Hep B Blog

Category Archives: Hepatitis B Diagnosis & Monitoring

New Resource: Guide To Hepatitis B Management for Primary Care Providers

The Hepatitis B Primary Care Workgroup has released a new resource that helps primary care providers prevent, diagnose, and manage hepatitis B! Hepatitis B experts from diverse health disciplines have contributed to making this comprehensive guide, which is available to download for free on the University of Washington’s website. 

Hepatitis B is a complex condition that typically is managed by a liver specialist (hepatologist). However, many people in the U.S. and other parts of the world do not have access to a hepatologist. Many primary care doctors do not feel comfortable or know how to properly care for someone living with hepatitis B. This leaves a large gap in managing and treating the infection. Hepatitis B Management: Guidance for the Primary Care Provider helps to close this gap by giving all providers the tools to understand the virus and how to manage it.

Dr. Amy Tang, Director of Immigrant Health at NorthEast Medical Services and one of the hepatitis B experts involved in creating the guide, answered a few questions about why this resource is so important: 

 

Why was a guide on hepatitis B management needed? What gaps will this help fill? 

 

Primary care providers are recommended to screen and vaccinate for hepatitis B in at-risk individuals.  However, when an individual tests positive for hepatitis B, they are typically referred to a specialist for care.  Because the majority of persons with chronic hepatitis B in the United States are foreign-born with limited English proficiency and often face both linguistic and access barriers to specialists, referral and retention in specialty care for chronic hepatitis B can often lead to lost follow-up.  Chronic hepatitis B management involves visits at least every 6 months for lab monitoring as well as routine ultrasounds for liver cancer surveillance for patients who fulfill high-risk criteria for liver cancer including Asian and African men over 40 years of age and Asian women over 50 years of age.  Because primary care is already performing routine blood tests and cancer screening for a variety of other chronic diseases such as diabetes, hypertension, and breast, cervical, and colon cancers respectively, we believe that empowering primary care providers with a simple to use hepatitis B algorithm would promote increased access and retention in care for persons with chronic hepatitis B.

 

How does this tool work towards the elimination of hepatitis B? 

 

The National Academies of Science, Engineering, and Medicine report for viral hepatitis elimination by 2030 recommends that primary care providers work closely with hepatitis B specialists and their organizations, e.g., the American Association for the Study of Liver Diseases (AASLD) and the Infectious Disease Society of America (IDSA), to increase primary care capacity for HBV screening, vaccination, monitoring, and treatment. Thus the National Taskforce on Hepatitis B in collaboration with ECHO Institute and San Francisco Hep B Free—Bay Area hosted a meeting at the 2018 AASLD Annual Liver Meeting in San Francisco to convene a workgroup of hepatitis B specialists in hepatology, infectious disease, public health, primary care, and pharmacy, as well as representatives from American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) to discuss how we can increase primary care capacity for not only hepatitis B screening and vaccination, but also management and treatment.

Currently, the majority of hepatitis B care is managed by specialists.  AASLD puts forth guidelines and guidance for hepatitis B every couple of years, however, the guidelines can be lengthy, difficult to access, or intimidating for busy primary care providers to utilize. We polled over 100 primary care providers across the country through the National Association of Community Health Centers’ network of providers and found that primary care providers were interested in managing hepatitis B but felt like they did not have the tools and resources at their fingertips to do it manage it confidently.  They reported using web-based references like Up-to-Date for easily accessible guidance on conditions they were less familiar with. Thus, we wanted to create an easy to use document that would be easily accessible and free online. We teamed up with University of Washington’s Hepatitis B Online to host our Hepatitis B Guidance for Primary Care Providers as a means to widely disseminate our recommendations and work towards the elimination of hepatitis B in the United States and globally.

 

How and when should primary care providers use this? 

 

Primary care providers should use this hepatitis B guidance document when they decide to screen a patient for hepatitis B as the document guides them through how to properly screen for hepatitis B in asymptomatic individuals, how to interpret their lab results and provide appropriate counseling, and for patients who screen positive for hepatitis B, how to perform their initial evaluation, monitoring, treatment, and liver cancer surveillance.  We also have a dedicated section on perinatal management of women screened for hepatitis B that clearly illustrates the simple steps that can be taken by the primary care provider to prevent transmission of hepatitis B from mother to child. 

