B is a short-term condition, lasting 6 months or less. However, some people develop chronic hepatitis B, which increases the risk of liver failure, liver cancer, and serious scarring of the liver (cirrhosis).

Fortunately, most adults with hepatitis B recover fully, even those with difficult symptoms. But infants and children have a harder time ridding their bodies of the virus and therefore have a higher risk of developing a chronic, long-lasting hepatitis B virus infection.

Because there is a potential for serious health risks early detection and effective management are critical for preventing severe complications.

Managing hepatitis B: How do you get it?

HBV is transmitted through direct contact with infected blood, semen, or bodily fluids. Importantly, it cannot spread through sneezing, coughing, sharing food, or casual encounters. Alarmingly, HBV is highly transmissible and can live on environmental surfaces for at least 7 days.

The most common ways to get hepatitis B are:

Sexual contact. You can get hepatitis B if you don’t use a condom while having sex with someone infected. The virus can pass to you if the person’s blood, saliva, semen, or vaginal fluids enter your body.
Sharing of needles and syringes. Using needles and syringes tainted with infected blood puts you at high risk of hepatitis B.
Accidental needlesticks. HBV is a concern for healthcare workers and anyone else who comes in contact with human blood.
Pregnant person to newborn. Pregnant people infected with HBV can pass the virus to their babies during childbirth. Importantly, in most cases, a newborn can be vaccinated to prevent infection.

Preventing hepatitis B transmission.

Fortunately, you can prevent hepatitis B by getting vaccinated.

Additionally, other simple ways to help stop the spread of hepatitis B include:

Wash your hands thoroughly with soap and water after any potential exposure to blood.
Use condoms during sexual encounters.
Avoid direct contact with blood and bodily fluids.
Clean up blood spills with a fresh diluted bleach solution (mix 1 part bleach with 9 parts water).
Cover all cuts carefully.
Avoid sharing sharp items such as razors, nail clippers, toothbrushes, and earrings or body rings.
Discard sanitary napkins and tampons into plastic bags.
Do no inject illegal street drugs.
Make sure new, sterile needles are used for ear or body piercing, tattoos, and acupuncture.

Managing hepatitis B: Symptoms

Importantly, you can have Hepatitis B without any signs or symptoms. In fact, approximately 50–70% of people with acute hepatitis B have no symptoms. The lack of symptoms makes it easy to unknowingly transfer the virus to other people.

However, you may experience the symptoms outlined below.

Acute hepatitis B symptoms.

There are three phases of acute hepatitis B infection, each with their own symptoms. Recognizing hepatitis B symptoms is essential since chronic hepatitis B progresses through stages. Early intervention and regular monitoring can prevent severe liver damage.

Early in the disease, called the prodromal phase, symptoms may include:

Fever.
Joint pain or arthritis.
Rash.
Edema (swelling).

The next phase, the preicteric (pre-jaundice) stage, can include the following symptoms:

Fatigue.
Myalgia (muscle pain).
Anorexia.
Nausea and/or vomiting.
Fever.
Cough.
Abdominal pain and/or diarrhea.
Dark urine and light stool color.

During the icteric (jaundice) phase, symptoms can include:

Jaundice (yellowing of the skin and whites of the eyes).
Increased anorexia, nausea, and vomiting.
Irritated skin lesions.

Interestingly, in this phase, other symptoms may subside.

Chronic hepatitis B symptoms.

Most patients with chronic hepatitis B experience no symptoms unless their disease progresses, although others may experience nonspecific symptoms, such as fatigue.

However, for some patients, a worsening of the infection leads to symptoms similar to those of acute hepatitis.

If patients with chronic hepatitis B progress to cirrhosis (severe scarring of the liver) patients will develop signs and symptoms of liver failure, including:

Jaundice.
Splenomegaly (an enlarged spleen).
Ascites (fluid retention in the abdomen).
Peripheral edema (swelling of extremities, especially in the legs and feet).
Encephalopathy (A build-up of toxins in the blood which can affect brain function, leading to confusion.)
Liver cancer (hepatocellular carcinoma).

