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Living with Hepatitis B:
An Interactive Learning Guide for Acute and Chronic
Infection
Learning Guide Table of Contents
- Hepatitis B Is
- Let's Begin
- Getting Your Blood Test
- Hepatitis B Blood Panel
- Common Hepatitis B Test Results
- Testing Positive for Hepatitis B
- Acute Hepatitis B Infection
- Chronic Hepatitis B
- Finding a Liver Specialist
- Visiting Your Doctor
- Additional Tests
- Monitoring Your Hepatitis B
- Approved Hepatitis B Treatments
- Treatment Issues to Consider
- Clinical Trials
- Take A Breather
- Protect Your Loved Ones
- See Your Doctor Regularly
- Make Healthy Life Choices
- Healthy Life Choices Continued
- Pregnancy and Chronic Hepatitis B
- Protect Your Newborn
- Hepatitis B and Breastfeeding
- Health Insurance and Employment
- Support Groups
- Get Educated
- Enjoy Your Life
- Spread the Word
- Conclusion
Printable Documents: Glossary, Questions to Ask Your Doctor and Links
Hepatitis B is...
Hepatitis B is the worlds most common liver infection. It is caused by the hepatitis B virus (HBV), which can attack and injure the liver. HBV is transmitted through blood and infected bodily fluids. This can occur through direct blood-to-blood contact, unprotected sex, reusing needles, and from an infected woman to her newborn during the delivery process.
- Two billion people around the world (almost 1 out of 3 persons) have been infected with hepatitis B.
- Each year, there are 10-30 million new infections worldwide.
- In the U.S., there are approximately 1.25 million people who are chronically infected with hepatitis B, and there are almost 100,000 new infections each year.
- Hepatitis B is a silent disease, which means that someone can be infected for years, even decades, without having any symptoms. During this time, the virus can be silently causing damage to the liver. Most people do not have symptoms until they already have liver damage.
Let's Begin.
Through a blood test, perhaps because you have been having symptoms, or perhaps after you have donated blood, you have been diagnosed with hepatitis B. The first thing to remember is Dont Panic. We are here to help, and we will break down your diagnosis and describe what you need to do next into small, simple steps.
Getting Your Blood Test
Your doctor has probably ordered the hepatitis B panel of blood tests to diagnose your hepatitis B. Remember to ask the doctor to explain each test result to you, and get a copy of your blood test results for your own files. The next slides will explain the three tests that make up the hepatitis B blood panel.
Hepatitis B Blood Panel
The hepatitis B blood panel is made up of 3 tests, but you only need to give one blood sample. This test can be done easily in your doctors office or local health clinic.
- Hepatitis B Surface Antigen (HBsAg): if this test is positive, then the hepatitis B virus is present in the blood. This means that you have a hepatitis B infection.
- Hepatitis B Surface Antibody (HBsAb or anti-HBs): If this test is positive, then you are immune to hepatitis B. You cannot become infected with the virus, nor can you pass the virus on to others.
- Hepatitis B Core Antibody (HBcAb or anti-HBc): If this test is positive, then you may have been exposed to the hepatitis B virus, but it does not tell you whether you are currently infected. Once you are exposed to hepatitis B, this test will likely remain positive for life, even after you have recovered.
Clinic — If you want to be tested for hepatitis B, you can visit www.hepclinics.org to find a clinic near you. (back to text)
Common Hepatitis B Test Results
Here are the most common hepatitis B blood panel test results and what they mean (keep in mind that your actual test results may read as "+" or "reactive", or "-" or "non-reactive").
HBsAg- HBsAb- HBcAb-
Not Infected Need Vaccine
- You are not infected with hepatitis B.
- You are still at risk for a hepatitis B infection.
- Get Vaccinated!!
- Thank you for taking our interactive tutorial!
HBsAg- HBsAb+ HBcAb+/-
Not Infected Immune
- You have had a previous hepatitis B infection.
- You have recovered and you no longer have hepatitis B.
- You cannot pass the virus on to others.
- OR, you have been successfully vaccinated and are protected against hepatitis B.
- Thank you for taking our interactive tutorial!
