An inflammatory process in the liver characterized by diffuse or patchyhepatocellular necrosis affecting all acini.

Pathologically this can be due to a range of causes:

*viruses infection, often extremely contagious
*bacteria or other micro-organisms
*parasitic infestation
*toxic damage due to alcohol or other drugs (both recreational &therapeutic), as well as some plant poisons such as pyrolizadine alkaloids.

The differential diagnosis between viral hepatitis, chronic non-viral hepatitis and alcohol induce liver disease is crucial. However all forms of active hepatitis are characterized by malaise, anorexia, fatigue, sometimes initiated with `flu like symptoms, and often associated with a range of specific signs from vomiting to jaundice.

Actions indicated for the processes behind this disease
Hepatics have a positive effect upon liver metabolism and functioning.
Anti-microbials will be crucial if there is an ineffective basis to the hepatitis. Even if the herbs cannot deal with the specific virus, they will be helpful as surface immune support.
Bitters will contribute there unique brand of whole body toning.
Cholagogues are remedies that have a direct upon the secretion and release of bile, and so might be indicate if jaundice is present.
"Eliminative support" must be given to help the body as a whole deal with the systemic problems caused by the liver dysfunction. Laxatives, diuretics and diaphoretics are the most important ones to consider.
Alteratives/Tonics will support the body as a whole in its healing work.
Lymphatics support the tissue drainage work of this important system.
Nervines may be needed for symptomatic support.

Hepatitis B Virus
The hepatitis B virus is a small DNA virus that belongs to the Hepadnaviridae family of viruses. The hepatitis B virus causes hepatitis B in humans. Related viruses in this family cause hepatitis in ducks, ground squirrels and woodchucks.

The hepatitis B virus contains an inner core and outer envelope. There is an outer shell (or envelope) composed of protein that is termed "surface antigen" or "HBsAg".

The surface antigen is generally produced in vast amounts, and the hepatitis B blood tests can detect this portion of the virus in the blood of infected individuals.

The outer shell surrounds an inner protein shell that is referred to as the core particle or "HBcAg", which contains the viral DNA and enzymes used in viral replication (called "DNA polymerase").

Statistics

Most healthy adults (90%) who are infected will recover and develop protective antibodies against future hepatitis B infections. A small number (5-10%) will be unable to get rid of the virus and will develop chronic infections. Unfortunately, this is not true for infants and young children – 90% of infants and up to 50% of young children infected with hepatitis B will develop chronic infections. Therefore, vaccination is essential to protect infants and children.

Hepatitis B is 100 times more infectious than the AIDS virus, yet it can be prevented with a safe and effective vaccine. For the 400 million people worldwide who are already chronically infected with hepatitis B, the vaccine is of no use. The future, however, is much brighter with the current advances in drug development and treatment options.

Hepatitis B In the World
*2 billion people have been infected (1 out of 3 people).
*400 million people are chronically infected.
*10-30 million will become infected each year.
*An estimated 1 million people die each year from hepatitis B and its complications.
*Approximately 2 people die each minute from hepatitis B.

Hepatitis B In the United States
-12 million Americans have been infected (1 out of 20 people).
-More than one million people are chronically infected .
-Up to 100,000 new people will become infected each year.
-5,000 people will die each year from hepatitis B and its complications.
-Approximately 1 health care worker dies each day from hepatitis.

Transmission

Hepatitis B is transmitted through blood and infected bodily fluids.

This can occur through:

-direct blood-to-blood contact
-unprotected sex
-unsterile needles
-from an infected woman to her newborn during the delivery process.

Other possible routes of infection include sharing sharp instruments such as razors, toothbrushes or earrings. Body piercing, tattooing and acupuncture are also possible routes of infection unless sterile needles are used

Hepatitis B is NOT transmitted casually. It cannot be spread through sneezing, coughing, hugging or eating food prepared by someone who is infected with hepatitis B. Everyone is at some risk for a hepatitis B infection, but some groups are at higher risk because of their occupation or life choices.