Managing hepatitis B: When should you see a doctor?

If you know you’ve been exposed to the hepatitis B virus, call your healthcare professional right away. Importantly, a preventive treatment may lower your risk of infection if you receive the treatment within 24 hours of exposure to the virus.

Additionally, if you think you have symptoms of hepatitis B, call your healthcare provider.

Importantly, if you receive a hepatitis B diagnosis, all sexual partners and close family or household members should be tested for hepatitis B and vaccinated if needed.

Finding a liver specialist.

If your doctor diagnoses you with hepatitis B (or suspects you may have it) you should find a liver specialist for consultation, treatment, and monitoring.

To find a specialist, start by asking your primary care doctor for a referral. Liver specialists are often hepatologists, gastroenterologists, or infectious disease doctors. Additionally, you can use the Hepatitis B Foundation’s directory of liver specialists to find a doctor in your geographic area. Note that you may have to go to a larger hospital or a research/teaching hospital to find a qualified specialist.

Managing hepatitis B: Getting a diagnosis.

The hepatitis B diagnostic process begins with a thorough physical examination, during which you describe your symptoms and medical history. Additionally, your doctor will run diagnostic tests and may perform a liver biopsy.

Diagnostic tests.

To diagnose (and monitor) hepatitis B, doctors typically include the following diagnostic tests:

Blood tests for hepatitis B markers.
Blood tests for liver enzymes.
Complete Blood Count (CBC).
Blood tests indicating liver function.
Blood tests for liver cancer screening.

Additionally, your doctor may order an MRI or ultrasound to estimate the amount of scar tissue in the liver (called fibrosis), which results from liver inflammation over time.

Liver Biopsy

During a liver biopsy – performed with anesthesia – the surgeon removes liver tissue which is analyzed in a pathology lab. A biopsy can determine if you have hepatitis B and the degree of scar tissue.

A biopsy is generally ordered if:

Other tests were inconclusive.
Your symptoms are not typical.
Your doctor found evidence of chronic liver disease.

Managing hepatitis B: Regular monitoring is critical.

Importantly, regular monitoring of children, teens and adults with chronic hepatitis B infection reduces the risk of cirrhosis, liver failure, or liver cancer. Early detection of a serious liver problem increases one’s treatment options and improves long-term health outcomes.

For adults, the standard recommendation of care is to see a liver specialist (or other qualified provider) every six months, although this timeframe is dependent on your situation. During these check-ups, your doctor will conduct a physical exam and order the tests described above in the diagnostic section.

However, you should see a healthcare professional if you notice increased fatigue, worsening jaundice, or abdominal swelling.

Managing hepatitis B: Treatments.

Fortunately, many patients with acute hepatitis B recover without treatments. Moreover, people living with chronic hepatitis B can expect to live a long, healthy life.

However, if you have chronic hepatitis B, you will need treatment to suppress the virus and reduce the risk of long-term complications. Unfortunately, there is currently no cure.

Hepatitis B treatment: Medication

There are currently five FDA-approved oral medications and one injection available to treat hepatitis B. These medications, which help control the virus and reduce the risk of developing more serious issues, fall into two categories:

Immune modulator Drugs – These interferon-type drugs boost the immune system to help get rid of the hepatitis B virus. These drugs are injected over a period of 6 months to 1 year.
Antiviral Drugs – These drugs stop or slow down the hepatitis B virus from reproducing, which reduces the inflammation and damage of your liver. These drugs are pill taken once a day for at least 1 year and usually longer.

Current treatments, however, are generally found to be most effective in those who show signs of active liver disease (e.g. through a physical exam, blood tests and imaging studies such as an ultrasound).

Importantly, the newer oral medications – which have very few side effects – are stronger and less likely to develop viral resistance.

