What’s Hepatitis B?
Hepatitis B is a serious liver infection caused by the HBV (hepatitis B virus). The transmission of the HBV can happen during sexual contact (vaginal, anal or oral), through infected blood or other body fluids.
Most people infected won’t display any symptoms or will experience yellowing of the skin (jaundice) before they fully recover. Only 10% of the people infected will develop chronic hepatitis B that can over time lead to cirrhosis, cancer, and even death in some cases.
Treatments can be offered depending on the seriousness of the infection and its complications.
HBV directly impacts thec liver.
A safe an efficient vaccine available since 1982 can prevent hepatitis B. The vaccine is typically given as 3 injections and it can prevent infections in 99% of cases for people under 15 years old. The efficacy drops to 60% for people over 50. That’s why it’s recommended to get vaccinated as early as possible.
The WHO (World Health Organization) recommends vaccination to be done at birth. In Quebec newborns can be vaccinated starting at 2 months.
Among people already infected with HIV, the risk of developing chronic hepatitis B is between 25 and 40%. Hepatitis B is the most common and deadliest sexually transmitted and blood-borne infection (STBBI). 2 billion people, or one in 3 people, have been in contact with the virus. There are currently 350 million people living with chronic hepatitis B. It is responsible for 2 million deaths every year, which makes it the second leading cause for cancer after tobacco.
Transmission: How can Hepatitis B be contracted?
The hepatitis B virus is extremely contagious: 10 times more than the HCV (hepatitis C virus) and 100 times more than HIV. The virus can survive for up to 7 seven days without a host.
HBV is transmitted through contact with infected blood and other body fluids (semen, vaginal secretions, breast milk).
Unvaccinated people can be contaminated by:
- Sexual contact (vaginal, anal or oral) with a person infected with HBV.
- Sharing of needles or other injection and snorting equipment (spoons, straws..)
- Direct contact with the blood of a person infected by HBV.
- Pregnancy and or childbirth, from the pregnant person infected by HBV to their newborn
- Sharing of razors, toothbrushes, scissors, tweezers, piercings, earrings..
- Tattooing, piercings and acupuncture done without the necessary hygiene (single use or sterilized equipment).
You can’t be infected with HBV through food, water, or sharing toilets.
How does the infection evolve?
The incubation period for HBV can last between two to six months and is generally free of any symptoms. Afterwards the virus can cause an acute hepatitis case that will generally go unnoticed. 20 to 40% of people with acute hepatitis will have symptoms ranging from fatigue, fever et cold sweats, dark urine, diarrhea, the yellowing of the skin and the whites of the eyes, abdominal pain on the right side, itching.
Acute hepatitis can last for eight to twelve weeks. During this time, the quantity of virus found in blood, semen and vaginal secretions is very high, even without any symptoms. After this period nine in ten people will have eliminated the virus.
We don’t treat Acute Hepatitis B
In the blood analysis, HBs antigens (markers of the virus) will then be replaced by anti-HBs antibodies meaning the infection has been cured and the patient is now immune to HBV. But the infection becomes chronic for 10% of infected people, with the HBs antigen still present but no anti-HBs antibodies developing. That’s why it is important to have a serological test done six to eight weeks after an acute hepatitis.
Immunocompromised people (cancer chemotherapy patients, HIV/AIDS patients) infected by HBV have a considerably higher risk to develop chronic hepatitis. The diagnosis of an acute hepatitis should lead to tests and vaccinations of a person’s close circle and partners.
What are the symptoms of Chronic Hepatitis B?
Most people with chronic hepatitis B won’t feel anything out of the ordinary other than maybe light symptoms. Some mention symptoms that aren’t typically associated with the infection: fatigue, nausea and vomiting, joint and muscle pain.
20 to 30% will experience complications to their liver than can lead to cirrhosis. Their risk to develop liver cancer is considerably higher than usual.
After several years of infection, some patients will experience various extrahepatic symptoms that can impact other organs.
Note: The scaring of the liver caused by HBV can be significant even without any symptoms being felt.
Is it a notifiable disease?
Yes, HBV is notifiable disease in Canada. As soon as a positive result is received, the health care professionals involved are required to notify the provincial health authorities.
