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Hepatitis B

Hepatitis B

Hepatitis B is a virus that lives in liver cells and in the cells of the immune system. When the hepatitis B virus (HBV) infects the liver, immune system cells are attracted to the liver to help fight the infection. These disease-fighting cells can cause liver inflammation. The hepatitis B virus is passed through blood and bodily fluids and can be passed to an infant during childbirth if the mother has the virus. Most newborns and about 50 percent of children infected with hepatitis B develop chronic hepatitis.

Usually, children with hepatitis B show and feel no symptoms.

The symptoms of hepatitis B include:

  • Abdominal pain
  • Dark urine
  • Fever
  • Joint pain
  • Loss of appetite
  • Nausea and vomiting
  • Weakness and fatigue
  • Jaundice (yellowing of the skin and whites of the eyes)

Diagnosis of Hepatitis B

If your child experiences any of the symptoms of hepatitis B, a pediatric gastroenterologist at Riley at IU Health can perform the following exams and tests to make a diagnosis:

  • Physical exam. A pediatric specialist may find an enlarged liver or spleen during an examination of your child’s body.
  • Blood tests. Many blood tests are used to check for the different forms of hepatitis. Types of blood tests include:
    • Hepatitis B surface antigen. A hepatitis B surface antigen blood test shows that a patient has hepatitis B.
    • Hepatitis B e-antigen. A hepatitis B e-antigen blood test shows if there is active viral growth.
    • Hepatitis B deoxyribonucleic acid (DNA). A hepatitis B DNA blood test shows how much hepatitis B virus is present.
    • Liver enzyme. A liver enzyme blood test shows elevated levels of alanine transaminase (AST) and aspartate transaminase (ALT) liver enzymes in patients with active damage to the liver.
    • Prothrombin time. A prothrombin time blood test measures the time it takes for plasma (liquid portion of blood) to clot and shows if the liver is working well.

Other tests used to evaluate children with hepatitis include:

Treatments

Most children with hepatitis B have normal liver enzymes and are not initially candidates for treatment. Treatment of hepatitis B in children includes:

  • Hepatitis A vaccination. All patients with hepatitis B should be vaccinated against hepatitis A.
  • Avoiding toxins. Children with hepatitis B should avoid any substances that are toxic to the liver (hepatotoxic), including some over-the-counter pain relievers, prescription medicines and certain herbs and supplements. Teens should be instructed not to drink alcohol; even moderate amounts of alcohol speed up the progression of hepatitis B. Alcohol also reduces the effectiveness of treatment.

Children with chronic hepatitis B and elevated liver enzymes can be treated, but they will need to have their liver monitored regularly to check for liver damage. The following medicines for children with chronic hepatitis B and elevated liver enzymes are being studied:

  • Interferon. Interferons are proteins that the body normally makes to control the immune system and fight viruses. Interferons can be produced in pure form in a lab and given in high doses. Treatment consists of interferon injections given three times a week for a six-month period. This treatment is effective in reducing hepatitis B activity (the condition goes away) only about 10 percent of the time and comes with side effects that include:
    • Fevers
    • Chills
    • Flu-like symptoms for the first few doses
    • Low white blood cell counts
    • Depression
    • Gastrointestinal (GI) symptoms
  • Lamivudine. This Food and Drug Administration (FDA)-approved medicine is given daily in pill or liquid form, and treatment is continued for a year or more. One side effect is that the medicine may cause the virus to mutate (change) so that the medicine is no longer effective; this occurs as much as 40 percent of the time, although this mutated virus does not usually appear to be very harmful. About 25 percent of treated children respond to the medicine with decreasing virus activity (hepatitis B rarely clears with this treatment). There are much better medicines for hepatitis B now available for adults and in research studies. You should discuss this with your child's gastroenterologist.
  • Entecavir. Entecavir is an oral medication that interferes with the virus’ DNA. It has few side effects. It helps to make the hepatitis B inactive but does not cure it. Entecavir is only used in children with active hepatitis B.
  • Tenofovir. Like entecavir, tenofovir is a medicine that interferes with the virus' DNA. However, tenofovir is only approved for use in patients aged 12 years and older.





Patients with hepatitis B should also avoid sharing razors or other sharp objects that could carry blood.

Key Points to Remember

  • Hepatitis B is a condition of the liver caused by the hepatitis B virus, which can be passed from mother to child during childbirth or through contact with another person's blood or bodily fluids.
  • Many infected infants and children develop chronic hepatitis B, a lifelong condition.
  • Children with chronic hepatitis B and elevated liver enzymes can be treated, but they will need to have their liver monitored regularly to check for liver damage.

Support Services & Resources

Visit the websites below to find support groups and services and learn more about hepatitis B.

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

Riley at IU Health Liver Support Group

The Riley at IU Health Liver Support Group meets one or two times a year for a family-oriented education program and socializing. Topics include testing for liver disease, complications of liver disease, impact of chronic disease on the family, liver transplant, nutrition for liver disease and medicine for liver disease. Please call 317.944.3774 for meeting dates and times.

American Liver Foundation

This website includes information and resources for families of children with hepatitis B.

GIKids

This website from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition provides information for patients and families living with hepatitis B.

National Institute of Diabetes and Digestive and Kidney Diseases

This National Institutes of Health website offers information and resources about hepatitis B, including research and clinical trials.

Hepatitis B Research

Our pediatric gastroenterologists participate in research on the treatment of hepatitis B. Tell your child's doctor if you would like to know more about our clinical research studies.

Locations

Locations

In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.

Riley Outpatient Center at IU Health

Pediatric Gastroenterology, Hepatology & Nutrition
575 Riley Hospital Dr
Indianapolis, IN 46202

317.944.3774

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