HBsAg+ HBsAb- HBcAb+
Infected with Hepatitis B
- You are currently infected with hepatitis B.
- Please Click Here to learn what to do next.
Sometimes the hepatitis B blood panel can be difficult to interpret. Your blood test results may look different than these, so please make sure your doctor fully explains the results to you. Please refer to the Blood Tests page of our website for more detailed information.
Testing Positive for Hepatitis B
If your test results came back "HBsAg+, HBsAb-, HBcAb+," this indicates that you are currently infected with hepatitis B. You might have a new acute infection, or a long-term chronic infection.
If your doctor has run the HBcAb IgM test and it came back positive, then it is likely that you were infected with hepatitis B within the last 6 months and you have an acute infection.
Your doctor will want to retest you over the next 6 months to see if you get rid of the virus and recover. You may or may not have symptoms during this time. Most people do not, but some common symptoms can include fatigue and flu-like symptoms. For more detailed information on symptoms, click here.
If you already know that you have a chronic hepatitis B infection, click here.
Acute hepatitis B infection a new hepatitis B infection, occurring within the past 6 months. (back to text)
Chronic hepatitis B infection A patient who tests positive for the hepatitis B virus for more than 6 months is considered to have a chronic hepatitis B infection. (back to text)
Acute Hepatitis B Infection
There is no specific medication to help you get rid of the virus during an acute infection. But there are some things you can do to help keep yourself and your liver healthy.
- Make sure you follow-up with your doctor every few months and keep all appointments. Ask for copies of all test results.
- Get plenty of rest and talk to your doctor about treating any symptoms that you are having.
- Have household family members and sexual partners tested and vaccinated. Until you know that your family members are protected: avoid unprotected sex, sharing razors, needles, nail clippers, tooth brushes or earrings, make sure you keep all cuts covered, and clean all blood spills with bleach and water.
- Avoid alcohol, smoking and illegal drug use.
- Talk to your doctor before taking any medication, including over the counter medicines, vitamins, and herbal supplements, because some of these can be harmful to your liver.
Protected A simple blood test can tell whether a person is protected against hepatitis B. This blood test is called the "hepatitis B surface antibody" test, or "HBsAb." This test should be positive ("+" or "reactive" or ">10") if a person is protected against hepatitis B, and can be ordered one month after the third (final) dose of the hepatitis B vaccine. (back to text)
Chronic Hepatitis B
Six months after your initial diagnosis of hepatitis B, you should be tested again. Here are what your test results might look like:
HBsAg- HBsAb+ HBcAb+
Recovered
- You have recovered from your hepatitis B infection.
- You are now immune, so you cannot be infected by the hepatitis B virus again.
- You can no longer pass the virus on to others.
- Talk to your doctor about getting the hepatitis A vaccine to avoid getting another liver infection.
- Thank you for taking our interactive tutorial!
HBsAg+ HBsAb- HBcAb+
Chronic Hepatitis B Infection
- You have been tested positive for the hepatitis B virus (HBsAg+) for more than 6 months, and are now diagnosed as having a chronic hepatitis B infection.
- You will most likely carry the virus in your blood and liver for a lifetime, and could be at increased risk for liver problems later in life.
- We want to reassure you that you can expect to live a long, full, healthy life.
- Talk to your doctor about getting the hepatitis A vaccine to avoid getting another liver infection.
- Please click here to learn what your next steps should be.
Finding a Liver Specialist
Now that you have been diagnosed as having chronic hepatitis B, we will discuss some tips on managing your diagnosis.
- Find a liver specialist you will be working closely with your doctor, so make sure they are experienced in treating hepatitis B, you are comfortable with them, and they take time to answer your questions. A hepatologist or gastroenterologist is the doctor that can help you the most.
- The Hepatitis B Foundation can help you find a specialist in your area. Visit our Liver Specialist Directory.
Hepatologist (hepatologist) A doctor who specializes in the study and treatment of liver disease. (back to text)
Gastroenterologist (gastroenterologist) A doctor who focuses on the function and disorders of the gastrointestinal system, which includes the esophagus, stomach, pancreas, intestines, and liver. (back to text)
Visiting Your Doctor
When you first visit your doctor, he/she will take your medical history and give you a physical exam. They will also take some blood for tests and perhaps order an ultrasound of the liver.
