Hep B Blog

Why Your Family Health History Matters with Acute and Chronic Hep B

National Family Health History Day is November 28th, and it is the perfect time to sit down and talk to your family about health; it gives your loved ones an opportunity to provide the gift of a healthy future! As hepatitis B rarely has any symptoms, many people do not discover that they are infected until a family member is diagnosed or they develop liver damage or liver cancer. 

Approaching the topic and starting the conversation can help to break this cycle of transmission within families, and allow your loved ones to protect themselves. If you need some tips on how to start the discussion on family health, you can check out our blog post here!

Your family’s health history tells a powerful story. It guides us on what behaviors to avoid and actions that we can take to prevent developing certain illnesses or diseases. It can also help inform us on how to best navigate the health system. Do I need to be tested for liver cancer? Is the medication that I’m taking actually dangerous to my health? 

When a family member is living with or has lived with hepatitis B, family health history can become even more critical to creating a healthy future. Hepatitis B is one of the world’s leading causes of liver cancer, so it is extremely important to be aware of your risk! Although hepatitis B is not genetic or hereditary – it is only spread through direct contact with infected blood or through sexual contact –  multiple family members can be infected without knowing. This is because hepatitis B often does not have any symptoms and can be spread from mother to child during childbirth or by sharing sharp objects such as razors, toothbrushes, or body jewelry that may contain small amounts of infected blood. Knowing about a family members’ current or past infection is a signal to get tested for hepatitis B using the 3-panel hepatitis B blood test (HBsAg, HBsAb, HBcAb). Testing is the only way to be sure of your hepatitis B status. The test will let you know if you have a current infection, have recovered for a past infection, or need to be vaccinated. 

Why does this matter if myself or a family member has recovered from a past infection? 

If someone has recovered from a past infection (either acute or chronic), this is great news! Loss of the hepatitis B surface antigen may be exciting, but it does not mean that you don’t need to proceed with caution! Recovery from a past infection means that while the virus is no longer in your blood, it is still living in the liver in an inactive state. You cannot infect anyone else at this stage, but family members, and sexual partners should still get tested for the 3-panel hepatitis B blood test (HBsAg, anti-HBc, anti-HBs) because they may have been exposed in the past. Check out this helpful fact sheet on what it means to have recovered from an acute or chronic infection!

A past infection should be a part of all medical records as well. Various medications and treatments for other conditions, such as cancer or Rheumatoid arthritis have the potential to reactivate the virus that is sleeping in your liver.  Some medications can suppress the immune system, which gives hepatitis B a chance to reawaken and attack the liver. Healthcare providers need to be aware if you had a past infection so that they can monitor you and potentially prescribe medications to prevent the virus from reactivating in your body. 

Not every treatment will cause hepatitis B to reactivate, so it is important to be aware of the ones that carry a risk! Any treatment that suppresses the immune system such as chemotherapy and other cancer therapies, and certain arthritis, Crohn’s disease, Ulcerative colitis, asthma, and psoriasis drugs may pose a risk of hepatitis B reactivation. You can find a list of specific drug names and their risk levels on our website, but you should always consult your doctor or provider for the most accurate information. 

Every medication also comes with a warning label that you should read carefully. This section will let you know if there is a risk of reactivation. You can also use the National Institute of Health’s LiverTox website to search the name of treatment and see if there is a risk!

Talking to Your Family 

Hepatitis B may increase a person’s risk of liver disease and liver cancer but with knowledge of an infection, you can take measures to help manage it. For family members who have not been infected, they can take action to prevent future infection by getting vaccinated! Many people assume that they have already been vaccinated, but this is not always the case. Globally, adult completion rates of all 3 doses of the vaccine are low, meaning that most adults are vulnerable to infection. The vaccine is highly effective and is the best form of protection against the virus. Don’t assume you have been vaccinated; check your immunization records or ask your doctor! 

