Living With Hepatitis B
If you have hepatitis, you should:
- avoid having unprotected sex, including anal and oral sex, unless you’re sure your partner has been vaccinated against hepatitis B
- avoid sharing needles used to inject drugs with other people
- take precautions to avoid the spread of infection, such as not sharing toothbrushes or razors with other people
- eat a generally healthy, balanced diet there’s no special diet for people with hepatitis B
- avoid drinking alcohol this can increase your risk of developing serious liver problems
- speak to your doctor if you’re thinking of having a baby
People with hepatitis B can usually have a healthy pregnancy, but it’s a good idea to discuss your plans with a doctor first as you may need extra care and your medications may need to be changed.
There’s a risk of pregnant women with hepatitis B passing the infection on to their child around the time of the birth, but this risk can be reduced by ensuring the baby is vaccinated shortly after they’re born.
Page last reviewed: 30 January 2019 Next review due: 30 January 2022
Whos Most At Risk Of Hepatitis B
People at highest risk of hepatitis B include:
- people born or brought up in a country where the infection is common
- babies born to mothers infected with hepatitis B
- people who have ever injected drugs
- anyone who has had unprotected sex, including anal or oral sex particularly people who have had multiple sexual partners, people who have had sex with someone in or from a high-risk area, men who have sex with men, and commercial sex workers
- close contacts, such as family members, of someone with a long-term hepatitis B infection
The risk of getting hepatitis B for travellers going to places where the infection is common is generally considered to be low if these activities are avoided.
Your GP can arrange for you to have a blood test to check for hepatitis B and have the hepatitis B vaccination if youre at a high risk.
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What Is Involved In A Liver Transplant
A liver transplant is considered necessary when the liver is damaged and cannot function or in some cases of liver cancer. Your liver is very important. It is responsible for many functions related to making sure that your body stays healthy and is able to digest foods.
You may be eligible for a transplant if you have chronic hepatitis B infection or some of the diseases that may result from it, including liver cancer and cirrhosis. You will have to complete testing and be evaluated before being approved for a transplant. It is likely that you will be placed on a waiting list while an appropriate organ is found.
Donated livers come from two types of donors: living and deceased. Because the liver can regenerate, it is possible to use part of a liver for transplant. The remaining sections in both the donor and the receiver will grow into livers of adequate size.
People who get liver transplants must take anti-rejection drugs for the rest of their lives. These drugs make you more susceptible to infection. However, liver transplants have become more successful over time and continue to improve.
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Acute Vs Chronic Hepatitis B
A hepatitis B infection can result in either an acute infection or a chronic infection. When a person is first infected with the hepatitis B virus, it is called an “acute infection” . Most healthy adults that are infected do not have any symptoms and are able to get rid of the virus without any problems. Some adults are unable to get rid of the virus after six months and they are diagnosed as having a “chronic infection.” A simple blood test can diagnose an acute or chronic hepatitis B infection.
The risk of developing a chronic hepatitis B infection is directly related to the age at which a person is first exposed to the hepatitis B virus. The younger a person is when they are first infected, the greater the risk of developing a chronic hepatitis B infection:
- More than 90% of infants that are infected will develop a chronic hepatitis B infection
- Up to 50% of young children between 1 and 5 years who are infected will develop a chronic hepatitis B infection
- 5-10% of healthy adults 19 years and older who are infected will develop a chronic hepatitis B infection
The recommendation for hepatitis B vaccination of babies and children is so important because they are at the greatest risk of developing a chronic infection if they are not protected against the hepatitis B virus as soon as possible.
The Hepatitis B Vaccine
The hepatitis B vaccine is one of the most effective ways to prevent hepatitis B. Its usually divided into three doses, which are given over the course of six months. In many countries, infants receive their first dose of the vaccine at birth.
The Centers for Disease Control recommends that all children under the age of 19 be vaccinated if they havent already received the vaccination. Adults can also get the hepatitis B vaccine, and its generally recommended if you have an increased risk of infection due to:
- traveling to or living in a region where hepatitis B is common
- being sexually active with more than one partner
- working in a medical setting
- using intravenous drugs
If youve been exposed to the hepatitis B virus and havent been vaccinated, try to see a doctor right away. They can administer the first dose of the vaccine, though youll need to follow up to receive the remaining doses over the next few months.
They can also prescribe a medication called
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How Is Hepatitis B Treated
Your healthcare provider will treat you based on what type of hepatitis B you have, acute or chronic.
Acute hepatitis B infections
If you develop an acute form of the condition, you probably wont need medical treatment. Instead, your doctor will likely suggest that you get plenty of rest, drink lots of fluids and maintain a healthy diet to support your body as it fights off the infection.
