Living With Hepatitis B: Your Lifestyle
People living with HIV and hepatitis B can benefit from adopting a healthy lifestyle, including eating a balanced diet. Try to maintain a healthy weight. Being overweight is linked to fatty liver disease which can worsen liver damage.
Since people living with HIV and hepatitis may have an increased risk of cardiovascular disease and diabetes, your clinic should regularly monitor your blood fats or lipids and blood sugar .
People living with hepatitis B should limit how much alcohol they drink, and those with liver damage should avoid alcohol altogether. Not smoking and cutting down or stopping recreational drug use are also important for overall health.
- Eat a balanced diet including vegetables, fruit and wholegrains.
- Get regular moderate exercise.
Symptoms And Disease Progression
The majority of adults with hepatitis B have no symptoms, and infection is often only diagnosed by routine blood tests and monitoring the health of the liver. Among people living with HIV, routine liver function monitoring sometimes shows elevated liver enzymes, which can be a sign of liver inflammation due to hepatitis B.
Some people develop symptoms soon after hepatitis B infection, known as the acute phase. These can include the following:
- pain in the upper abdomen or belly
- muscle or joint aches
- feeling generally unwell
- yellowing of the skin and whites of the eyes .
A minority of people may develop severe symptoms during acute hepatitis B infection, and in rare cases it can lead to death.
After the acute stage , many people with chronic hepatitis B have few or no symptoms. Others may experience ongoing symptoms including fatigue and feeling unwell. Even if you have no symptoms, you can still pass on hepatitis B to others.
With or without symptoms, chronic hepatitis B infection can lead to serious liver disease over years or decades, including fibrosis, cirrhosis and liver cancer.
Should I Get Vaccinated Against Covid
It is important to consider getting vaccinated against COVID-19 if you have HIV. Many people with HIV have or are at an increased risk for developing the underlying conditions that increase their chances of developing COVID-19 or severe disease if they become infected with the virus that causes COVID-19.
Experts consider COVID vaccines to be safe and effective for people with HIV. Clinical trials of the vaccines have included a relatively small number of people with HIV, all of whom were taking ART and who were healthy and well. Further studies are needed to determine if the vaccine works as well for people with HIV as it does for the general population.
There is no information yet on how well the vaccine works in people living with HIV who have a compromised immune system. If you are not on treatment and have a very low CD4 count, discuss vaccination with your healthcare provider. Some experts recommend starting HIV treatment first to prevent HIV-related complications and to potentially improve vaccine effectiveness.
For more information on COVID-19 vaccines, see Frequently asked questions about vaccines for the prevention of COVID-19.
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Will The Vaccine Protect Me Against New Variants Of Sars
The virus that causes COVID-19 can change its structure or mutate. Many variants of SARS-CoV-2 are emerging now and are likely to emerge in the future. To date, it appears that the current vaccines approved in Canada still provide some protection against the emerging variants of concern, and will likely provide protection from developing severe disease if you become infected with one of the variants. Should a new vaccine or a booster shot become necessary because of new variants of SARS-CoV-2, public health authorities will issue guidance.
How Hepatitis B Is Spread
The hepatitis B virus is found in the blood and bodily fluids, such as semen and vaginal fluids, of an infected person.
It can be spread:
- from a mother to her newborn baby, particularly in countries where the infection is common
- within families in countries where the infection is common
- by having sex with an infected person without using a condom
- by having a tattoo, body piercing, or medical or dental treatment in an unhygienic environment with unsterilised equipment
Hepatitis B is not spread by kissing, holding hands, hugging, coughing, sneezing or sharing crockery and utensils.
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Section : Hbv Disease Progression And The Impact Of Hiv Coinfection
One of the most perplexing aspects of HBV infection is its disease progression. In fact, researchers still don’t fully understand why some people with HBV have no associated health problems, while others progress to serious liver disease however, we do know that HBV disease progression is driven by the immune system’s ability to control HBV replication, and that damages to the liver result from this dynamic process.
HIV worsens HBV because HIV directly attacks the immune system and gradually suppresses immune function by lowering the CD4 cell count. HIV infection also triggers persistent immune activation, which causes low-level inflammation throughout the body. These immune dysfunctions alter HBV disease progression.
Chronic HBV disease progression varies widely among individuals, but in general there are four distinct disease phases. Not everyone will go through every phase, and there can be fluctuations and reversions.
Phase 1: Immune Tolerant
Phase 2: Immune Clearance
Phase 3: Inactive
Phase 4: Reactivation
Section : Transmission And Prevention
Coming to terms with your HBV infection sometimes involves telling family members, sexual or drug-use partners, and other people close to you about your status. It may be very helpful for you to know how HBV is transmitted so that you can protect others from exposure and educate them about how to prevent becoming infected.
