10. Other Hepatitis B Information.
10.1 Coinfections with other viruses
i) The Hepatitis D Virus
The Hepatitis D Virus (HDV) is a unique, defective RNA virus that can only infect an individual in the presence of hepatitis B. It occurs either as a co-infection with acute HB or as a superinfection in people with chronic HB. HDV is mostly found among IV drug users, but transmission by other routes is possible. Infection with HDV can make the acute phase of hepatitis B unusually severe. It can cause an acute "exacerbation" in chronic hepatitis B carriers (superinfection), or cause a relatively aggressive course of chronic HB.
Some recent research as shown that hepatitis D can exist without Hepatitis B being present. But the presence of hepatitis B is required for the initial infection to take place.(?)
ii) The Hepatitis C Virus
Studies indicate that coinfection with hepatitis C can suppress hepatitis B and hepatitis C is the dominant illness. However sometimes the combination can lead to very aggressive hepatitis and also the risk of liver cancer (HCC) is increased.
There is still much research to be done in this field.
In general coinfection with HIV leads to a milder form of hepatitis although this may get much worse in patients with AIDS. Current research indicates that coinfection with HIV is should not be a factor in deciding weather to take interferon treatment as response rates are only slightly lower, however the risk of viral reactivation after a successful response is increased.
10.2 Non "e" Antigen Hepatitis
There are strains of hepatitis that do not produce the "e" antigen. This strain normally shows up in cases of mild chronic infection or occasionally in very aggressive disease. Research has shown that the response rate to interferon in this strain of hepatitis B is lower than normal. However where a long term response is achieved success rates are comparable.
After a chronic hepatitis B infection people do not, to my knowledge, produce the surface antibody that would provide protection. Even after being "cured" by interferon (I.e. loss of the surface antigen) there have been rare cases of viral reactivation if the immune system becomes suppressed or it may just happen.. It is therefore advised that your Hep B antigen status if examined periodically to be on the safe side.
10.4 Liver Cancer (hepatocellular carcinoma, hepatoma or HCC)
Chronic infection with hepatitis B can lead to an increased incidence of HCC (5%). It is believed that after several hears of chronic Hep B infection the Hep B viral DNA becomes integrated with human DNA. In most cases this poses no problems and the result generally causes the liver cell(s) where integration has occurred to produce surface proteins (HBsAg) but not complete viral particles. However when the DNA integration occurs sometime mistakes may be made during integration or it may be inserted into the human gnome at a place that "turns on" the instruction to replicate uncontrollably. The error may also occur as when liver cells naturally reproduce. Anyone expressing the HBsAg generally has increased risk of HCC. Treatment of HCC is a large subject in itself and when I have the time & information and I hope to expand on this information.
10.5 Living with the Hepatitis B Virus
You Can Lead a Normal, Healthy Life as a Hepatitis B Carrier:
Facts for the Hepatitis B Carrier
Most hepatitis B carriers do not feel or look sick and will never suffer from any health problems associated with hepatitis B.However, some carriers have an increased risk of becoming sick with liver disease. Carriers need to have the regular care of a doctor.
People who are not exposed to your or body fluids are not at risk for catching hepatitis B from you. Therefore, you do not need to mention your infection to your employers, co workers or people you are in casual contact with. It is okay to share meals with family and friends.
What You Can Do to Take Care of Yourself:
What You Can Do to Protect Others:
10.6 Cirrhosis of the Liver
Copyright 1993 Health Response Ability Systems
The liver weighs about 3 pounds and is the largest organ in the body. It is located in the upper right side of the abdomen, below the ribs. When chronic diseases cause the liver to become permanently injured and scarred, the condition is called cirrhosis.
The scar tissue that forms in cirrhosis harms the structure of the liver, blocking the flow of blood through the organ. The loss of normal liver tissue slows the processing of nutrients, hormones, drugs, and toxins by the liver. Also slowed is production of proteins and other substances made by the liver.
Cirrhosis is the seventh leading cause of death by disease. About 25,000 people die from cirrhosis each year. There also is a great toll in terms of human suffering, hospital costs, and the loss of work by people with cirrhosis.
i) What Are the Major Causes of
Cirrhosis has many causes. In the United States, chronic alcoholism is the most common cause. Cirrhosis also may result from chronic viral hepatitis (types B, C, and D).
Liver injury that results in cirrhosis also may be caused by a number of inherited diseases such as cystic fibrosis, alpha-1 antitrypsin deficiency, hemochromatosis, Wilson's disease, galactosemia, and glycogen storage diseases.
Two inherited disorders result in the abnormal storage of metals in the liver leading to tissue damage and cirrhosis. People with Wilson's disease store too much copper in their livers, brains, kidneys, and in the corneas of their eyes.
In another disorder, known as hemochromatosis, too much iron is absorbed, and the excess iron is deposited in the liver and in other organs, such as the pancreas, skin, intestinal lining, heart, and endocrine glands.
If a person's bile duct becomes blocked, this also may cause cirrhosis. The bile ducts carry bile formed in the liver to the intestines, where the bile helps in the digestion of fat.
In babies, the most common cause of cirrhosis due to blocked bile ducts is a disease called biliary atresia. In this case, the bile ducts are absent or injured, causing the bile to back up in the liver.