Spending your holiday talking about health may not sound like fun, but it is extremely important – it may even change your life! Set 30 minutes aside to sit down with your loved ones and talk about any diseases or disease risk factors, that are in your family. Awareness is the key to prevention! 

The Alarming Link Between Hep B and the Opioid Epidemic

This post was written by guest blogger Dr. Ahmed Howeedy.

Rates of hepatitis B transmission are on the rise in the United States. The little-known truth is why— and it has everything to do with the raging opioid epidemic that every day claims 130 lives to overdose.

How Opioid Epidemic Is Fueling Intravenous Drug Use

Heroin and prescription painkillers like oxycodone, hydrocodone and morphine have increasingly served as intravenous drugs of abuse for a growing number of Americans who suffer from untreated addiction to these drugs. That increase in intravenous drug use—and with it, higher rates of exposure to unclean needles and IV drug paraphernalia, coupled with low rates of hepatitis B vaccination—has fed a nationwide outbreak of hepatitis B. New cases of the liver disease are reportedly up by an average of 20 percent across the country, according to the Centers for Disease Control and Prevention (CDC).

How Hep B and the Opioid Epidemic Are Related

It’s therefore no coincidence that areas where the opioid epidemic has hit hardest have seen especially dramatic increases in hepatitis B transmission. Consider the following data collected by the U.S. Department of Health and Human Services:

  •  In opioid hot spots such as Kentucky, Tennessee and West Virginia, the incidence of acute hepatitis B infection rose by 114 percent between the years 2009 and 2013, CDC reported.
  • North Carolina reportedly saw a 56 percent jump in new Hep B cases in 2014-2016.
  • And, in Massachusetts, where the government declared in 2015 that there was an opioid crisis, cases of Hep B linked to intravenous drug use increased by 78 percent more than the national average in 2017, according to a Department of Public Health advisory.

How to Intervene When You Suspect Intravenous Drug Use

What is perhaps most tragic about the link between hepatitis B and intravenous drug use is that it is preventable, thanks to public health education and the hepatitis B vaccine. Today most reputable opioid treatment programs will educate incoming patients about the risks of hepatitis B, by testing for the disease and administering the vaccine. And, because quality opioid treatment addresses the roots of addiction that led someone down the path of intravenous drug use, a good rehab program is also the best way to help an intravenous drug user quit their risky behaviors and reduce their risks of overdose.

For family members who suspect their loved one is an intravenous drug user or in imminent danger of intravenous drug use, then, consider having an open, honest and non-judgmental conversation about your concerns. This is not the time to excoriate your loved one for engaging in risky behaviors. The most important, immediate concern should be one of preventing further harm in the form of an overdose, hepatitis B and other dangers like HIV. Here are some things you can do to intervene quickly and effectively when you suspect intravenous drug use:

  •  Encourage your loved one to get treatment for their addiction. Sometimes an intervention will be the most persuasive approach. Equally critical is finding quality integrated care that will treat the medical, neurological, psychological, and behavioral dimensions of an opioid addiction. A trusted treatment provider will offer the hepatitis B vaccine, yes. They will also offer medication-assisted treatment (MAT) for relieving the opioid cravings that so often can trigger a relapse—naltrexone has helped many of my patients with opioid addiction—but a good provider will also take an integrated, wraparound approach that treats the whole person and not just the physical aspects of their addiction.
  • Take your loved one to their primary care doctor for a checkup. Sometimes progress has to come in smaller steps. If you can’t persuade your loved one to enter a rehab program, insist on an annual check-up with their primary care doctor— and if possible, go with them. In these contexts, it’s routine for doctors to ask about lifestyle choices such as drinking, smoking and illicit drug use; and, as a doctor, I’ve found that patients answer these questions honestly most of the time. (For that matter, even if a patient lies about their intravenous drug use, the signs are hard to hide in a medical exam.) In this context, your loved one will be strongly encouraged to get the hepatitis B vaccine series and counseling for other blood-borne infectious diseases which they are at risk for.
  • If your loved one has given up on treatment or refuses to consider it, invite them to consider local harm reduction options. These options and their availability can depend on where you live. Many states now have needle exchange programs. There are approximately 185 such programs operating nationwide, according to a fact sheet from the ACLU. Other harm reduction initiatives include safe injection education and greater public access to the overdose prevention drug naloxone.

