Hepandnavirus or Hepatitis B Virus

The hepandnavirus is also known as hepatitis B virus. Acute course of hepandnavirus or hepatitis B infection is self-limiting and last for 6 to 8 weeks and in most cases there is no trace of virus observed in blood. Chronic hepatitis B infection lasts for prolong or life time. Individual suffering with chronic hepatitis B viral infection of lever has higher risk of developing cirrhosis or hepatocellular carcinoma. Hepandinavirus is classified as ds-DNA viruses. There are seven subtype of hepandnavirus or hepatitis B viruses are identified. The virus causes infection in human, apes and birds. The prolong chronic infection of liver often results in hepatocellular carcinoma and cirrhosis. Published data suggests in Europe 50% of cases suffering with hepatocellular carcinoma had history of suffering with hepatitis B viral infection.

The viruses are transmitted from infected individual to healthy individual by direct contact. Direct contact may involve touch and sharing common objects. Viruses are also transmitted during sexual contact through semen and saliva. The transmission of virus is also common when infected blood is transfused from asymptomatic donor. Infection is also observed in patient undergoing hemodialysis, following sharing needle or use of piercing of tattoo needle in infected and healthy individual. Mother of newborn suffering with Hepatitis B infection may transfer viruses during pregnancy or at the time of delivery to fetus.

Initial phase of hepadnavirus infection or hepatitis b virus infection is often asymptomatic and may last for 4 to 6 weeks. Acute asymptomatic infection of hepatitis B may disappear with no residual symptoms or any liver disease.

• Mild fever
• Headache
• Loss of appetite
• Body ache and muscle pain

• Nausea and Vomiting
• Jaundice
• Itchy skin
• Pale stool
• Yellow dark urine
• Jaundice- eye
• Pain right side

• Generalized weakness and fatigue
• Unusual and excessive bleeding while shaving or following minor injury
• Frequent bruising
• Severe itching
• Jaundice
• Dark urine
• Ascites– fluid accumulated abdomen
• Leg selling or edema
• Weight loss
• Hepatic encephalopathy- Slur speech, Confusion and drowsiness
• Spider like capillaries spread over the skin of extremities and upper body
• Testicular atrophy
• Gynecomastia- Breast enlargement in men

• Abdominal pain mostly localized on right side.
• Bruising and bleeding
• Enlarged abdomen secondary to ascites (fluid in abdominal cavity) and enlarged liver.
• Jaundice- Yellow skin, dark urine and yellow conjunctiva
• Rapid weight loss in short period of time.

• Rare
• Peripheral edema because of retention of fluid results in swelling of hands, feet and face.
• Weight gain
• Loss of appetite
• Hematuria- blood in urine

• Liver enzyme
• Elevated alkaline phosphatase levels
• Antigen or antibody Assays- During initial phase of the disease Surface antigen are detected in blood. Surface antigen are not seen during later phase of the disease. The most reliable test to diagnosed hepatitis B is to detect Ig M antibodies during chronic stage of disease. Higher rate of viral replication often causes increase concentration of antigen HBeAg, which is also detected in blood examination.

• Biopsy Procedure- Local anesthesia is used for placement of needle. Needle is placed within the liver tissue under ultrasound guidance. The liver tissue is aspirated and sent for lab study.
• Hepatocellular Carcinoma- If symptoms suggest patient may be suffering with hepatocellular carcinoma. The biopsy will confirm the diagnosis.
• Cirrhosis- Diagnosis of cirrhosis is confirmed following biopsy results.

Treatment depends on severity of the disease. The acute phase and chronic phase of hepatitis B demands different treatment. Complications like cirrhosis and hepatocellular carcinoma are treated aggressively to prevent life threatening conditions.

• No treatment
• Hydration
• Healthy food

• Tylenol and NSAIDs prescribed for fever, body ache and muscle pain.
• Hydration- drink plenty of water, IV fluid if patient is consistently suffering with nausea and vomiting.
• Antiviral Drugs- Chronic hepatitis and presence of viruses in blood is treated with antiviral medications such as Epivir, adefovir, tenofovir and telbivudine.
• Interferone Injection- Available in 3 forms described as alpha, beta and gamma interferon. The medication improves immune response against Hepatitis B virus.
• Healthy food

• Fluid Retention- Cirrhosis causes fluid retention, which is treated with fluid restriction, low sodium or salt intake and diuretics.
• Paracentesis- Excessive fluid around abdominal cavity (ascites) and lung (pleural effusion) is removed by placing needle through the skin under ultrasound guidance following local anesthesia.
• TIPS (Trans-jugular Intrahepatic Porto-systemic Shunt)- The fluid from abdominal cavity is moved into jugular vein.

• Beta blocker- Beta blocker constricts the enlarged esophageal blood vessels and stops bleeding.
• Sclerotherapy- Procedure is performed to stop bleeding. The fibrosing agents injected into esophageal variceal using endoscopy.
• Balloon Tamponade- The balloon is pass into esophagus and placed against the surface of esophagus which is bleeding from variceal. The balloon is expanded to apply pressure against bleeding blood vessels to stop the bleeding.

• Low Protein Diet- The liver metabolism is restricted in patient suffering with cirrhosis and hepatocellular carcinoma. Increased protein diet causes building up of toxins, which are not metabolized by liver. Low protein diet is advised.
• Lactulose- Lactulose helps to neutralize ammonia and other protein metabolites resulting in less toxin in the blood. The treatment along with low protein diet prevents symptoms of encephalopathy.

• Liver transplant is considered in extreme cases of liver failure secondary to cirrhosis.

• Vaccine series of 3 to 4 injection.
• Adult and children at risk should be vaccinated
• Combination vaccine against Hepatitis A and B (Twinrix)

• Condom- Use condom to prevent transmission of virus during sex through semen.
• Avoid sharing needle- Needle is contaminated when used by an infected patient. Hepatitis B virus is transmitted into normal person when same needle is shared and used.
• Avoid tattoo- Viruses are transmitted from one individual to another when the same tattooing needle is used to engrave tattoo in patient suffering with Hepatitis B and then reused in normal individual.
• Gloves- Nurses, lab technician and doctors should use gloves if handing blood sample or treating patient suffering with hepatitis B in close contact.
• Alcohol- Patient suffering with hepatitis B should avoid alcohol. Alcohol can damage liver resulting in cirrhosis.

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