To prepare for your doctors visit,
- take a list of questions with you
- bring copies of your previous blood test results
- invite a friend or family member along for support
- try to take notes while you talk to the doctor so that you have important information written down
Additional Tests
Here are some of the tests that your doctor might order at this time:
- ALT (Alanine Aminotransferase) blood test used to evaluate the health of your liver
- HBV-DNA measures the amount of hepatitis B virus in your blood
- AFP (alpha-fetoprotein) used as a liver cancer marker
- e-antigen and e-antibody measure how active the virus is in your body. These results can change over time, as the virus becomes more and less active.
- Ultrasound of the liver allows the doctor to see if there are any abnormalities on the surface of your liver
- Liver biopsy The removal of a small piece of tissue from the liver using a special needle. The tissue is examined under a microscope to look for inflammation or liver damage.
The results of these tests will tell you and your doctor how active the virus is in your body, whether you have any liver damage, and if you are a candidate for treatment at this time. For more specific information on each of these tests, please visit: http://www.hepb.org/patients/additional_blood_tests.htm and http://www.hepb.org/patients/liver_biopsy.htm
Monitoring Your Hepatitis B
Depending on your test results, you and your doctor might decide to wait and monitor your condition. If your test results indicate that you would be a good candidate for treatment, then your doctor will discuss the current treatment options with you. Whether you start treatment or not, your doctor will want to see you at least every six months, or more frequently.
Before you start any treatment, make sure you research each treatment option, and ask your doctor to thoroughly explain each option, so that you are well informed. It also might be a good idea to get a second opinion from another doctor before starting any treatment, because more information is always better!
Approved Hepatitis B Treatments
Although there is currently no cure for chronic hepatitis B, there are several FDA approved medications that can slow down the virus and help prevent liver damage. Please be sure to discuss each treatment option with your doctor to find out which one is right for you.
The Hepatitis B Foundation offers additional treatment resources that can be useful for you and your doctor. Click on the links below to learn more:
- http://www.hepb.org/professionals/approved_hbv_drugs.htm
- http://www.hepb.org/professionals/hbf_drug_watch.htm
Treatment Issues to Consider
There are several issues you should consider before making the decision to start any hepatitis B treatment:
- Make sure your doctor clearly explains why he/she is recommending treatment for you.
- Ask your doctor to discuss the pros and cons of the treatment option that is being recommended.
- If possible, get a second opinion to make sure you are getting the best advice.
- If you are a woman who wants to have children now, or in the near future, talk to your doctor about treatment and pregnancy. You cannot get pregnant while on medication for hepatitis B, but this does NOT mean that you cannot plan for a family. Some questions to consider are: should you postpone treatment to become pregnant now, or do you need to start treatment now and postpone pregnancy? Also, women on treatment for hepatitis B cannot take birth control pills, so make sure you speak to your doctor about alternate forms of birth control that you can take while you are on treatment.
Clinical Trials
There are several other promising new drugs that are being tested for hepatitis B treatment:
- Before any drug is approved for general use, it must go through three phases of testing called "clinical trials".
- People volunteer to participate in these clinical trials and must meet strict criteria before being accepted.
- For more information on clinical trials and new drugs for hepatitis B, please visit the Hepatitis B Foundation Drug Watch and our Clinical Trials page.
Take A Breather
For the remainder of this learning guide, we are going to talk about the different aspects of living with chronic hepatitis B. We know there is a lot of information for you to absorb, so this may be a good time to get up, stretch, and get a drink of water and a snack before finishing this learning guide!
Protect Your Loved Ones
It is important to make sure you prevent transmission of the hepatitis B virus to those you love:
- The first step is to have household family members and sexual partners tested, and vaccinated if they are not infected.
- Hepatitis B can be spread through direct blood contact, unprotected sex, and contact with infected bodily fluids, so until you know that your family members are protected:
- avoid unprotected sex
- dont share razors, needles, nail clippers, tooth brushes or earrings
- make sure you keep all cuts and open sores covered
- clean all blood spills with a fresh 1:9 solution of bleach and water (1 part bleach to 9 parts water), making sure gloves are used.