These babies are jaundiced (their skin is yellowed) after their first month in life. Sometimes they can be helped by surgery in which a new duct is formed to allow bile to drain again from the liver.
In adults, the bile ducts may become inflamed, blocked, and scarred due to another liver disease, primary biliary cirrhosis. Another type of biliary cirrhosis also may occur after a patient has gallbladder surgery in which the bile ducts are injured or tied off.
Other, less common, causes of cirrhosis are severe reactions to prescribed drugs, prolonged exposure to environmental toxins, and repeated bouts of heart failure with liver congestion.
ii) What Are the Symptoms of
People with cirrhosis often have few symptoms at first. The two major problems that eventually cause symptoms are loss of functioning liver cells and distortion of the liver caused by scarring. The person may experience fatigue, weakness, and exhaustion. Loss of appetite is usual, often with nausea and weight loss.
As liver function declines, less protein is made by the organ. For example, less of the protein albumin is made, which results in water accumulating in the legs (oedema) or abdomen (ascites). A decrease in proteins needed for blood clotting makes it easy for the person to bruise or to bleed.
In the later stages of cirrhosis, jaundice (yellow skin) may occur, caused by the build-up of bile pigment that is passed by the liver into the intestines.
Some people with cirrhosis experience intense itching due to bile products that are deposited in the skin. Gallstones often form in persons with cirrhosis because not enough bile reaches the gallbladder.
The liver of a person with cirrhosis also has trouble removing toxins, which may build up in the blood. These toxins can dull mental function and lead to personality changes and even coma (encephalopathy).
Early signs of toxin accumulation in the brain may include neglect of personal appearance, unresponsiveness, forgetfulness, trouble concentrating, or changes in sleeping habits.
Drugs taken usually are filtered out by the liver, and this cleansing process also is slowed down by cirrhosis. The liver does not remove the drugs from the blood at the usual rate, so the drugs act longer than expected, building up in the body. People with cirrhosis often are very sensitive to medications and their side effects.
A serious problem for people with cirrhosis is pressure on blood vessels that flow through the liver. Normally, blood from the intestines and spleen is pumped to the liver through the portal vein.
But in cirrhosis, this normal flow of blood is slowed, building pressure in the portal vein (portal hypertension). This blocks the normal flow of blood, causing the spleen to enlarge. So blood from the intestines tries to find a way around the liver through new vessels.
Some of these new blood vessels become quite large and are called "varices." These vessels may form in the stomach and oesophagus (the tube that connects the mouth with the stomach). They have thin walls and carry high pressure.
There is great danger that they may break, causing a serious bleeding problem in the upper stomach or oesophagus. If this happens, the individual's life is in danger, and action must be taken quickly to stop the bleeding.
iii) How Is Cirrhosis
The doctor often can diagnosis cirrhosis from the individual's symptoms and from laboratory tests. During a physical exam, for instance, the doctor could notice a change in how your liver feels or how large it is. If the doctor suspects cirrhosis, he or she will recommend that you have blood tests.
The purpose of these tests is to find out if liver disease is present. In some cases, other tests that take pictures of the liver (such as the computerised axial tomography scan, ultrasound, and the radioisotope liver/spleen scan) may be recommended.
The doctor may suggest that the diagnosis be confirmed by putting a needle through the skin (biopsy) to take a sample of tissue from the liver.
In some cases, cirrhosis is diagnosed during surgery when the doctor is able to see the entire liver. The liver also can be inspected through a laparoscope, a viewing device that is inserted through a tiny incision in the abdomen.
iv) What Are the Treatments
Options for Cirrhosis?
Treatment of cirrhosis is aimed at stopping or delaying its progress, minimising the damage to liver cells, and reducing complications.
In alcoholic cirrhosis, for instance, the person must stop drinking alcohol to halt progression of the disease. If a person has hepatitis, the doctor may administer steroids or antiviral drugs to reduce liver cell injury.
Medications may be recommended to control the symptoms of cirrhosis, such as itching. Oedema and ascites (fluid retention) are treated by reducing salt in the diet. Medications called "diuretics" are sometimes used to remove excess fluid and to prevent oedema from recurring.
Diet and drug therapies can help to improve the altered mental function that cirrhosis can cause. For instance, decreasing di-etary protein results in less toxin formation in the digestive tract. Laxatives such as lactulose may be given to help absorb toxins and speed their removal from the intestines.
The two main problems in cirrhosis are liver failure, when liver cells just stop working, and the bleeding caused by portal hypertension. The doctor may prescribe blood pressure medication, such as a beta blocker, to treat the portal hypertension.
If the individual bleeds from the varices of the stomach or oesophagus, the doctor can inject these veins with a sclerosing agent administered through a flexible tube (endoscope) that is inserted through the mouth and oesophagus.
In critical cases, a liver transplant or another surgery (such as a portacaval shunt) that is sometimes used to relieve the pressure in the portal vein and varices may be an option.
Individuals with cirrhosis often live healthy lives for many years. Even when complications develop, they usually can be treated. A few individuals with cirrhosis have undergone successful liver transplantation.
It's important to remember, however, that all tests, procedures and medications carry risks. To make an informed decision about your health, be sure to ask your physician about the benefits, risks and costs of all procedures and medications.
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