Hepatitis B may be the slower, more insidious killer in an opioid epidemic that’s better known by the overdose figures— but it’s a dangerous killer nonetheless. The good news is that with greater public awareness about the problem of prescription painkillers, intravenous drug use and their link to Hep B, we can put an end to that killing spree. Make sure that yourself and your loved ones are protected from hepatitis B by speaking with them or a doctor about the 2-3 doses vaccine!

Dr. Ahmed Howeedy is Chief Medical Officer at FHE Health, a nationally recognized behavioral health provider. Learn more about FHE Health’s addiction treatment programs.

How To Talk To Your Doctor About Hep B in 5 Minutes

 

Going to the doctor can be an intimidating experience for anyone, but perhaps even more so when you’re living with hepatitis B. You have plenty of questions to ask and not enough time! This guide can help you focus on the important questions and become more comfortable discussing your infection with your doctor. 

  • Be Prepared: With only a limited amount of time to discuss concerns, it is essential to ask what matters most. Write down questions that you have been wondering about in order from most urgent to least. This will ensure that you get the answers that you need the most before you run out of time. We have a list of helpful questions that you can take, or they can help you create your own! You can also take a second person along to take notes and help ask follow-up questions. It may be helpful to organize your questions, previous test results, and any notes that you may have in a single folder to take along with you.

 

  • Do Your Research: Hepatitis B is a complex virus and its lack of symptoms can make it tricky to grasp what is going on inside of your body.  Familiarizing yourself with hepatitis B blood test results, liver enzyme tests, or liver function tests and being aware of test results out of normal ranges can go a long way in helping you understand your own body, and to figure out what questions you should ask. Remember to always get copies of all of your test results so you can monitor how they change over time. If something is abnormal, you can address it immediately. 

 

Be sure you are doing your research on trustworthy websites! Misinformation can be damaging, so it is extremely important to find information that is based upon scientific evidence. How do you know if the information is trustworthy? Some common tips are to look for information from trusted institutions, such as a government health department like the Centers for Disease Control and Prevention (CDC) or established organizations like the American Association for the Study of Liver Diseases (AASLD). You should avoid articles that have anonymous authors, and avoid getting information directly from a website from a company that is trying to sell you something. Academic institutions are a great place to look for information, like a local university or peer-reviewed journal articles. 

  • Review the Guidelines: There are several hepatitis B guidelines on how to prevent, treat, and manage hepatitis B. These are designed by medical experts to help doctors around the world make informed decisions about an individual’s status, and are a great source of information. While some individuals may not qualify for treatment, you can take the guidelines to your appointment and ask the doctor to explain why or why not you are a candidate for treatment at the moment. Just be sure to highlight the parts you wish to review beforehand! View the guidelines here. 

 

  • The doctor is the expert – but so are you!: Doctors can be extremely knowledgeable, but you are the one living in your own body! While hepatitis B often does not have symptoms, other factors can have an impact on your infection. One example is medication. Some medications may interact negatively with your liver, which can have an impact on the virus and result in serious consequences. If you notice any changes in your body after taking a new medication, you should alert your doctor to prevent potential liver damage. Your doctor and pharmacist should always be aware if you are living with (or have recovered from) hepatitis B so they can prescribe proper medications, but if an error occurs, it is important to speak up! 

Ensure you inform your doctor of any vitamins, supplements or herbal remedies you may be taking. Companies making these alternative therapies are not regulated so there may be no testing for quality and purity. You do not know what you’re getting from bottle to bottle or even dose to dose! Some alternative medicines can do more harm than good to your liver. 