- Once you are sure that loved ones are protected, you do not have to worry about possibly infecting them.
- Hepatitis B is NOT spread through casual contact, hugging, coughing, sneezing, or eating food prepared by someone who is infected. You do not have to worry about these things even before your family members are protected by the vaccine. So, even while your family members or sexual partners and completing the vaccine series, you do not have to worry about transmitting the virus through casual contact.
See Your Doctor Regularly
Make sure you see your doctor regularly:
- Follow up with your physician twice a year (or more frequently as needed), even if you are not on treatment, so he/she can closely monitor your health and the health of your liver.
- Inform your doctor of any symptoms or changes that you think are important.
- Speak to your doctor about getting the hepatitis A vaccine to prevent you from getting another dangerous liver infection.
- Talk to your doctor before taking other medications, vitamins, or herbal supplements to make sure they are not harmful to your liver.
Make Healthy Life Choices
Maintaining a healthy lifestyle can help keep you and your liver healthy!
- Avoid alcohol chronic hepatitis B and alcohol are a dangerous mixture. Studies have shown that even small amounts of alcohol can damage an already weakened liver.
- Avoid smoking and illegal drug use.
- Eat a balanced diet Although there is no diet specific for chronic hepatitis B, studies show that eating green and yellow vegetables (cabbage, broccoli, cauliflower) is good for the liver. The American Cancer Societys diet, which includes low fat, low cholesterol, and high fiber food is beneficial as well. Shellfish is generally not recommended for anyone with hepatitis B because of the risk of eating contaminated shellfish.
Healthy Life Choices Continued
Maintaining a healthy lifestyle can help to keep you and your liver healthy, continued!
- Get regular exercise, and make sure you speak to your doctor before starting any exercise program.
- Reduce your stress as much as possible.
- Make sure you get enough rest. Listen to your body when you are tired, lie down, take a nap, read quietly, or try meditation to help you relax and refresh yourself.
- Avoid inhaling fumes from paint, paint thinners, glue and household cleaning products, which may contain chemicals that could damage the liver.
Pregnancy and Chronic Hepatitis B
If you are chronically infected with hepatitis B and pregnant, or thinking about becoming pregnant, there are some things you need to know. The virus CAN be transmitted to your baby during pregnancy or delivery.
Fact: 90% of babies born to hepatitis B infected moms will become infected with hepatitis B at birth.
Fact: The good news is that you CAN prevent the hepatitis B virus from infecting your baby.
Protect Your Newborn
Protecting your newborn:
- Your baby must be given two shots in the delivery room, within the first 12 hours of life the first dose of hepatitis B vaccine and one dose of hepatitis B immune globulin (HBIG).
- Make sure you tell your obstetrician and your babys future pediatrician before you give birth, so that your doctors will have these two shots available in the delivery room with you.
- Your baby will need additional doses of hepatitis B vaccine at one and six months of age to provide complete protection.
- The baby can be tested any time after 12 months of age to make sure they have developed immunity to the hepatitis B virus. The best time to test the baby is 3-9 months after the last dose of the vaccine.
- Make sure you regularly follow-up with your liver specialist throughout your pregnancy.
If the hepatitis B vaccine and HBIG are given correctly within the first 12 hours of life, a newborn has a 95% chance of being protected against a lifelong hepatitis B infection. This is very important make sure you protect your child as soon as he/she is born!
Obstetrician (obstetrician) a doctor who specializes in pregnancy and childbirth. (back to text)
Pediatrician (pediatrician) a doctor who specifically treats children. (back to text)
Hepatitis B and Breastfeeding
Women with hepatitis B are encouraged to breastfeed their babies since the benefits of breastfeeding outweigh the very small potential risk of transmitting the virus through breast milk. Since all newborns should receive the hepatitis B vaccine at birth, this further reduces any small risk of transmission.
According to the leading hepatitis B experts at the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), it is safe for an infected mother to breastfeed her infant. For more information, visit the CDC website.