A list of sexual partners, family and friends need to be established so they can be contacted and get tested. The name of the person infected with HBV won’t be revealed to them. They will only be informed that they have been in contact with someone infected by the virus and that they should get tested or vaccinated.
In Quebec, the PVSQ is a community organization that offers a fast, confidential and free service to contact sexual partners who need to be notified.
The Vaccin
A safe and effective vaccine can prevent HBV infections. It has been available since 1982 and is generally done in three injections. It protects against infection from the hepatitis B virus for 90 to 95% of the people vaccinated. But age impacts the efficacy of the vaccine ; it has a 99% efficacy rate for people under 15, but of only 60% for people over 50.
It is recommended to vaccinate children as early as possible ; preferably alongside the other vaccines recommended to newborns. In Quebec newborns can be vaccinated starting at 2 months. There are no risk associated with HBV vaccination at birth.
The vaccine can help drastically reduce the number of chronic hepatitis B, cirrhosis and liver cancers. A blood test is done in the 10 years following the vaccination to measure the efficacy of the vaccine. Some people will require booster shots to reach immunization.
If you have sex with unvaccinated partners, or if you’re unsure about their vaccination status, condom use is essential to prevent getting infected by HBV (and other sexually transmitted diseases and infections). Beside children, vaccination is recommended for the following groups:
- Pre-teens (11-13 years old) before they become sexually active.
- People partaking in high-risk activities (unprotected sex, people with multiple partners, needle sharing…)
- People living or traveling to high HBV infection rates regions (Africa, Asia, South America and Eastern Europe)
- Health care professionals
- The people living with HIV/AIDS
Co-infections Hepatitis B and HIV
If you’re living with HIV, you need to ask your doctor for PCR testing of HBV (if you believe you’ve been in contact with the virus). Regular screening methods aren’t sufficient to reach a clear diagnosis for people who are HIV seropositive. The common method of transmission in HIV and HBV leads to a higher prevalence of HBV among people who are HIV seropositive, especially if they have a low CD4 count.
Over 80% of HIV seropositive people have been in contact with the hepatitis B virus. HIV infection worsens the prognostic of chronic hepatitis B by accelerating the degradation of liver cells and making treatments less effective.
Treatments exist for both viruses.
Can Chronic Hepatitis B be treated for people co-infected by HBV and HIV?
Only patients with more serious conditions will receive a treatment. Those conditions include cirrhosis, people with liver enzymes levels at least twice above regular levels, or older patients who have been infected for over 30 years and experience extrahepatic (outside of the liver) complications.
Treatments only control the evolution of the infection by suppressing viral replications in the liver for most patients. However, the treatment may be needed for years, or for life in some cases.
An interruption of treatment may be accompanied by a rebound in HBV replication and induce the need for an additional treatment.
For co-infected patients, HBV does not speed up the progression of HIV and does not prevent a good response to antiretroviral therapy.
There are two types of treatments:
- Interferon-alpha which works by increasing the body’s immune activity against the hepatitis B virus. It is effective in inactivating HBV infection in about one-third of patients treated.
- Antiviral drugs (nucleoside analogues) which directly inhibit the virus by preventing it from replicating: Lamivudine (heptovir), Viread (tenofovir) and Baraclude (entecavir).
The recommendations for people co-infected with HIV and HBV are to choose anti-HIV therapy with Truvada (tenofovir + FTC) or 3TC (lamivudine) because these treatments are also effective for HBV.
Increasingly effective treatments but no definitive cure.
Prevention and vaccination are essential.
Is there a Post-Exposure Prophylaxis?
A person who has had unprotected sex or another type of risky behaviour (for instance, sharing needles, accidental needle sticking with contaminated equipment) may be given a dose of gammaglobulin (antibodies). The antibodies are given by injection, within 24 to 48 hours of the risky behaviour.
You should contact your doctor or another health care professional for additional information.
Text by Laurence Mersilian, July 2005, Updated in September 2021
Sources :
- Infection par le virus de l’hépatite B chez les patients infectés par le VIH, Y. Benhamou, service d’hépato-gastroentérologie Groupe Hospitalier Pitié-Salpêtrière (Paris)
- Canadian Liver Foundation
- SOS hépatities
- AIDS MEDS