The guide includes detailed information on the following topics:

  • Chronic Hepatitis B Testing and Management Algorithm
  • Interpretation of hepatitis B test results
  • Tests to run on a hepatitis B surface antigen positive (HBsAg +) individual and how to counsel them
  • Monitoring and management of the HBsAg + individual 
  • Managing pregnant women who are HBsAg + 
  • Monitoring for liver cancer

The guide is part of Hepatitis B Online – a free suite of materials for providers that supplies information on all topics related to hepatitis B such as when a person should begin treatment and liver cancer screenings. The website also includes prescribing information for approved hepatitis B treatments, and clinical calculators to aid in interpreting predictors of liver damage such as the AST to Platelet Ratio Index (APRI) and fibrosis score. 

 To access and download the new tool, click here! 

New Resource: Guide To Hepatitis B Management for Primary Care Providers

The Hepatitis B Primary Care Workgroup has released a new resource that helps primary care providers prevent, diagnose, and manage hepatitis B! Hepatitis B experts from diverse health disciplines have contributed to making this comprehensive guide, which is available to download for free on the University of Washington’s website. 

Hepatitis B is a complex condition that typically is managed by a liver specialist (hepatologist). However, many people in the U.S. and other parts of the world do not have access to a hepatologist. Many primary care doctors do not feel comfor table or know how to properly care for someone living with hepatitis B. This leaves a large gap in managing and treating the infection. Hepatitis B Management: Guidance for the Primary Care Provider helps to close this gap by giving all providers the tools to understand the virus and how to manage it.

Dr. Amy Tang, Director of Immigrant Health at NorthEast Medical Services and one of the hepatitis B experts involved in creating the guide, answered a few questions about why this resource is so important: 

Why was a guide on hepatitis B management needed? What gaps will this help fill? 

Primary care providers are recommended to screen and vaccinate for hepatitis B in at-risk individuals.  However, when an individual tests positive for hepatitis B, they are typically referred to a specialist for care.  Because the majority of persons with chronic hepatitis B in the United States are foreign-born with limited English proficiency and often face both linguistic and access barriers to specialists, referral and retention in specialty care for chronic hepatitis B can often lead to lost follow-up.  Chronic hepatitis B management involves visits at least every 6 months for lab monitoring as well as routine ultrasounds for liver cancer surveillance for patients who fulfill high-risk criteria for liver cancer including Asian and African men over 40 years of age and Asian women over 50 years of age.  Because primary care is already performing routine blood tests and cancer screening for a variety of other chronic diseases such as diabetes, hypertension, and breast, cervical, and colon cancers respectively, we believe that empowering primary care providers with a simple to use hepatitis B algorithm would promote increased access and retention in care for persons with chronic hepatitis B.

How does this tool work towards the elimination of hepatitis B? 

The National Academies of Science, Engineering, and Medicine report for viral hepatitis elimination by 2030 recommends that primary care providers work closely with hepatitis B specialists and their organizations, e.g., the American Association for the Study of Liver Diseases (AASLD) and the Infectious Disease Society of America (IDSA), to increase primary care capacity for HBV screening, vaccination, monitoring, and treatment. Thus the National Taskforce on Hepatitis B in collaboration with ECHO Institute and San Francisco Hep B FreeBay Area hosted a meeting at the 2018 AASLD Annual Liver Meeting in San Francisco to convene a workgroup of hepatitis B specialists in hepatology, infectious disease, public health, primary care, and pharmacy, as well as representatives from American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) to discuss how we can increase primary care capacity for not only hepatitis B screening and vaccination, but also management and treatment.

Currently, the majority of hepatitis B care is managed by specialists.  AASLD puts forth guidelines and guidance for hepatitis B every couple of years, however the guidelines can be lengthy, difficult to access, or intimidating for busy primary care providers to utilize. We polled over 100 primary care providers across the country through the National Association of Community Health Centers’ network of providers and found that primary care providers were interested in managing hepatitis B but felt like they did not have the tools and resources at their fingertips to do it manage it confidently.  They reported using web-based references like Up-to-Date for easily accessible guidance on conditions they were less familiar with. Thus, we wanted to create an easy to use document that would be easily accessible and free online. We teamed up with University of Washington’s Hepatitis B Online to host our Hepatitis B Guidance for Primary Care Providers as a means to widely disseminate our recommendations and work towards the elimination of hepatitis B in the United States and globally.

How and when should primary care providers use this? 

