Hepatitis B Can Be Diagnosed Through Certain Laboratory Tests. Treatment Is Not Always Necessary

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Hepatitis B Can Be Diagnosed Through Certain Laboratory Tests. Treatment Is Not Always Necessary
Hepatitis B Can Be Diagnosed Through Certain Laboratory Tests. Treatment Is Not Always Necessary

Video: Hepatitis B Can Be Diagnosed Through Certain Laboratory Tests. Treatment Is Not Always Necessary

Video: Hepatitis B Can Be Diagnosed Through Certain Laboratory Tests. Treatment Is Not Always Necessary
Video: Internal Medicine | Diagnosis & treatment of Chronic Hepatitis B | Prof. Dr. Bikram Pradhan | BPKIHS 2023, March

Hepatitis B: Symptoms, Diagnosis & Therapy

Both acute and chronic hepatitis B often cause no or only atypical symptoms. As a result, hepatitis B infection often goes unnoticed. It is not uncommon for hepatitis B to be recognized when a routine blood test unexpectedly reveals an increase in liver values and then searches for the cause. Drug treatment depends on the severity of the course. If the body is not able to fight the hepatitis B virus sufficiently, the hepatitis B cannot be completely cured, even with medication.

However, by supporting the immune system in fighting the virus or by suppressing virus replication, the risk of developing severe liver damage or secondary diseases can be reduced. The risk of infection can also be reduced through drug treatment.


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  • What are the symptoms?
  • How is the diagnosis made?
  • ">How is hepatitis B treated?
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  • Further diagnostics and check-ups
  • Whom can I ask?
  • How will the costs be reimbursed?

What are the symptoms?

Symptoms of acute hepatitis B

Clinically, acute hepatitis B cannot be distinguished from other acute liver inflammations (triggered by hepatitis A, C, D and E viruses) or autoimmune hepatitis. A third of the sick have no symptoms. Progression with jaundice only occurs in about 30 percent of cases. Hepatitis B (incubation period about six to 26 weeks) can begin with nausea, vomiting, fever and loss of appetite. As a result, the eyes and skin (jaundice, so-called jaundice) may turn yellow three to ten days after the onset of the disease. In addition to the dark color of the urine, the stool will also be light in color. It can also cause itching, joint pain and a rash. Fulminant hepatitis with the development of hepatic encephalopathy or ascites etc. are very rare.

Symptoms of chronic hepatitis B

  • Fatigue and decreased performance,
  • Poor concentration,
  • Feeling of fullness (also pain in the right upper abdomen),
  • possibly jaundice (jaundice),
  • Occasionally vascular inflammation with involvement of the kidneys, joint and muscle pain and very rarely diseases of the nervous system.

In most cases, however, chronic hepatitis B is completely symptom-free. As the disease progresses, symptoms may arise as a result of cirrhosis of the liver or hepatocellular carcinoma ().

How is the diagnosis made?

Sometimes the doctor can detect signs of inflammation of the liver during the physical examination - e.g. enlargement of the liver, which may be painful on pressure, or jaundice (jaundice). He / she may also be able to detect signs of secondary diseases such as cirrhosis of the liver. However, hepatitis B can only be diagnosed by detecting virus components or antibodies against the virus in the blood.

Note If hepatitis B is transmitted at birth, it is usually chronic in the affected child. Therefore, pregnant women are routinely checked for hepatitis B.

Laboratory evidence of hepatitis B

In the case of hepatitis B, three different parameters can be detected in the blood - depending on the stage of infection: genetic material of the virus (HBV-DNA), the body's own antibodies (anti-HBs, anti-HBe, anti-HBc-IgG, anti-HBc-IgM) and virus building blocks (antigens HBs-Ag, HBe-Ag).

You can find more information in the laboratory values table under Liver and virus infections.

  • If anti-HBc is negative (that is, undetectable) in the laboratory diagnostics, an infection can be ruled out fairly reliably.
  • If anti-HBc is detectable (anti-HBc positive), hepatitis B infection is suspected. In the case of HBc antibodies, a distinction is made between HBc-IgM and HBc-IgG. HBc-IgM antibodies can be detected in the acute stage of infection.
  • HBs antigen is mostly (90 percent) positive in hepatitis B infection.
  • Detection of HBe antigen indicates high virus activity. If it can be detected in the blood, the disease is very contagious.
  • A detection of HBe antibodies suggests that hepatitis B has healed or is chronic with a low risk of infection.
  • The level of infectivity can best be estimated by determining the number of viruses in the blood (viral load) using quantitative direct virus-DNA detection.
  • Immunity after having suffered an infectious disease is given by the presence of HBs and HBc antibodies. However, in rare situations (e.g. necessary immunosupressants), hepatitis B may reactivate.
  • The body reacts to the hepatitis B vaccination by producing HBs antibodies. Titer determinations from the blood can provide information about the possible need for a booster vaccination.

Note If you have a hepatitis B infection, you should always test for hepatitis D at the same time.

How is hepatitis B treated?

Acute hepatitis B

In most cases, acute hepatitis B is not treated. Physical rest and avoidance of substances that are harmful to the liver, such as alcohol, are recommended. The rare fulminant courses of the disease require hospital treatment. The nucleoside analog lamivudine can be used in severe cases. Liver transplantation often has to be carried out if the disease is fulminant.