High Risk Groups

*Health care workers and emergency personnel
*Infants born to mothers who are infected at the time of delivery
Partners or individuals living in close household contact with an *infected person
*Individuals with multiple sex partners, past or present
*Individuals who have been diagnosed with a sexually transmitted disease
*Illicit drug users (injecting, inhaling, snorting, popping pills)
*Men who have sex with men
*Individuals who received a blood transfusion prior to 1992
*Individuals who get tattoos or body piercing
*Individuals who travel to countries where hepatitis B is common (Asia, Africa, South America, the Pacific Islands, Eastern Europe, and the Middle East)
*Individuals emigrating from countries where hepatitis B is common, or born to parents who emigrated from these countries (see above)
*Families adopting children from countries where hepatitis B is common (see above)
Individuals with early kidney disease or undergoing kidney dialysis
Individuals who use blood products for medical conditions (i.e.hemophilia)
*Residents and staff of correctional facilities and group homes

Symptoms

Hepatitis B is called a "silent infection" because most people do not have noticeable symptoms when they are first infected. When a healthy adult is infected with the hepatitis B virus, their body can respond in different ways. People who do not know they are infected can unknowingly pass the virus to others.

*Hepatitis B causes no symptoms in about 69 percent of infected people.
*Approximately 30 percent of infected individuals will have some symptoms. Many will think they just have the flu and ignore the symptoms.
*About 1 percent of those infected will develop life-threatening "fulminant hepatitis". These people may go into liver failure and require immediate medical attention. Although this response is rare, fulminant hepatitis develops suddenly and can be fatal if left untreated.
Common symptoms of hepatitis B infection include:

*Fever, fatigue, muscle or joint pain
*Loss of appetite
*Mild nausea and vomiting

Serious symptoms that require immediate medical attention and maybe even hospitalization:

-Severe nausea and vomiting
-Yellow eyes and skin ("jaundice")
-Bloated or swollen stomach

It is always a good idea to talk to your doctor if you don't feel well or if you are uncertain about whether you have been infected with hepatitis.

Acute vs. Chronic Hepatitis B
When a person is first infected with the hepatitis B virus, this is called an "acute infection". A person may not have any symptoms or s/he could become seriously ill. Most adults will recover and get rid of the virus without any problems. If the virus remains in the blood for more than six months, then a person is diagnosed as having a "chronic infection".

Fortunately, most healthy adults (90%) who are infected with the hepatitis B virus will recover and develop protective antibodies against future hepatitis B infections.

Unfortunately, this is not true for infants and young children — 90% of infants and up to 50% of young children infected with hepatitis B will not get rid of the virus and will develop a chronic infection. A smaller number of infected adults (5-10%) will also become chronically infected with hepatitis B.



Acute Hepatitis B
A patient with an acute infection will test positive for the hepatitis B virus (HBsAg), HBc-IgM, and possibly the HBe-antigen.

An acute hepatitis B infection follows a relatively long incubation period — from 1 to 6 months (with or without symptoms) and infected persons are able to pass the virus to others at this stage;

Therefore, the screening and vaccination of close family/household members and sexual partners is advised. Repeat blood tests over a six-month period are needed to diagnose recovery or chronic infection.


Chronic Infections

The risk of developing a chronic hepatitis B infection is directly related to the age at which one becomes infected with the virus:

**90% of infants exposed to the hepatitis B virus will develop chronic hepatitis B infections
**Up to 50% of young children exposed to the hepatitis B virus between the ages of 1 and 5 years will develop chronic infections
**5 - 10% of healthy adults who are infected will develop chronic infection.

Diagnosis of Chronic Hepatitis B

People who test positive for the hepatitis B virus (HBsAg) for more than six months are diagnosed as having a chronic infection. This means they were not able to get rid of the virus and it still remains in their liver and blood. Since chronically infected individuals can pass the virus on, they should follow safe sex practices and avoid spreading their blood to others. Sex partners and close family/household members should be screened and vaccinated.