Health Insurance and Employment
Many people with chronic hepatitis B have health insurance and employment questions. Hepatitis B should not be a barrier to your employment. If you are having difficulties at work, check your employers infection control policies through employee health or human resources.
The Americans with Disability Act (ADA) is a broad law that protects those with disabilities, which can include hepatitis B. For more information, visit the ADA website. You can also check the U.S. Equal Employment Opportunity Commission to help answer questions regarding employment and hepatitis B.
For health insurance resources, contact your state Health Insurance Commission or your state hepatitis B coordinator for assistance.
Support Groups
It is important to get the support that you need as you manage your hepatitis B. Support groups, both in-person and online, are a great way to find the emotional support you need from people who are going through similar experiences. Often, you can find many answers through support groups from people who have lived with chronic hepatitis B for many years, and are happy to share their knowledge and experiences with you.
It might be difficult to find an in-person support group near you that focuses on hepatitis B. However, there is an international online support group (the Hepatitis B Information and Support List: HB-List) at www.hblist.org. This group, run by volunteers who live with chronic hepatitis B, has been online for over 6 years, and is a great resource for patients, families, and others affected by hepatitis B.
The Hepatitis B Foundation sponsors the annual B Informed Conference, the only patient-focused hepatitis B conference. Patients, family members, and health care providers get the chance to share stories and experiences, learn about the latest updates in treatment and research, and form a strong hepatitis B community of friends. Click here to learn more about past B Informed Conferences, and join us for the next one!
Get Educated
Get educated about hepatitis B! There are many good resources you can find to help you learn more about living with hepatitis B, including websites and books. The Hepatitis B Foundation has a free quarterly newsletter, information packets, printable material, and videos. You can find our free resources. You can also find great books at our online bookstore.
The more information you have about hepatitis B, the better you will be able to manage your diagnosis.
Enjoy Your Life
While living with hepatitis B can be difficult and scary at first, the more information and support that you have, the easier it gets. Many patients become such experts at managing their hepatitis B that they sometimes teach their health care providers about the latest research and information!
The most important thing to remember is that hepatitis B is a chronic medical condition (such as diabetes and high blood pressure) that can be successfully managed if you take good care of your health and your liver. You should expect to live a long, full life.
Spread the Word
Dont forget to spread the word! It is important that we make everyone aware that hepatitis B is an important health issue. Help us educate the public about hepatitis B, how easily it can be prevented, and how important it is to continue research into new medications for a cure.
You can also support our efforts at the Hepatitis B Foundation to find a cure and improve the lives of those affected by hepatitis B worldwide through research, education, and patient advocacy.
Conclusion
Thank you for taking the time to complete this learning guide about living with chronic hepatitis B. We hope that we were able to help answer some of your questions and to reassure you that you can live successfully with chronic hepatitis B.
Feedback
We need your feedback!! How did we do? Please fill out this quick feedback form your feedback helps us bring you quality information that you can use.
As always, the Hepatitis B Foundation is available for more information: you can email us at info@hepb.org or call us at 215-489-4900 (M-F, 9-4:00 EST).
Questions to Ask Your Doctor
- What kind of hepatitis B infection do I have: a new "acute" infection, or a "chronic" infection?
- Could you please explain each hepatitis B blood test result, and any additional test results (ultrasound)? Please make copies of my test results for my own personal files.
- Where can I get my family, spouse or sexual partner tested and vaccinated for hepatitis B? What do I need to do to protect them until they are completely vaccinated?
- Am I a good candidate for treatment? If not, why not? If yes, please explain why and tell me about the treatment options?
- Could you tell me about clinical trials? Do you offer any clinical trials for hepatitis B? If so, could you please explain them to me?
- For young women: If I want to have children, should I wait to start treatment? If I need to start treatment now, at one point can I consider having children?
- How will having hepatitis B affect my job or ability to work?
- How will having hepatitis B affect my health insurance or my ability to get health insurance?
- Here are the names of the medications that I currently take are they safe for my liver?
- What over the counter medications or herbal supplements can I safely take for pain, cold symptoms, etc.?