Chronic hepatitis B infections
If you have chronic hepatitis B, you might be a candidate for drug therapy. Usually, drug therapy is used only if you have active liver disease. There are seven drugs that are approved by the U.S. Food and Drug Administration to treat hepatitis B. Two are injectable forms of interferon, while the five other antivirals are tablets.
You will need to take these medications every day. They help by slowing the viruss ability to multiply in your system. This helps reduce swelling and liver damage. Youll need to be regularly monitored for early signs of liver damage and liver cancer. Your healthcare provider will want to see you once or twice a year.
If I Am Infected How Can I Prevent Passing On The Virus To Others
If you have a current hepatitis B infection you should:
- Avoid having sex with anyone until they have been fully immunised and checked with a blood test to see that the immunisation has worked.
- Not share any injecting equipment such as needles, syringes, etc.
- Not donate blood or semen or carry a donor card.
- Not share razors, toothbrushes, etc, that may be contaminated with blood.
- Cover any cuts or wounds with a dressing.
- Make sure that, if any of your blood spills on to the floor or other surfaces following an accident, it is cleaned away with bleach.
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Can Hepatitis B Be Controlled By Eating Right And Exercising
It is important that people with liver disease follow a healthy, nutritious diet as outlined by Health Canada in Eating Well with Canadas Food Guide.
Alcohol can also damage the liver so it is best that people with hepatitis B do not drink. Following a healthy lifestyle may also prevent fatty liver disease, another liver disease highly prevalent in Canada.
However, hepatitis B cannot be controlled by healthy eating and exercise alone. Hepatitis B can only be controlled by currently available treatment as prescribed by your doctor. Your doctor will need to do regular blood tests to know how much of the active virus is in your blood . The viral load test is used to monitor and manage hepatitis B patients. Viral load can tell your doctor if you need treatment for hepatitis B and how well you are responding to treatment.
Chronic Hepatitis B Infection
People who test positive for the hepatitis B virus for more than six months are diagnosed as having a chronic infection. This means their immune system was not able to get rid of the hepatitis B virus and it still remains in their blood and liver.
The risk of developing a chronic hepatitis B infection is also directly related to the age at which one first becomes exposed to the hepatitis B virus:
- 90% of infected newborns and babies will develop a chronic hepatitis B infection
- Up to 50% of infected children will develop a chronic hepatitis B infection
- 5-10% of infected adults will develop a chronic hepatitis B infection
Learning that you have a chronic hepatitis B infection can be very upsetting. Because most people do not have symptoms and can be diagnosed decades after their initial exposure to the hepatitis B virus, it can be a shock and a surprise to be diagnosed with a chronic hepatitis B infection. The good news is that most people with chronic hepatitis B should expect to live a long and healthy life.
There are effective drug therapies that can control and even stop the hepatitis B virus from further damaging a liver. There are also promising new drugs in the research pipeline that could provide a cure in the very near future. Although the risk of developing a serious liver disease or liver cancer is higher for those living with chronic hepatitis B than those who are not infected, there are still many simple things a person can do to help reduce their risks.
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Prevent The Spread Of Hbv:
- Cover any open cuts or scratches. If blood from a wound gets on a surface, clean the surface with bleach right away. Put on gloves before you clean. Throw away any items with blood or body fluids on them, as directed by your healthcare provider.
- Do not share personal items. These items include toothbrushes, nail clipper, and razors. Do not share needles.
- Tell your sex partners that you have hepatitis B. Use a condom during sex. Even if you have acute hepatitis B and your infection goes away, you can still spread the virus for up to 6 months.
- Protect your baby if you are pregnant. You will be checked for hepatitis B during each pregnancy. This is done even if you received the hepatitis B vaccine or were tested before. Your healthcare provider may recommend you get the hepatitis B vaccine if you never received it. The vaccine will help protect you from an HBV infection during pregnancy. You may need to have an HBV infection treated before you give birth. Your baby will need the hepatitis B vaccine at birth if you plan to breastfeed. Ask your healthcare provider for more information on how to protect your baby from HBV.
- Do not donate blood, organs, or tissues. Donations are screened for HBV, but it is best not to donate at all.
Treatment For Chronic Infection
Treatment for hepatitis B does not cure hepatitis B but works to delay or even to prevent complications from developing, like liver damage and scarring of the liver . People with chronic hepatitis B usually need treatment to stop or to reduce the activity of the virus, so limiting liver damage. A liver specialist will usually advise on when treatment may be beneficial. There are two types of treatment currently given:
- Interferon. This medicine is similar to a substance produced in your body, which is also called interferon. It works to fight infections by boosting your immune system. Interferon is usually given as an injection each week.