Primary care providers should use this hepatitis B guidance document when they decide to screen a patient for hepatitis B as the document guides them through how to properly screen for hepatitis B in asymptomatic individuals, how to interpret their lab results and provide appropriate counseling, and for patients who screen positive for hepatitis B, how to perform their initial evaluation, monitoring, treatment, and liver cancer surveillance.  We also have a dedicated section on perinatal management of women screened for hepatitis B that clearly illustrates the simple steps that can be taken by the primary care provider to prevent transmission of hepatitis B from mother to child. 

The guide includes detailed information on the following topics: 

  • Chronic Hepatitis B Testing and Management Algorithm
  • Interpretation of hepatitis B test results
  • Tests to run on a hepatitis B surface antigen positive (HBsAg +) individual and how to counsel them
  • Monitoring and management of the HBsAg + individual 
  • Managing pregnant women who are HBsAg + 
  • Monitoring for liver cancer

The guide is part of Hepatitis B Online – a free suite of materials for providers that supplies information on all topics related to hepatitis B such as when a person should begin treatment and liver cancer screenings. The website also includes prescribing information for approved hepatitis B treatments, and clinical calculators to aid in interpreting predictors of liver damage such as the AST to Platelet Ratio Index (APRI) and fibrosis score. 

 To access and download the new tool, click here

Fighting the Doom and Gloom: Screening Saves Lives!

blood tubes

By Anu Hosangadi

Liver Cancer Connect’s “Fighting the Doom and Gloom” series is highlighting some of the advances in prevention, screening, and treatment that are helping to increase survival among people with liver cancer. Previously, we talked about how prevention works. Now we’ll explain how screening and surveillance save lives.
Continue reading "Fighting the Doom and Gloom: Screening Saves Lives!"

Journey to the Cure: What Does Liver Cancer Research Look Like? ft. Aejaz Sayeed, PhD

Welcome to “Journey to the Cure.” This is a web series that chronicles the progress at the Hepatitis B Foundation and Baruch S. Blumberg Institute towards finding the cure for hepatitis B.

In the fourth episode (part 2), Kristine Alarcon, MPH sits down with Aejaz Sayeed, PhD, Assistant Professor at the Baruch S. Blumberg Institute, to talk about his research in liver cancer. For any questions about hepatitis B, please email info@hepb.org.

Disclaimer: The information provided in this audio post is not intended to serve as medical advice of endorsement of any product. The Hepatitis B Foundation strongly recommends each person discuss this information and their questions with a qualified health care provider.

Edited by:
Kristine Alarcon, MPH

Special thanks:
Samantha Young

Music:
Modern – iMovie Library Collection

Script:

Welcome to “Journey to the Cure!” Every month, we’ll sit down with scientists from the Hepatitis B Foundationand the Baruch S. Blumberg Instituteto talk to you about hepatitis B and efforts to find a cure for hepatitis B. There’s still a long way to go, but we’re here to walk you through our journey.

Kristine Alarcon, MPH:
Can you tell me about your research?

Aejaz Sayeed, PhD:
That’s an interesting question. I’vespent a lot of time pursuing breast cancer and prostate cancer. I just started working on the liver cancer. There are millions of people who are pursuing cancer research, but the challenge is that we have done a lot of progress in some cancers, but some cancers, still, we do not have a handle on. For example, we have done a lot of progress in breast and prostate cancer. We have not done much in pancreatic and liver cancer. And, the five-year survival rates of breast and prostate and other cancers have drastically increased, but we have not done much of a progress in pancreatic or a specific form of brain cancer or pancreatic cancer or liver cancer. The problem, again, is that we’re not able to detect the disease at an early stage, and if we had a good set of biomarkers available, there’s a good opportunity, there’s a good chance that we should be able to control these diseases as well.

Kristine Alarcon, MPH:
What attracted you to studying liver cancer?

Aejaz Sayeed, PhD:
I’ve been working on breast cancer and prostate cancer, so in liver cancer, I want to use the tools and techniques, which I used in breast and prostate cancer. That’s why there’s that desire to use the similar strategies, which I used in breast and prostate cancer to discover and characterize markers. That’s why I’m still setting up collaborations with transplant surgeons because liver cancer is treated generally by either resecting the tumor or transplanting the liver. The liver is such an important organ that you cannot really take the liver away. You need the liver. Transplanting the liver is another strategy of treating these patients, so, yes, it is basically that desire that we have more biomarkers, and I can use the knowledge that I gained in breast and prostate to recapitulate the same kind of events, so that we can make a dent.