Chronic hepatitis B

The primary goal of the treatment of patients with chronic hepatitis B is a permanent and long-term suppression of virus replication in the no longer detectable area. The formation of HBe or HBs antibodies (seroconversion) is also a sign of therapeutic success. The currently approved drugs cannot completely cure chronic hepatitis B. An "aggressive" form (signs of severe inflammation and scarring, increased transaminases, high levels of virus) can, however, be significantly alleviated. This reduces the risk of developing or progressing liver cirrhosis and liver cancer. In addition, the hepatitis B therapy reduces the risk of transmission.

If hepatitis B shows a "mild" course (normal or minimally increased liver values, low virus levels), drug therapy can be waited for. However, regular clinical and laboratory checks are recommended.

Note If there is a lack of immunity, vaccination against hepatitis A is recommended.

There are two different therapy concepts available for treating chronic hepatitis B.

  • Nucleoside and nucleotide analogs: Most patients today are treated with nucleoside analogues (e.g. lamivudine, telbivudine, entecavir) and nucleotide analogues (e.g. adefovir, tenofovir), which are taken as tablets. These substances intervene in the reproduction of the genetic information (DNA) of the virus. Faulty modules are installed, which lead to the abortion of the duplication. As a result, they inhibit the replication of the virus and the activity of chronic hepatitis B. Compared to older nucleoside and nucleotide analogues, the newer substances entecavir and tenofovir less often develop resistance and have fewer side effects. Doctors therefore prefer to use them. The nucleotide analog adefovir is used due to its low activity against hepatitis B viruses,its side effects and the frequent occurrence of resistance are no longer recommended.
  • Interferon alpha:Has antiviral and immunomodulatory properties, but can cause significant side effects. There are also some contraindications to interferon therapy, i.e. circumstances under which the therapy must not be carried out (e.g. advanced liver cirrhosis). The pegylated interferon alpha (PEG interferon), which is almost exclusively used today, is injected under the skin once a week. The non-pegylated interferons alpha-2a and -2b are also approved for the treatment of chronic hepatitis B. They are injected under the skin three times a week. The therapy usually lasts 48 weeks. For HBe-negative patients, it may make sense to extend the duration of therapy. The chances of success of therapy with interferon alpha depend on several factors, e.g. genotype, viral load,Level of liver enzyme GPT and HBe-Ag status. Genotypes A and B respond better to interferon therapy than genotypes C and D.

Therapy choice

All drugs for the treatment of hepatitis B require a head doctor. The specialist (specialist in internal medicine with sound hepatological knowledge) decides together with the patient which therapy is the right one for the patient. In principle, the disease situation must be considered individually for each patient. Treatment with nucleoside and nucleotide analogs usually requires years of therapy. When you stop taking these drugs, the hepatitis B virus can multiply again. Under certain circumstances, this can be so severe that fulminant hepatitis develops. This is not observed with the time-limited interferon therapy.

For each patient, due to the limited duration of the therapy, a check is made to see whether interferon therapy is possible. If it cannot be carried out or is not wanted by the patient or has been unsuccessful, nucleotide or nucleoside analogs are used.

In severe cases of acute or chronic hepatitis B, a check is carried out to determine whether a liver transplant is a possible treatment option for the affected patient.

Note The main decisive factors for the success of the therapy are avoiding the development of resistance by regularly taking the medication and keeping control appointments (adherence to therapy).

Further diagnostics and check-ups

Checks are carried out through regular physical examinations, laboratory examinations (liver tests, kidney function parameters, blood count, blood coagulation, viral load in the blood) as well as six-monthly ultrasound examinations and controls of the tumor marker (alpha-1 fetoprotein) for the early detection of hepatocellular carcinoma (liver cancer).

Note Therapy is monitored by determining the viral load. An increase in the viral load during hepatitis B therapy can be due to the development of resistance to the drug used. Drug resistance can be proven through laboratory tests.

As part of a so-called elastography, the elasticity of the liver tissue can be checked using ultrasound or magnetic resonance imaging (MRT). A reduced elasticity suggests the presence of liver cirrhosis. A tissue sample (liver biopsy) may also be required to determine the inflammatory activity in the liver and the degree of "scarring".

Whom can I ask?

Diagnosis and treatment of hepatitis B are possible in the following facilities:

  • Resident area: Specialist in internal medicine with sound hepatological knowledge,
  • special hospital outpatient department: e.g. hepatological outpatient department,
  • in the case of serious illnesses or complications at a department for internal medicine (with a focus on gastroenterology and hepatology),
  • Cash outpatient clinics with a special hepatology clinic.

How will the costs be reimbursed?

All necessary and appropriate diagnostic and therapeutic measures are taken over by the health insurance carriers. You can find more information under What does a hospital stay cost? Your resident doctor or outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (treatment contribution) (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract). For more information, see What does a hospital stay cost, a doctor's visit: Costs and deductibles.

For certain non-drug treatments (e.g. physical therapy) - in some cases only when a certain level has been reached - approval from the health insurance provider may be required.

For certain services (e.g. medical aids and medical aids) - depending on the health insurance provider - patient co-payments are provided. Most health insurance providers provide for a permit, sometimes depending on the type of medical aid. The prescription fee has to be paid for medication on a “prescription”. For more information about the respective provisions, please contact your health insurance provider, which you can find on the social security website, for example.

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