You should always be aware of what type of doctor you are talking to as well. Some primary care doctors may be more experienced in chronic hepatitis B management than others. Gastroenterologists and hepatologists are the experts in the liver. It is recommended that individuals living with hepatitis B see a hepatologist but if this is not possible, a knowledgeable primary care doctor should be able to monitor you. If you feel that the doctor you are seeing is not experienced in managing hepatitis B, do not hesitate to ask them to review the official management guidelines with you, or to switch doctors. Your health is valuable and should be treated as such! 

When To See the Doctor Immediately

In some cases, those living with chronic hepatitis B can experience symptoms such as jaundice (yellowing of the skin or eyes), ascites (fluid in the abdomen that gives it a hard, round appearance), or severe vomiting and diarrhea. If any of these symptoms occur, it is extremely important to get to a doctor or healthcare professional as soon as possible. Severe symptoms indicate that immediate blood work is needed to prevent severe liver damage or liver failure. Remember that liver disease and liver cancer are both manageable if diagnosed early and monitored regularly, so it is important to attend regular doctor appointments, keep a clear record of your medical history, and become your own health advocate by empowering yourself with knowledge and getting involved in your care! 

I Have Hepatitis B; Can I Get Married?

At the Hepatitis B Foundation, we answer thousands of calls, social media messages, and emails a year from individuals affected by hepatitis B. One of the most common questions we receive is: If I have hepatitis B, can I still get married? 

To put it simply, yes, a person living with hepatitis B can get married. In fact, a healthy relationship can be a source of love and support for those who may feel alone in their diagnosis. Transmission of hepatitis B can easily be prevented if your partner is vaccinated! Any future children can also be vaccinated starting as a newborn to help prevent transmission, even if the mother is hepatitis B surface antigen positive (HBsAg+)!

If your partner is waiting for the vaccine or is unable to be vaccinated for some reason, there are other precautions that one can take to prevent transmission: practice safe sex by using a condom, properly wrap all wounds, clean up any spilled blood with gloves and a fresh solution of 1 part bleach to 9 parts water, and don’t share sharp personal items (razors, toothbrushes, nail clippers, and body jewelry). This list may seem like a lot, but they are mostly things that we do every day without thinking much about it! 

Physically, there are no barriers that prevent an individual living with hepatitis B from getting married. The question often stems from a place of fear that is fueled by the stigma and discrimination around them. Oftentimes, we give fear too much power in our lives. It can control our actions and cause us to isolate ourselves. It’s important to remember that an individual is not their diagnosis. The essence of who you are as a person has not changed! 

Many of our #justB storytellers are leading happily married lives with supportive spouses who help them maintain a healthy lifestyle. Chenda was already engaged when she first discovered that she was living with hepatitis B. She said, “ When my fiance called, I was scared to answer but I told him the truth. He said ‘I love you’ and encouraged me to see a doctor”. Chenda and her husband now have a baby who they made sure was protected from the virus! Another storyteller, Heng, shares how he felt when the woman he was in love with told him that she was living with hepatitis B. After she told him, he got tested and found out he was already protected due to the vaccine! They later married and had children. “We make better lifestyle choices because of her illness, but we don’t let it define our lives”. 

Hepatitis B is not a weakness. Each day, millions of people living with chronic hepatitis B make the choice to wake up and live life to the fullest. Like many others, Edwin – one of our new #just B storytellers – was surprised by his diagnosis. Instead of letting it hold him back, he decided to show the world how strong he was by competing in a series of rigorous athletic competitions to set an example for others like him. “I want to show that Hepatitis B is not a condition that debilitates someone,” said Edwin.  “We can triumph through adversity.” 

Our #justB storytellers are examples of hope, inspiration, and strength; they are people living their truths.They also remind us that the difficulties that we face in life can make us stronger as a person. Despite the fear that Bright felt, he persevered and took action. “Slowly I started to have days when I wasn’t hopeless, when I could face the unknown. I talked to my doctors, did my own research, and made my own decisions….Now I realize I have changed: I am more resilient than ever before.”