Keep Personal Items Personal
Any tools or implements that may have a bit of blood on them from infected people are potential sources of hepatitis B or C transmission. Toothbrushes, nail clippers, razors, needles, and washcloths may all contain trace amounts of blood that can transmit infection. Keep personal items such as these to yourself and never use personal items that belong to others.
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
Laboratory Markers Following Acute Hbv Infection
In persons with acute HBV infection, HBsAg can be detected in serum 4 to 10 weeks after HBV acquisition. Although HBV DNA is usually detectable 10 to 20 days before the appearance of HBsAg, testing for HBV DNA is not part of routine HBV screening. Shortly after the appearance of HBsAg, HBeAg becomes evident HBeAg is a marker of active viral replication and persons with positive HBeAg typically have high levels of circulating serum HBV DNA. Concurrent with the onset of clinical symptoms, anti-HBc appears, primarily detectable as the IgM class . Although IgM anti-HBc antibodies typically decline to undetectable levels within 6 months, the IgG class persists indefinitely as a marker of past HBV infection. Resolution of infection is marked by the loss of HBsAg and the appearance of HBsAb. Individuals who clear HBV infection will also lose HBeAg and develop anti-HBe.
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Who’s 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 you’re at a high risk.
Immune Reconstitution Inflammatory Syndrome
Though current guidelines suggest treatment of HBV/HIV coinfected patients with dual antiviral regimen targeting HBV and HIV, immune reconstruction-related hepatic flare following the ART should be noted . IRIS is considered as a complication induced by the initiation of highly active antiretroviral therapy in HBV/HIV coinfected patients. It is an inflammatory disorder related to the worsening status of existing infection .
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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.
Impact Of Hbv On Natural History Of Hiv
Analysis of data from three different time periods of the Multicenter AIDS Cohort Study study noted a higher liver-related mortality in persons with HIV-HBV coinfection than with HIV and hepatitis C virus coinfection . Multiple other studies have reported HIV-HBV coinfection and HIV-HCV coinfection both have played a major role in liver-related deaths in persons with HIV. The impact of HBV on HIV natural history remains less clear, with some studies demonstrating no significant effect of HBV coinfection on HIV-related outcomes and others suggesting an adverse impact. A recent large observational cohort study from the United Kingdom reported higher all-cause mortality and liver-related mortality in persons with HIV if they had coinfection with HBV and/or HCV coinfection, but no increase in AIDS-related mortality .
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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:
- fatigue
- 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.
History Of Hbv Testing
Only 302 patients had been tested for HBsAg prior to the study according to data collected from routine medical records and patients interviews. Of these, 34 had been found positive. Nine of these 34 patients were HBsAg negative at the time of the present study. Thus, of the 159 patients who were HBsAg positive at the time of the present study, only 25 had a known HBV coinfection prior to the study.
HBV testing had been performed prior to ART initiation in 151 patients , the day of ART initiation in 21 patients , and after ART initiation in 123 patients . The proportion of patients tested for HBsAg ranged from 0.8 to 72.5% according to the individual hospital .
Fig. 1
Factors associated with a history of HBV testing are shown in Table . A history of HBV testing was lower in women than in men . By contrast, a history of HBV testing was higher in patients with a secondary or higher educational level than in those with a lower school educational level , and higher in patients who initiated ART in 2010 or later than in those who started ART prior to 2010 . Finally, a history of HBV testing was higher in patients with increased ALT level . It is worth noting that a history of HBV testing was not associated with any hospital-related characteristic such as the region, setting and administrative sector of study hospital, type of HIV service, and task-shifting of ART prescription renewals or follow-up consultations to nurses.
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How Can I Prevent Spreading Hepatitis B To Others
If you have hepatitis B, follow the steps above to avoid spreading the infection. Your sex partners should get a hepatitis B test and, if they arent infected, get the hepatitis B vaccine. You can protect others from getting infected by telling your doctor, dentist, and other health care professionals that you have hepatitis B. Dont donate blood or blood products, semen, organs, or tissue.