- Antiviral medicines. These work by stopping the hepatitis B virus from multiplying in the body. They include lamivudine, adefovir, tenofovir, and entecavir. Your doctor will discuss these in more detail with you, as the medicine used can vary between people. A combination of antiviral medicines is sometimes used.
Treatment with medicines is usually continued for many years.
Side-effects with these medicines can occur. You will be monitored regularly while you are taking treatment, which includes blood tests. Some people need to change their medicines, or take a lower strength, if they have troublesome side-effects. Also, in some people, resistance can develop to their treatment medicine, which means that it does not work so well. If this happens then it is likely you will have to change the medicine you take.
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Return To The Emergency Department If:
- You have a sudden, severe headache and head pressure.
- You have new or increased bruising or red or purple dots on your skin.
- You have bleeding that does not stop easily.
- Your abdomen is swollen.
- You have severe nausea or cannot stop vomiting.
- You see blood in your urine or bowel movements, or you vomit blood.
- You have new or increased yellowing of your skin or the whites of your eyes.
- You have severe pain in your upper abdomen.
Who Is Most At Risk Of Developing Chronic Hepatitis B
The risk of developing chronic hepatitis B is related to the age at which you first become exposed to the hepatitis B virus. Most babies or children who are infected with hepatitis B are unable to clear the virus from their liver and it stays there for the rest of their life:
- infants who are infected at age less than 1 year: 9 out of every 10 infants will develop chronic hepatitis B infection
- children who become infected at aged 1 to 4 years: 3 of every 10 children will develop chronic hepatitis B infection
- adults who get hepatitis B: less than 5 out of every 100 adults will develop chronic hepatitis B infection.
Also at higher risk are:
- people born in New Zealand prior to the introduction of national vaccination in 1988
- immigrants from countries with limited access to vaccination
- people of Mori, Pasifika, South-East Asian or Chinese ethnicity.
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What Occupations Have Increased Risk Of Hepatitis B
In general, occupational groups with increased risk include:
- Health-care workers repeatedly exposed to blood or blood products or those who are at risk of needlestick injury.
- Pathologists, laboratory personnel, or embalmers.
- Dentists, dental assistants, and dental hygienists.
- Certain staff members of institutions for the developmentally handicapped.
- Staff of institutions where workers may be exposed to aggressive, biting residents.
Travellers to regions with intermediate or high rates of endemic HBV infection may also consider being vaccinated.
How Is Chronic Hepatitis B Treated
Chronic hepatitis B is not curable and life-long treatment is usually required. Long-term treatment is well tolerated and will prolong your survival. The treatments aim to prevent the virus being active and multiplying in your liver and causing long-term liver damage and liver cancer. In New Zealand the main medicines to treat chronic hepatitis B are entecavir and tenofovir tablets. Pegylated interferon injection is used for some people.Entecavir tablets are taken once a day. Nearly everyone who takes entecavir achieves viral suppression and improved liver blood tests. However, the virus is still present in your blood. Read more about entecavir.Tenofovir tablets are also taken once a day. It is a suitable option for treatment of HIV infection and chronic hepatitis B and for pregnant women who have chronic hepatitis B. Read more about tenofovir.
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Further Support And Information
The Hepatitis Foundation can offer support and information on hepatitis B.
The Hepatitis Foundation of New ZealandFreephone: 0800 33 20 10Website: www.hepfoundation.org.nzFor information about hepatitis B vaccination, consult a doctor or contact the:Immunisation Advisory CentreWebsite: www.immune.org.nz
What Should You Know About Pregnancy And Hepatitis B
A pregnant woman who has hepatitis B can pass the infection to her baby at delivery. This is true for both vaginal and cesarean deliveries.
You should ask your healthcare provider to test you for hepatitis B when you find out you are pregnant. However, while it is important for you and your healthcare provider to know if you do have hepatitis B, the condition should not affect the way that your pregnancy progresses.
If you do test positive, your provider may suggest that you contact another healthcare provider, a liver doctor, who is skilled in managing people with hepatitis B infections. You may have a high viral load and may need treatment during the last 3 months of your pregnancy. A viral load is the term for how much of the infection you have inside of you.
You can prevent your infant from getting hepatitis B infection by making sure that your baby gets the hepatitis B vaccine in the hours after they are born along with the hepatitis B immunoglobulin. These two shots are given in two different locations on the baby. They are the first shots needed.
Depending on the type of vaccine used, two or three more doses must be given, usually when the baby is 1 month old and then 6 months old, with the last by the time the baby is 1 year old. It is critical that all newborns get the hepatitis B vaccination, but even more important if you have hepatitis B yourself.
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