Kristine Alarcon, MPH:
Yeah; that’s so cool.

Aejaz Sayeed, PhD:
Thank you.

Kristine Alarcon, MPH:
Well, thank you for joining us on this episode of “Journey to the Cure.” Please join us next time for our next episode. Thank you for joining us!

Aejaz Sayeed, PhD:
Thank you!

Newly Diagnosed with Hepatitis B? How Did I Get this? Learning the HBV Transmission Basics

If you have just been diagnosed with hepatitis B virus (HBV) then you need to understand how HBV is transmitted. This is important whether you have an acute or chronic infection.  You must understand you are infectious and can transmit the virus to others.

How is hepatitis B transmitted? Hepatitis B is transmitted through direct contact with infected blood. This can happen through direct blood-to-blood contact, unprotected sex, unsterile needles, unsterile medical or dental equipment, and from a HBV infected mother to her baby at birth.  For kids, pediatric experts report that the fluid that oozes from cuts and open sores is also highly infectious, so keep those open cuts covered. HBV can also be transmitted inadvertently by the sharing of personal items such as razors, toothbrushes, nail clippers, body jewelry and other personal items that have small amounts of blood on them.

Hepatitis B is not transmitted casually by sneezing or coughing, shaking hands, hugging or sharing or preparing a meal.  In fact HBV is not contracted during most of life’s daily activities. You don’t need to keep cups and utensils separate. Hugging, or even kissing won’t cause infection unless there are bleeding gums or open sores during the exchange. It’s really all about trace amounts of infected blood, though the virus is in other bodily fluids in lower concentrations.  For example, it’s not about the saliva on the toothbrush that is a big concern, but rather the potential for trace amounts of blood that could be exchanged with a shared toothbrush.

How did I get this? If you have been diagnosed with hepatitis B virus you are likely racking your brain trying to figure out how you could have gotten HBV.  Some can immediately track their likely exposure to a recent event, or perhaps a time period in their life where they were more likely to have been exposed. They may fit into an at-risk category for hepatitis B due to lifestyle choices, country of origin, frequent travel and exposure in endemic areas of the world, or an unsafe blood transfusion, or medical or dental procedures performed without proper infection control. Some may never know how they were infected. What is important is that you are now aware.

Since HBV is a silent infection there can be years before it is detected.  Many individuals born in endemic parts of the globe find out later in life that they are hepatitis B positive, even though they have likely had HBV since birth or early-childhood. Children are especially vulnerable to chronic HBV. Greater than 90% of babies and up to 50% of young children infected with HBV will remain chronically infected, and most will have no symptoms.  Often it remains undetected until it is caught in routine blood work, blood donation, or later in life after there is liver inflammation or disease progression. In Asia, vertical transmission from mother to child is particularly common; whereas in Africa, horizontal transmission at a young age may be more likely.

Although not casually transmitted, there are inadvertent opportunities for exposure to hepatitis B. If you are from an area where HBV is very common, then the odds of exposure, transmission, and infection will be higher. Many are surprised when family is tested, and they learn hepatitis B appears to “run in their family”.  Hepatitis B is NOT genetic! It is not carried on the sperm of a man or the egg of a woman, but it is very easily passed from an HBsAg positive mom to her baby at birth. Hep B is a vaccine preventable disease, but not all moms living with the virus have access to the birth dose for their baby or able to complete the vaccine series, or they have a high viral load resulting in failure of HBV birth prophylaxis. The good news is that today we can prevent the transmission of hepatitis B to the next generation.

If you do, or have participated in high-risk activities at some point in your life, you are also at greater risk. This is not a time to judge or be judged.

Time to move forward. Unless your infection is acute and you can definitively identify your exposure, I would advise that you let it go and move forward. I spent a number of years wondering about the details of my daughter’s infection, but ultimately, it really didn’t matter. What is important is seeing a doctor to learn more about your infection, getting treatment if you need it, preventing transmission to others, and moving forward with your life.

Journey to the Cure: How is Hepatitis B Related to Liver Cancer ft. Aejaz Sayeed, PhD

Welcome to “Journey to the Cure.” This is a web series that chronicles the progress at the Hepatitis B Foundation and Baruch S. Blumberg Institute towards finding the cure for hepatitis B.