Being diagnosed as having hepatitis B can be upsetting,but the good news is that most people with chronic hepatitis B should expect to live a long and healthy life. Altough there is an increased risk for developing serious liver disease later in life, there are also several treatments available that can slow down the virus.

The future is bright for all those living with chronic hepatitis B and a cure is on the near horizon. Approved and experimental treatments exist for chronic hepatitis B. Visit our HBF Drug Watch and Hepatitis B Clinical Trial pages for more information.

To find a liver specialist in your area, visit the HBF Directory of Liver Specialists. If you would like to recommend a liver specialist, please contact us.

We also have a glossary to help you to understand the terms used in diagnosing and treating hepatitis B.

Approved Drugs for Adults

The future looks bright for individuals living with chronic hepatitis B. Only a decade ago there were no treatment options. Although there is still no complete cure for hepatitis B, there are 6 approved drugs for adults (2 for children) and many promising new drugs in development. Current treatments seem to be most effective in those who show signs of active liver disease

Not every person with chronic hepatitis B needs to be on medication. You should talk to your doctor about whether you are a good candidate for drug therapy or a clinical trial. Be sure that you understand the pros and cons of each treatment option.

Whether you decide to start treatment or not, it is very important to be seen by a liver specialist or doctor knowledgeable about hepatitis B on a regular basis.

Approved Hepatitis B Drugs in the United States
--Interferon-alpha (Intron A) is given by injection several times a week for six months to a year, or sometimes longer. The drug can cause side effects such as flu-like symptoms, depression, and headaches. Approved in 1991 and available for both children and adults.
--Pegylated Interferon (Pegasys) is given by injection once a week usually for six months to a year. The drug can cause side effects such as flu-like symptoms, depression and other mental health problems. Approved May 2005 for adults.
--Lamivudine (Epivir-HBV, Zeffix, or Heptodin) is a pill that is taken once a day, with almost no side effects, for at least one year or longer. The possible development of hepatitis B virus mutants during and after treatment is a concern. Approved in 1998 and available for both children and adults.
--Adefovir dipivoxil (Hepsera) is a pill taken once a day, with few side effects, for at least one year or longer. Kidney problems can occur while taking the drug and is a concern, but are reversible once the drug is stopped. Approved September 2002 for adults. Pediatric clinical trials are being planned.
--Entecavir (Baraclude) is a pill taken once a day, with almost no side effects for up to one year. It is considered to be the most potent oral antiviral drug for chronic hepatitis B to date. Approved April 2005 for adults. Pediatric clinical trials may be planned for the future.
--Telbivudine (Tyzeka, Sebivo) is a pill taken once a day, with almost no side effects for up to one year. Studies have shown that it rapidly and profoundly suppresses HBV levels. Approved October 2006 for adults.

Who Should Be Treated

The decision of whether to start treatment (or enroll in a clinical trial) should be based on careful evaluation of your physical exam, blood tests, and liver biopsy (if one is done). Be sure you see a liver specialist (hepatologist) for the most current information about hepatitis B therapies.

Studies show that the current treatments appear to be of greatest benefit to those who show signs of active liver disease:

*Elevated liver enzymes (ALT)
*Positive blood tests for:
Hepatitis B virus (HBsAg)
Hepatitis B e-antigen (HBeAg)
*Elevated levels of hepatitis B DNA
Some doctors may order a liver biopsy (this involves taking a small sample of your liver to examine under the microscope) to help decide whether treatment is needed, but this practice is not as common as it used to be.

It is always a good idea to get a second opinion before starting any treatment.

Although the FDA has approved these six drugs for chronic hepatitis B, they do not provide a complete cure, except in rare cases (a "cure" generally means that a person loses the hepatitis B virus and develops protective surface antibodies).

The drugs, however, significantly decrease the risk of liver damage from the hepatitis B virus by slowing down or stopping the virus from reproducing. As with HIV, it appears that combination therapy will probably be the most effective method of combating chronic hepatitis B infections.

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