HBV is transmitted through blood, semen, and other body fluids. HBV is 50-100 times more infectious than HIV and can survive outside the body for up to seven days.
HBV is most commonly transmitted through:
- Birth, from an infected mother to her infant
- Having unprotected anal or vaginal sex with someone who has HBV the risk from unprotected oral sex is unclear
- Sharing drug injection equipment, including needles, cookers, ties, cotton, straws, water, and even measuring syringes
- Sharing personal-care items that may have blood on them, such as razors or toothbrushes
- Getting a tattoo with any shared, unsterilized equipment, such as needles, ink, and inkwells
- Getting a medical procedure with unsterilized equipment and
- Accidental needlestick injuries or other occupational hazards involving exposure to blood from an infected person.
HBV cannot be transmitted through casual contact such as kissing, shaking hands, hugging, or sharing drinking glasses or eating utensils.
HBV Testing and Vaccination
Who Should Get It?
How Long Does It Work?
Vaccination for HIV-Positive People
Preventing Mother-to-Child Transmission
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How Effective Are The Vaccines
All approved vaccines demonstrated high efficacy at preventing COVID 19 disease in research studies:
- Moderna 94% effective at preventing symptomatic COVID-19 disease starting a couple of weeks after the second dose
- Pfizer-BioNTech 95% effective at preventing symptomatic COVID-19 disease starting a couple of weeks after the second dose
- AstraZeneca COVID-19 vaccine 59.5% effective at preventing symptomatic COVID-19 disease starting a couple of weeks after the second dose
For vaccines that require two doses, both doses of the vaccines are needed to achieve optimal effectiveness. In rolling out the vaccines quickly, some jurisdictions are trying a more flexible approach to the timing between doses in order to maximize coverage. The research studies used to demonstrate the efficacy of the vaccines for approval did not look at the effect of changing the timing between doses although there is growing evidence that this can be safely done with some COVID-19 vaccines. Delaying the second dose by a few months is not expected to result in lower vaccine efficacy after the second dose. In general, the immune system shows a better response to most vaccines when doses are delayed.
Do You Have To Tell Your Employer About Your Hepatitis B
Do I have to tell my new employer about my hepatitis B?
After years of cautiously completing medical forms for schools, camps and college, my daughters question took me by surprise. It shouldnt have. Many jobseven when they dont involve direct medical carerequire a physical exam and confirmation of hepatitis B immunization.
There may be a safe and effective vaccine and new treatments for hepatitis B, but ignorance and stigma remain stubbornly entrenched in many HR departments. So here is what every job applicant, employee and employer should know about hepatitis B and employment.
During the application process or job interview, can an employer ask about my health?No. The Americans with Disabilities Act strictly limits what can be asked during an interview. According to federal law, an employer cant ask if you have a disability or require you to undergo a medical exam before offering you a job.
They CAN ask if you can perform the job or how you would perform a job, but they cant ask about your health.
Can an employer require a medical exam or ask medical questions after an offer is made?
Yes. After the offer is made, employers can require you to answer certain medical questions and undergo a medical examas long as everyone who performs that job has to undergo the same exam.
If the medical exam reveals a disability that prevents you from doing the job, even after a reasonable accommodation is made, then the employer can withdraw the job offer.
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Section 1: Other Viral Hepatitis
HAV is found in feces . People become infected when feces from a person who is infected with HAV enters their mouth. This may occur when food or water is contaminated with sewage when an infected person handles food without washing his/her hands after using the bathroom through oral-anal sex with an infected person and, rarely, from blood transfusions.
A vaccine is available to prevent HAV infection, and every person with HIV or HBV should be vaccinated
Some people with HAV — especially children — don’t feel sick at all others have symptoms including nausea, vomiting, diarrhea, fever, fatigue, rash, jaundice, liver pain, and dark brown urine. There is no treatment for HAV itself, but the symptoms can be treated.
HAV is not a chronic infection — it goes away by itself, usually within two months. A person can be infected with HAV only once.
HCV is found in blood . You can get HCV from:
- Sharing drug-use or tattoo equipment, including needles measuring syringes water cookers cotton and tattoo ink and inkwells
- Unprotected sex that involves blood: rough anal or vaginal sex, and fisting, are riskier
- Mother to child during birth and
- Sharing personal-care items that may have blood on them, such as razors and toothbrushes.
You can get HCV more than once, even if you already cleared it with treatment or through your own immune response.