In the four episode (part 1), Kristine Alarcon, MPH talks with Aejaz Sayeed, PhD, Assistant Professor of the Baruch S. Blumberg Institute. They talk about how hepatitis B is connected to liver cancer and doctors and scientists tell if a patient has cancer.

For any questions about hepatitis B, please email info@hepb.org.

The Hepatitis B Foundation is a national nonprofit organization dedicated to finding a cure and improving the lives of those affected by hepatitis B worldwide through research, education and patient advocacy. Visit us at www.hepb.org, on Facebook at www.facebook.com/hepbfoundation, on Twitter at @hepbfoundation, and our Blog at www.hepb.org/blog

Disclaimer: The information provided in this video is not intended to serve as medical advice or endorsement of any product. The Hepatitis B Foundation strongly recommends each person discuss this information and their questions with a qualified health care provider.

Edited:
Kristine Alarcon, MPH

Special thanks:
Samantha Young

Music:
Modern – iMovie Library Collection

 

 

Finding the Missing Millions in Ghana

Theobald Owusu-Ansah, President of the Hepatitis Foundation of Ghana and Hepatitis Coalition of Ghana and Guest Blogger, shares his efforts to eliminate hepatitis B in Ghana.

Viral Hepatitis is very common in Ghana, but awareness and testing has remained low. The Hepatitis Foundation of Ghana is working hard to address these gaps. Our mission is to eliminate viral hepatitis and improve the quality of life for those living with chronic hepatitis B and C in Ghana. We have a robust viral hepatitis community screening and awareness program. Through this program, we are working to reduce hepatitis B and C transmission among people in Agona, a farming community in the Nzema East Municipality of the Western region, Ketu South of the Volta Region, Kumasi in the Ashanti Region and Sekondi Komfoase and Takoradi in the Western; and also raise awareness on viral hepatitis infection, reducing stigma and discrimination through free screening, vaccination and education activities. Since this program started, we have made great progress towards these goals! Read on to learn about our most recent successes:

EVENT AT AGONA ON 22ND DECEMBER, 2017

The Hepatitis Foundation of Ghana held a free hepatitis B screening, education and community gathering in Agona, a farming community in the Nzema East Municipality of the Western region A total of 101 persons were screened for hepatitis B. In all, 6 people tested positive for hepatitis B. Those who tested positive were counselled and referred to the district hospital for proper care and treatment.

EVENT AT KETU SOUTH ON 23RD DECEMBER, 2017

Hepatitis B free screening and education were held at Ketu South, a community in the Volta region. A total of 244 persons were screened for hepatitis B. In all, 6 people tested positive. They were counselled and referred to the district hospital for proper care and treatment.

There have been some deaths reported within the community as a result of viral hepatitis according to the people in the community. Interestingly, a majority of the people attributed them to some form of spiritual or traditional mishaps. This was due to the lack of awareness on the risks of viral hepatitis. To help overcome these myths, hepatitis educational materials such as pamphlets and stickers were delivered to the community.

EVENT WITH VOLTIC GHANA LTD IN KUMASI ON 1st MARCH, 2018.

VENUE: KNUST CAMPUS. 

We worked with the Zoom Lion division of the Voltic Ghana Ltd, providing free hepatitis B and C testing.

Those who tested negative were provided with the first two doses of the hepatitis B vaccine. They were also educated and encouraged to spread the knowledge they had received. The people expressed their appreciation for the gesture at the end of the program and promised to get their last dose of hepatitis B vaccine!

EVENT AT SEKONDI KOMFOASE AND TAKORADI ON THE 25TH TO 26TH MAY, 2018

This special event began with a health walk through the streets in the Sekondi Komfoase area and followed with a hepatitis health talk and screening. Most of the people were afraid to come and do the hepatitis B and C tests because of some common perceptions on the radio and TV. I was able to share my family story with them, and that helped some of them come forward to do the test. The screening continued the next day at Home Church in Takoradi. Overcoming misperceptions about hepatitis B is very challenging – but we were able to screen179 persons, and are following up with all of those who tested positive.

There is a lot of work still to be done in Ghana, but we will keep working to change knowledge, overcome challenges and get people tested, vaccinated and treated!

Thank you to Theobald for serving as our guest blogger this week! If you would like more information from Theobald Owusu-Ansah or the Hepatitis Foundation of Ghana, please visit their website or contact them here

Recently Diagnosed with Hepatitis B? Getting Through the Next Months Waiting to Confirm if Your Infection is Acute or Chronic

Have you recently been told you have hepatitis B?  Dealing with the diagnosis and waiting out the next six months to determine if your infection will resolve itself or learning that it is a chronic infection can be nerve-wracking.

