Hepatitis B (cont.)
Mary D. Nettleman, MD, MS, MACP
Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
In this Article
- Hepatitis B facts
- What is hepatitis?
- How is the hepatitis B virus spread (transmitted)?
- What are the symptoms of acute hepatitis B?
- What are the symptoms of chronic hepatitis B?
- How is hepatitis B diagnosed?
- What is the role of a liver biopsy in chronic hepatitis B?
- What is the natural course of chronic hepatitis B?
- What medications are used to treat hepatitis B?
- What are the effects of alcohol on hepatitis B?
- What are the effects of immunosuppressive medications on hepatitis B?
- What is delta hepatitis?
- What about co-infection with hepatitis B virus and hepatitis C virus?
- What happens in co-infection with hepatitis B virus and HIV?
- What is the role of liver transplantation in hepatitis B?
- What can be done to prevent hepatitis B?
- What is new in the treatment of hepatitis B?
- Find a local Gastroenterologist in your town
What are the effects of alcohol on hepatitis B?
Agents that damage the liver are particularly harmful in patients who already have hepatitis B. For this reason, it is recommended that people with hepatitis B avoid drinking alcohol.
What are the effects of immunosuppressive medications on hepatitis B?
Even in people with chronic hepatitis B, the immune system is working to suppress the virus. Medications that suppress the immune system allow the virus to reproduce in large numbers and may cause the hepatitis to flare.
Examples of medications that suppress the immune system are:
- prednisone: used to treat many diseases, including asthma, inflammatory bowel disease, and certain types of skin disease and arthritis
- methotrexate (Rheumatrex, Trexall): used to treat certain types of skin disease, arthritis, and cancer;
- cyclophosphamide (Cytoxan): used to treat some cancers.
If an immunosuppressant drug is stopped, the body's immune system's activity may rebound and cause severe inflammation of the liver.
What is delta hepatitis?
Delta hepatitis is caused by a virus that only infects people who already have hepatitis B. The delta hepatitis virus (also known as hepatitis D or HDV) is an RNA virus, meaning that its genetic material is made up of ribonucleic acid. It is spread through exposure to contaminated blood, especially with illicit, intravenous drug use, and by sexual contact. Delta hepatitis can be acquired at the same time as acute hepatitis B. When this happens, infected people are quite sick but more than 95% are eventually able to eliminate the viruses from their bodies. People who already have chronic hepatitis B can acquire delta hepatitis as well. This often causes severe inflammation of the liver, and the viruses are less likely to be cleared.
Delta hepatitis makes chronic hepatitis B much worse. It increases the risk of complications, especially cirrhosis, which occurs in up to two-thirds of patients.
There is no vaccine against delta hepatitis. Interferon treatment may cause improvement in the hepatitis, but relapse is common after therapy is stopped. Prevention includes avoiding contaminated needles and practicing safer sex (abstaining or limiting the number of partners, using barrier methods of contraception). Universal vaccination of newborns with hepatitis B vaccine effectively prevents delta hepatitis because the delta hepatitis virus only causes disease in the presence of hepatitis B virus.
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