When taking one of these medications, you will likely undergo periodic blood tests to monitor drug resistance and determine whether the medication is having an effect.

Clinical trials for hepatitis B.

In addition to the FDA-approved drugs, you may be eligible for a clinical trial evaluating new hepatitis B medications. Learn more about hepatitis B clinical trials on the Hepatitis B Foundation’s website.

Hepatitis B treatment: Liver Transplant

You may need a liver transplant if your chronic hepatitis B infection leads to cirrhosis (severe scarring of the liver), liver cancer or end stage liver disease. Rarely, acute hepatitis B can cause severe liver failure which requires liver transplantation.

Lifestyle improvements can reduce your risk of complications.

There are decisions you can make to protect your livers such as seeing a liver specialist or health care provider regularly, avoiding alcohol and tobacco, and eating healthy foods.

Nutrition tips for people with hepatitis B.

Importantly, doctors know liver function improves when people with hepatitis B eat a nutritious, well-balanced diet with whole grains, fruits, vegetables, and lean proteins. Conversely, highly processed foods, fats, red meat, and sugary foods make the liver work harder.

Although eating a healthy diet will not cure hepatitis B, it can increase the likelihood of your liver recovering completely due to a reduced stress on your liver.

Foods to eat if you have hepatitis B.

You can enjoy a wide variety of foods, including lean meats, fish, whole grains, vegetables, and fruit. Interestingly, experts recommend you eat smaller, more frequent meals throughout the day.

Healthy foods to eat include:

All types of vegetables, but plenty of broccoli, cabbage, cauliflower, collard greens, and other cruciferous vegetables.
Lean proteins, including fish, meat, and eggs.
Nuts and seeds.
Whole grains and cereals, including brown rice, quinoa, barley, beans, lentils, and oatmeal.
Fruit.
Low-fat dairy items, including cottage cheese and skim milk.
Fortified soy products, including tofu.
Vegetable oils, including olive and rapeseed.

Although you can eat fruit and vegetables raw or cooked, experts advise you to carefully wash all fruits and vegetables to remove any insecticides.

Foods to avoid if you have hepatitis B.

Foods to reduce or eliminate from your diet include:

Fast food.
Fried foods, including potato chips.
Full fat dairy products, including cream and butter.
Saturated fats.
Highly processed foods, including hot dogs, cured meats such as ham, store-bought salad dressings, and sweetened breakfast cereals.
Salty foods and salt.
Rich sauces and relishes.
Sugary foods and drinks, including sodas, cookies, and many packaged baked goods.
Raw or undercooked shellfish.

Other lifestyle tips.

People with hepatitis B can benefit from simple lifestyle changes including:

Quitting smoking, if applicable.
Staying hydrated by drinking lots of water.
Avoiding or cutting back on alcohol.
Achieving and maintaining a moderate weight.
Staying physically active.
Checking with your pharmacist or doctor before taking any new prescription or over-the-counter medications, including vitamins or herbal supplements.

Minimize your stress.

Chronic stress can worsen inflammation and harm liver health. Managing stress is crucial for controlling your condition and improving overall wellness. Consider these suggestions:

Practice stress management techniques.

Simple relaxation methods like deep breathing, meditation, or tai chi can lower stress. Even 10 minutes a day can make a difference over time.

Find a support network.

Importantly, hepatitis B support groups can provide much needed emotional comfort along with practical tips from others with similar experiences. Look online for a group or connect through a local hepatitis B organization.

Learn more…

To help yourself get the best healthcare and outcome possible, it’s important to be an engaged, empowered, effective member of your medical team. Read these posts for tips:

I wrote this article in collaboration with Tim Yu from Mediway Medical Centre, Singapore’s trusted provider of health screenings and expert care you can rely on.

Managing Hepatitis B: Tips to Stay Healthy

Managing hepatitis B: What is it?