There is less research on HIV coinfection with these viral hepatitis infections:
What Causes Hepatitis B
The hepatitis B virus causes hepatitis B. The hepatitis B virus spreads through contact with an infected persons blood, semen, or other body fluids. Contact can occur by
- being born to a mother with hepatitis B
- having unprotected sex with an infected person
- sharing drug needles or other drug materials with an infected person
- getting an accidental stick with a needle that was used on an infected person
- being tattooed or pierced with tools that were used on an infected person and werent properly sterilized, or cleaned in a way that destroys all viruses and other microbes
- having contact with the blood or open sores of an infected person
- using an infected persons razor, toothbrush, or nail clippers
You cant get hepatitis B from
- being coughed on or sneezed on by an infected person
- drinking unclean water or untreated water that has not been boiled
- eating food that is unclean or has not been properly cooked
- hugging an infected person
- shaking hands or holding hands with an infected person
- sharing spoons, forks, and other eating utensils
- sitting next to an infected person
Mothers who have hepatitis B can safely breastfeed their babies. If a baby receives hepatitis B immune globulin and starts receiving the hepatitis B vaccine to prevent hepatitis B infection shortly after birth, hepatitis B is unlikely to spread from mother to child through breastfeeding.15
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Medications For Hepatitis B
Several drugs are currently available for treatment of hepatitis B. Most of these are antiviral drugs that directly stop hepatitis B from reproducing. Hepatitis B treatment may also include pegylated interferon, which stimulates the body’s immune response against the virus.
Most hepatitis B drugs are nucleoside or nucleotide analogues, similar to one class of drugs used to treat HIV. In fact, some commonly used anti-HIV drugs are also active against hepatitis B. This can make treatment of both viruses easier, since it requires fewer drugs, but it must be done carefully to avoid either virus becoming resistant. These are:
- lamivudine .
- emtricitabine .
- tenofovir disoproxil or TDF .
- tenofovir alafenamide or TAF .
Other antiviral drugs are used to treat hepatitis B but not HIV:
- telbivudine .
How Should The Liver Be Monitored
Everyone with HIV should have regular tests to monitor the health of their liver. These tests are especially important in cases of coinfection with hepatitis B. In those cases, doctors should closely monitor liver function using blood tests.
Ultrasound examinations may also be performed, particularly if the liver shows signs of damage. Another test, called a FibroScan, can also test the liver for cirrhosis or fibrosis.
Sometimes, people also need a liver biopsy, where a tiny piece of tissue from the liver is removed for investigation.
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If I Have Hepatitis B And Feel Healthy Do I Need To Keep Going To My Doctor
Chronic hepatitis B is a silent disease because often no symptoms appear until your liver is severely damaged. Although many people with chronic hepatitis B have an inactive disease and will remain healthy, about one in four will have an active disease that may lead to cirrhosis, liver failure, and liver cancer.
Because hepatitis B has no symptoms until your liver is badly damaged, a blood test is the only way for your doctor to find out if your hepatitis B is active or inactive, and to offer treatment, if needed. To help your doctor monitor how your disease behaves over time, you will need lifelong repeat blood tests every six to 12 months. Some tests, such as HBV DNA may need to be done more frequently . No treatment is required while the virus is inactive, but you should continue to get regular blood tests from your doctor to monitor your liver disease.
Chronic Hepatitis B Infection
If you develop chronic hepatitis B, youll be given treatment to reduce the risk of permanent liver damage and liver cancer. Treatment does not cure chronic hepatitis B and most people who start treatment need to continue for life.
Without treatment, chronic hepatitis B can cause scarring of the liver , which can cause the liver to stop working properly.
A small number of people with cirrhosis develop liver cancer, and these complications can lead to death. Other than a liver transplant, there is no cure for cirrhosis. However, treatments can help relieve some of the symptoms.
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If Im On Prep How Will Hepatitis B Affect Me
The medication used for PrEP is also used in the treatment of chronic hepatitis B. Before starting PrEP, make sure you have been tested for hepatitis B and that your vaccination is up to date. While PrEP is an excellent prevention tool for HIV, vaccination is the best protection against hepatitis B.
How Do You Test For Hepatitis B
A simple blood test carried out by a healthcare professional will show whether you have the virus. You may also be given extra tests to see if your liver is damaged.
If youve got hepatitis B you should be tested for other STIs. Its important that you tell your recent sexual partner/s so they can also get tested and treated. Many people who have hepatitis B dont notice anything wrong, and by telling them you can help to stop the virus being passed on. This can also stop you from getting the infection again.
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What Are Clinical Trials For Hepatitis B
Clinical trialsand other types of clinical studiesare part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future.
Researchers are studying many aspects of hepatitis B, such as
- progression of hepatitis B and long-term outcomes
- new treatments for hepatitis B
- prevention of reactivated or worsening hepatitis B in people receiving cancer treatment
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.
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