Fortunately, greater than 90 percent of healthy adults who are newly infected will clear or resolve an acute hepatitis B infection.  On the hand, greater than 90% of babies and up to 50% of children infected with hepatitis B will have lifelong, chronic infection. Sometimes people are surprised to learn they have a chronic infection. It can be confusing since there are typically few or no symptoms for decades. If a person continues to test hepatitis B positive for longer than 6 months, then it is considered a chronic infection. Repeat testing is the only way to know for sure.

Acute hepatitis B patients rarely require hospitalization, or even medication.  If you are symptomatic, (some symptoms include jaundice, dark urine, abdominal pain, fever, general malaise)  you may be anxiously conferring with your doctor, but if you are asymptomatic, you might not feel compelled to take the diagnosis seriously.  Ignoring your diagnosis can be very serious. If you have concerning symptoms like jaundice (yellow eyes and skin), a bloated abdomen or severe nausea and vomiting, please see your doctor immediately. Your doctor will be monitoring your blood work over the next few months to see if you clear the virus, or monitoring your liver if there are concerning symptoms.

Your job is to start loving your liver …today.  STOP drinking alcoholic beverages.  Refrain from smoking cigarettes.  Your liver is a non-complaining organ, but you cannot live without it.  Make your diet liver-friendly and healthy filled with a rainbow of vegetables and fruits, whole grains, fish and lean meats. Minimize processed foods, saturated fats and sugar.  Drink plenty of water.

Talk to your doctor before taking prescription medications, herbal remedies, supplements or over-the-counter drugs.  Some can be dangerous to a liver that is battling hepatitis B.  Get plenty of rest, and exercise if you are able.

Don’t forget that you are infectious during this time, and that loved ones, sexual partners and household contacts should be tested to see if they need to be vaccinated to protect against hepatitis B.  Sometimes family members or close household contacts may find that they have a current infection or have recovered from a past HBV infection.  If anyone fears exposure, ensure them that hepatitis B is not transmitted casually. They should get tested, and vaccinated if needed, and take simple precautions. Remind them that 1/3 of the world’s population will be infected with the hepatitis B virus during their lifetime.

On the flip-side… Do not let this new hepatitis B diagnosis consume you.  As the weeks and months pass, you might find that the infection is not resolving, and you might worry that you have a chronic infection.  The associated stress and anxiety can be challenging, even overwhelming.  It can contribute to physical symptoms you may be experiencing.  Find a family member, friend, or health care professional with whom you can share your concerns.

If you are told you have recovered from an acute HBV infection (you are now HBsAg negative, HBcAb positive and HBsAb positive) be sure to get copies of your lab reports to ensure there are no mistakes. Compare them with our easy to use blood tests chart.   If something looks wrong, or if you’re confused, speak up and ask your doctor. Once confirmed, be sure to include hepatitis B as part of your personal health history. This is important in case you have conditions requiring treatment later in life that might once again warrant monitoring of your hepatitis B. It is possible for a past HBV  infection to reactivate if a person requires longterm immune suppressing drugs .

No one wants to learn they have chronic hepatitis B but it is a manageable disease. You’ll want to see a doctor with experience treating chronic HBV so they can run additional tests. There are very effective treatments available, though not everyone with chronic HBV needs treatment. All people living with chronic HBV benefit from regular monitoring since things can change with time. Please do not panic or ignore a chronic hepatitis B diagnosis. Take a deep breath and get started today learning more about your HBV infection and the health of your liver.  Things are going to be okay!

If you are confused about your diagnosis, please feel free to contact the Hepatitis B Foundation at info@hepb.org.

If Hepatitis B Is Sexually Transmitted, How Come My Partner Isn’t Infected?

Image courtesy of Canva

I thought hepatitis B was sexually transmitted? I just tested positive, but my partner tested negative, we’ve been together for years, what gives?

This question is a common one. Hepatitis B is indeed easily transmitted sexually, so why do some people — who were not vaccinated — never get hepatitis B from their sexual partners?

It comes down to variables, such as the type of sexual activity you engage in, the viral load (HBV DNA) of the infected partner, and who is on the receiving end of infectious body fluids, especially blood that contains the most virus, and semen.