How Is Hepatitis B Diagnosed
Everyone should be tested for hepatitis B soon after their HIV diagnosis to see if they have been infected with the hepatitis B virus as well. This is done through a blood test.
In the UK, pregnant women are screened for hepatitis B. Babies born to mothers with hepatitis B can also be vaccinated soon after birth to prevent the infection being passed on to them.
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Evaluating And Counseling Persons With Hbv
Individuals with HIV who are also diagnosed with chronic HBV should undergo further HBV-related evaluation and receive counseling. Laboratory studies, particularly HBeAg, anti-HBe, and HBV DNA levels, can help determine the phase of the chronic HBV infection these phases represent a dynamic interaction between HBV replication and the host immune response . The following information summarizes key recommendations for the initial evaluation of persons diagnosed with HBV in the setting of HIV coinfection:
Symptoms Of Liver Disease
In the early stages of liver disease, there may not be any obvious symptoms. Once there is some damage to the liver, typical symptoms include extreme tiredness, a feeling of general poor health, weight loss, loss of appetite, nausea and vomiting, fever, abdominal pain, itchy skin, and an enlarged or tender liver. Jaundice may also develop. This is easily noticeable as the skin and whites of the eyes turn yellow, urine becomes dark and stools pale.
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How Do You Get Hepatitis B
Hepatitis B is really contagious. Its transmitted through contact with semen , vaginal fluids, and blood. You can get it from:
-
having vaginal, anal, or oral sex
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sharing toothbrushes and razors
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sharing needles for shooting drugs, piercings, tattoos, etc.
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getting stuck with a needle that has the Hep B virus on it.
Hepatitis B can also be passed to babies during birth if their mother has it.
Hepatitis B isnt spread through saliva , so you CANT get hepatitis B from sharing food or drinks or using the same fork or spoon. Hepatitis B is also not spread through kissing, hugging, holding hands, coughing, sneezing, or breastfeeding.
General Information On Hiv
The human immunodeficiency virus is an enveloped RNA virus belonging to the family of Retroviridae, genus Lentivirus. HIV infection and its natural evolution lead to a set of opportunistic, infectious, or tumoral manifestations, consequences of an immunodepression qualified as acquired immunodeficiency syndrome . To date, there are two types of HIV: the first, called HIV-1, is responsible for the pandemic and HIV-2 is more common in West Africa .
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Treatment Of Hepatitis C Virus With Coexisting Hiv Infection
Increased rates of cirrhosis in patients with hepatitis C virus are attributable to various factors, including older age, alcoholism, male sex, and HIV infection higher rates of progression to cirrhosis are seen in patients with HCV/HIV.
HCV infection in patients with HIV infection can have significant consequences, including liver disease progression, liver fibrosis, cirrhosis, increased rates of end-stage liver disease, and shortened lifespan after hepatic decompensation.
Genotype 1 accounts for approximately 75% of hepatitis C infections in the United States.
Should I Be Screened For Hepatitis B
Screening is testing for a disease in people who have no symptoms. Doctors use blood tests to screen for hepatitis B. Many people who have hepatitis B dont have symptoms and dont know they are infected with hepatitis B. Screening tests can help doctors diagnose and treat hepatitis B, which can lower your chances of developing serious health problems.
Your doctor may recommend screening for hepatitis B if you9,14
- are pregnant
- were born in an area of the world where 2 percent or more of the population has hepatitis B infection, which includes Africa, Asia, and parts of the Middle East, Eastern Europe, and South America
- didnt receive the hepatitis B vaccine as an infant and have parents who were born in an area where 8 percent or more of the population had hepatitis B infection, which includes sub-Saharan Africa and parts of Asia
- are HIV-positive
- are a man who has sex with men
- have lived with or had sex with a person who has hepatitis B
- have an increased chance of infection due to other factors
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Can Hepatitis B Be Prevented
The hepatitis B vaccine is one of the best ways to control the disease. It is safe, effective and widely available. More than one billion doses of the vaccine have been administered globally since 1982. The World Health Organization says the vaccine is 98-100% effective in guarding against the virus. Newborns should be vaccinated.
