Also this issue: Silent Killer While SARS is getting all the attention, hepatitis B Is the real health scourge in Chinatown. -Helen i-lin Hwang Photographs by Michael T. Regan

April 24-30, 2003

cover story

Hepatitis B: The Breakdown of the Science What is hepatitis?

Killer B: This virus is responsible for millions of deaths worldwide.

by H.H

Hepatitis is the inflammation of the liver, which is the largest organ in the body. Besides storing iron, vitamins and sugar to give energy and break down waste products, the liver also helps blood to clot. The hepatitis B virus, in its worst-case scenario, will cause acute hepatitis, cirrhosis of the liver and liver cancer.

There are several types of hepatitis: Hepatitis A is the most common, but hepatitis B is the deadliest, according to the World Health Organization.

How could I get it?

The virus is spread primarily through blood. Transmission occurs through blood, body fluids, shared needles and from infected mother to baby during delivery, which is the most common way it is spread among Asians. It can't be contracted via kissing, coughing, sneezing, food prepared by an infected individual or casual contact -- all modes through which the current SARS (severe acute respiratory syndrome) pandemic is suspected of spreading.

In contrast to HIV, the virus can survive in dried blood for at least seven to 10 days. An informal experiment done at Fox Chase Cancer Center involved leaving a vial of blood containing the hepatitis B virus on a lab counter in ambient temperature for a year. When the scientists checked it again, the hepatitis B virus was still capable of being infectious. Hepatitis B is considered 100 times more contagious than HIV.

Sharing razors, toothbrushes and tattoo needles can pose a danger, since dried blood can spread hepatitis B. The hepatitis B online support group even cautions people to be wary of manicures and pedicures if the implements are not sterilized properly.

How would I feel if I had it?

Common symptoms include jaundice, fatigue, abdominal pain, appetite loss and nausea. But most chronic carriers don't experience any symptoms at all. This is one of the reasons that hepatitis B is a major problem in the world; people often don't know they have it and the only way to find out is to request a specific blood test.

Figuring out the blood tests

For hepatitis B, there are three parts to the blood panel test, which needs to be specifically requested from the doctor. It is much more complicated to interpret than an HIV test. Occasionally, this leads to confusion and misinformation and worst of all, potential widespread infection. (For an HIV test, you are either positive if you have it or negative if you don't.) Hepatitis B test results include positive or negative readings for hepatitis B surface antigen, hepatitis B surface antibody and hepatitis B core antibody. Be sure to request a written copy of the results from the doctor.

Antigen refers to a foreign substance in the body, such as a virus. The surface antigen is the protective protein coat of the virus, easily detected with blood tests. The surface antigen used to be called the "Australian antigen" because it was originally discovered in the blood of an Australian aborigine. An antibody is a protein made by the body, which helps fight off infections. It's a vital element of the immune system.

You need all three readings to get a good sense of whether or not you are currently immune to hepatitis B. The Hepatitis B Foundation and Centers for Disease Control websites provide clear tables on how to interpret these factors.

What do you mean by chronic?

Chronic hepatitis B carriers are defined as those positive for hepatitis B surface antigen (HBsAg+) for more than six months.

Once a person finds out he or she is a chronic hepatitis B carrier, he or she should also undergo a hepatitis e-antigen blood test to see how high the virus level is, which also correlates to how contagious a person may be. The higher the level, the more contagious a person is because this measures how quickly the virus is multiplying. People with elevated levels are colloquially referred to as "active" chronic hepatitis B carriers. Chronic hepatitis B carriers can also undergo a liver function test to check on the condition of the liver by measuring enzymes and active liver damage.

What can happen if I’m a chronic hepatitis B carrier?

Hepatitis B is a liver disease. You can get acute hepatitis, cirrhosis of the liver or liver cancer. A person has acute hepatitis when they are showing symptoms, have jaundice or elevated enzyme levels and test positive for hepatitis B surface antigen. Cirrhosis of the liver is liver damage that can lead to scarring and eventual death due to liver failure. Liver cancer is a disease that results from uncontrollable growth and division of cells. Most types of cancer cells form a mass called a tumor. The most common type of liver cancer is called hepatocellular carcinoma, or HCC.