Having one partner infected, and other not, can add more stress to an already traumatic hepatitis B diagnosis. “It was very confusing and made me question how was it possible I was the only one infected,” said a woman who tested positive while her husband tested negative.  “I thought it was possibly a mistake, maybe I was a biological anomaly, which of course I was not.”

Let’s look at the factors that affect who gets infected and who doesn’t when two people have sex.

Viral load: Semen, vaginal fluids and blood all contain the hepatitis B virus (HBV), and the higher the viral load, the more infectious one’s blood and body fluids are. However, having an undetectable viral load doesn’t mean you won’t infect someone during unsafe sex. Even if a man has an undetectable viral load, studies show his semen still contains some HBV and can spread infection, though the risk is lower.

So, the rule here is if a man tests positive for the hepatitis B surface antigen (HBsAg), he must consider himself infectious.

The role of gender: In heterosexual relationships, uninfected women are at higher risk of getting infected by a male partner infected with hepatitis B, than the reverse. Women are on the receiving end of semen, which greatly increases their risk of becoming infected unless a condom is used.

When a woman is infected with hepatitis B, an uninfected man is at risk through direct contact with her vaginal secretions, but that contact is lower-risk than a woman’s direct exposure to infectious semen during intercourse.

However, an infected woman who is menstruating is more likely to spread hepatitis B because blood can contain higher levels of HBV than vaginal secretions. That is why gloves and dental dams are recommended to provide a barrier against exposure.

The type of sexual activity: Certain sexual activities are far more efficient at spreading hepatitis B than others. Oral sex appears to have a lower rate of hepatitis B transmission than vaginal sex. Anal sex carries a very high risk of transmission because of tears in the skin that can occur during penetration, which improves transmission of HBV.

Fingering carries a lesser risk, unless the infected woman is menstruating or a person has bruises or cuts on their hands that allow entry of hepatitis B virus in semen or vaginal fluids, then gloves are recommended.

The “uninfected” partner could already have been infected and cleared hepatitis B: When a person is first diagnosed with hepatitis B, doctors often test his or her partner for only the hepatitis B surface antigen (HBsAg), which indicates a current hepatitis B infection. If they are negative for HBsAg, they are immediately vaccinated.

If the partner isn’t also tested for the hepatitis B surface antibody (anti-HBs or HBsAb), then no one knows if the individual was already protected, either due to recovery from a past hepatitis B infection, or because they had already been vaccinated.

Hepatitis B is not called the “silent” infection for nothing — many people who get hepatitis B never have any symptoms and never realize they were infected. As a result, a wife, husband, partner or lover who tested negative for HBsAg, may actually have been infected in the past and cleared the infection and now has protective hepatitis B surface antibodies to forever safeguard them from infection. If they’re immediately vaccinated and retested after the three-dose vaccination, they will test positive for surface antibodies, without ever knowing that their antibodies resulted from a past infection, not immunization.

Bottom line, if one of you have been diagnosed and the other is not infected, it is unusual but not uncommon. Get tested and immediately vaccinated if the uninfected partner tests negative for the hepatitis B surface antibody.

Take a quiz to find out how much you know about hepatitis B transmission: click here.

Find an earlier version of this post here

Journey to the Cure: What do I do if I’m pregnant and have hep B? ft. Maureen Kamischke

Welcome to “Journey to the Cure.” This is a web series that chronicles the progress at the Hepatitis B Foundation and Baruch S. Blumberg Institute towards finding the cure for hepatitis B.

In the third episode (part 1), Kristine Alarcon, MPH sits down with Maureen Kamischke, Hepatitis B Foundation Social Media Manager, to discuss what expectant mothers can do when they have hepatitis B.

For any questions about hepatitis B, please email info@hepb.org.

The Hepatitis B Foundation is a national nonprofit organization dedicated to finding a cure and improving the lives of those affected by hepatitis B worldwide through research, education and patient advocacy. Visit us at www.hepb.org, on Facebook at www.facebook.com/hepbfoundation, on Twitter at @hepbfoundation, and our Blog at www.hepb.org/blog

Disclaimer: The information provided in this video is not intended to serve as medical advice or endorsement of any product. The Hepatitis B Foundation strongly recommends each person discuss this information and their questions with a qualified health care provider.

Edited:
Kristine Alarcon, MPH

Special thanks:
Samantha Young

Music:
Modern – iMovie Library Collection