The disease has also been more widely prevented thanks to:
- Widespread global adoption of safe blood-handling practices. WHO says 97% of the blood donated around the world is now screened for HBV and other diseases.
- Safer blood injection practices, using clean needles.
- Safe-sex practices.
You can help prevent hepatitis B infections by:
- Practicing safe sex .
- Never sharing personal care items like toothbrushes or razors.
- Getting tattoos or piercings only at shops that employ safe hygiene practices.
- Not sharing needles to use drugs.
- Asking your healthcare provider for blood tests to determine if you have HBV or if you are immune.
Immunization To Prevent Hepatitis B Infection
Although HBV vaccination has been recommended since the 1980s for men who have sex with men , and since 2006 for all individuals with HIV, HBV vaccination rates for persons with HIV remain low. Indeed, recent surveillance data from the Centers for Disease Control and Prevention suggest that over a third of the persons living with HIV who were receiving medical care in the United States did not have documentation of HBV infection, immunity, or vaccination. Recommendations and vaccine schedules for HBV are addressed in detail in the Immunizations in Adults Topic Review in the Basic Primary Care Module.
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Who Is More Likely To Get Hepatitis B
People are more likely to get hepatitis B if they are born to a mother who has hepatitis B. The virus can spread from mother to child during birth. For this reason, people are more likely to have hepatitis B if they
- were born in a part of the world where 2 percent or more of the population has hepatitis B infection
- were born in the United States, didnt receive the hepatitis B vaccine as an infant, and have parents who were born in an area where 8 percent or more of the population had hepatitis B infection
People are also more likely to have hepatitis B if they
- are infected with HIV, because hepatitis B and HIV spread in similar ways
- have lived with or had sex with someone who has hepatitis B
- have had more than one sex partner in the last 6 months or have a history of sexually transmitted disease
- are men who have sex with men
- are injection drug users
- work in a profession, such as health care, in which they have contact with blood, needles, or body fluids at work
- live or work in a care facility for people with developmental disabilities
- have been on kidney dialysis
- live or work in a prison
- had a blood transfusion or organ transplant before the mid-1980s
In the United States, hepatitis B spreads among adults mainly through contact with infected blood through the skin, such as during injection drug use, and through sexual contact.12
What Are The Symptoms Of Hepatitis B
Many people with hepatitis B dont have any symptoms. If you do get symptoms you may not notice them until two or three months after infection and they can last up to three months. There are two types of infection acute and chronic.
Acute symptoms include:
- flu-like symptoms, including tiredness, fever and aches and pains
- feeling and/or being sick
- jaundice, meaning your skin and the whites of your eyes turn yellow
- dark urine
- pale faeces .
People who cant fight off acute infection after six months, such as babies, young children and people with a weakened immune system because of HIV, can go on to develop chronic hepatitis B. This is when people are at higher risk of liver failure, liver disease and cancer of the liver.
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What Causes Hepatitis In General
- Virus and other infections
- Autoimmune response
- Ischemia
- Metabolic disorders
- An acute illness caused by the hepatitis A virus .
- Transmitted through food and water contaminated by feces of infected people.
Acute Hepatitis B Infection
There is no specific treatment for acute hepatitis B, and most people recover within one to two months. Usually, you can manage symptoms at home with painkillers if necessary. Your healthcare professional should advise you to have regular blood tests and physical check-ups. Most people make a full recovery from acute hepatitis B.
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Looking After Your Liver When You Have Hepatitis B
- Drink plenty of fluids.
- Stick to a healthy diet.
- If your skin is itchy keep cool, avoid hot showers and baths and wear loose clothes.
- Avoid alcohol and recreational drugs.
- Attend all your medical appointments and check-ups.
Ibuprofen or paracetamol can help with stomach pain in the acute phase. Check with a clinician if you’re unsure whether you should take them.