Hepatitis B - FAQ

Hepatitis B is the most common serious liver infection in the world. It is a virus that specifically attacks cells in the liver. Globally, there are nearly 300 million people living with chronic Hepatitis B. Additionally, it has been estimated that about 2 billion people have been infected with Hepatitis B (either acute or chronic). There are other viruses that may attack the liver such as Hepatitis A, C, D and E, but each virus is unique. Fortunately, there is a vaccine to prevent new Hepatitis B infections and excellent treatments for those that need treatment.

Hepatitis B can result in either an acute or chronic infection. When a person is newly infected, it is called an “acute” infection. If the person continues to test positive for Hepatitis B surface antigen (HBsAg) for longer than 6 months, then it is considered a chronic infection. Testing is the only way to know for sure if a person is infected with Hepatitis B, and if they have acute or chronic infection.

Babies and young children are particularly vulnerable to the Hepatitis B virus. While ninety percent (90%) of babies and up to 50% of young children will progress to chronic infection with Hepatitis B, only up to 10 percent (10%) of healthy adults will progress to chronic infection. (90% of healthy adults will clear acute Hepatitis B infections. Most do not require any medication to clear an acute infection.).

People are often surprised to learn of their hepatitis B infection because there may be few or no symptoms for decades. They may think they have an acute hepatitis B infection, when, in fact, they were infected as a baby or young child and have a chronic infection. This is because hepatitis B may go unnoticed with no – or few mild – symptoms.

The good news is that hepatitis B can be prevented with the safe and effective hepatitis B vaccine. Ideally, ALL babies are vaccinated within 24 hours of birth and complete the vaccine series on schedule, to protect them from hepatitis B for a lifetime.

Hepatitis B is dangerous because it is a “silent infection,” which means it can infect people without them knowing it. Most people who are infected with Hepatitis B are unaware of their infection for many years and can unknowingly spread the virus to others through direct contact with their infected blood and sexually. Please visit this page to learn more about Hepatitis B transmission and how to protect your family. For those who become chronically infected, there is an increased risk of developing serious liver disease later in life. The virus can quietly and continuously attack the liver over many years without being detected because there are often few or no notable symptoms. The only way to confirm a Hepatitis B infection is through a blood test.

Hepatitis B may feature typical viral Hepatitis symptoms like yellow skin, yellow eye-white “sclera” and dark urine. Alternatively, it may occur unnoticed with subtle fatigue and/or muscle pain. This is why it is often missed.

In general, you want to be sure you are living a healthy lifestyle. Avoid alcohol and cigarettes. Eat a healthy, well-balanced diet, and get regular exercise. When possible, choose whole foods fresh vegetables, fruits, whole grains, plant-based proteins (like tofu, grains, and peanuts), fish and lean meats. Avoid processed foods and limit sugary drinks (sodas and fruit juices) and foods with added sugar. Limit red and fatty cuts of meat and limit foods deep fried in unhealthy oils. Avoid processed meats (like hot dogs and deli meats). Make sure to buy your nuts from trusted sources, and to inspect the nuts and grains for any signs of Aflatoxin poisoning (mouldy appearance and discoloration). Also be very careful with medications or herbal remedies and supplements. Some supplements and herbs can do more harm than good.

If you have been carefully evaluated by a knowledgeable doctor and learned you do not need treatment, it is important to continue with regular monitoring of your Hepatitis B infection and the health of your liver every 6 months or at least annually because things can change with time – even if you have been in an inactive phase of the virus.

In general, you want to be sure you are living a healthy lifestyle. Avoid alcohol, cigarettes, and eat a healthy, well-balanced diet, and get regular exercise. Eat a diet full of vegetables, fruits, whole grains, plant-based proteins, fish and lean meats. Avoid processed foods and limit sugary drinks (sodas and fruit juices) and foods with added sugar. Limit red and fatty cuts of meat and limit foods deep fried in unhealthy oils. Also be very careful with medications or herbal remedies and supplements. Some supplements and herbs can do more harm than good.

You also want to be sure close household contacts, family members, and sexual partners are tested. We are very lucky that Hepatitis B is a vaccine preventable disease.

In order to understand your Hepatitis B status, it is important that your doctor order the Hepatitis B blood panel. This panel includes 3 basic biomarkers, but only one sample of blood is needed. Make sure you request a written copy of your blood test results so that you fully understand what tests were ordered and the actual results of each. Also, be sure to have your doctor clearly explain the results to you so that you fully understand your situation.

It is important to wait 6-8 weeks after a possible exposure before getting tested.  If done before this time (known as “the window period”), the blood tests can have a false negative result. The window period is the time between exposure and the appearance of these markers in blood. The 3-part blood test includes the following:

1. Hepatitis B surface Antigen (HBsAg) – This directly tests for the presence of the Hepatitis B virus. It should be negative if there is NO virus present.
2. Hepatitis B surface Antibody (HBsAb or anti-HBs) – This tests for the production of protective antibodies against the Hepatitis B virus. This blood test should be positive if the protective antibodies are produced in response to vaccination or recovery from a natural infection.
3. Hepatitis B core Antibody (HBcAb or anti-HBc) – This antibody does not provide any protection. A positive result may indicate that a person has been exposed to the Hepatitis B virus. This test must be interpreted in relation to the above 2 test results.

Please note that all three blood test markers are interpreted in relation to each other. Depending on one marker alone may not provide the full or accurate picture of your Hepatitis B status.

Yes, you can safely marry and have children if you are living with Hepatitis B.

Although there is sometimes stigma associated with having Hepatitis B and fear of transmission, it should not be that way. There is a safe and effective vaccine to prevent transmitting Hepatitis B infection to loved ones. Be sure your future partner is vaccinated with the 3-dose Hepatitis B vaccine series given at 0, 1 and 6 months. Practice safe sex using a condom until your partner completes the vaccine series.

Since marriage is a shared journey, so is the journey with Hepatitis B. Assure your partner that you will take good care of your health, and that you will make sure to keep your regular visits to the doctor and maintain a healthy lifestyle. Also make sure to involve your partner in every step of the journey, and seek their support when it comes to treatment options, or keeping a healthy lifestyle.

No. The blood bank will not accept any blood that has been exposed to Hepatitis B, even if you have recovered from an acute or chronic infection.

Yes, you can and should hug your loved ones! Hepatitis B is not spread casually, and it cannot be spread through hugging.

Actually, hugging has many health benefits like reducing stress and fear, boosting heart health, and reducing pain, to name a few.

In many parts of the world, where Hepatitis B is common, Hepatitis B infection is most often transmitted from a mother who is living with hepatitis B to her new-born baby due to blood exchanged during the delivery process. Hepatitis B is transmitted through direct contact with infected blood and infected sexual fluids. This can occur through sharing sharp instruments such as razors, nail clippers, toothbrushes, earrings or body jewellery, since small amounts of blood can be exchanged through these items. Hepatitis B may also be transmitted during unprotected sex with an infected partner, sharing needles, unsterilized medical or dental equipment. Also, body piercing and tattooing are potential sources of infection if unsterile needles or contaminated ink are used. The good news is that completion of the Hepatitis B vaccination series provides lifelong protection against a Hepatitis B infection in anyone who has not already been infected.

This is not an easy situation, and it is a challenge that is shared by many people living with Hepatitis B.

Before you share your Hepatitis B status, you should be prepared. Make sure you are well-informed, because once you share the information, there will be questions you’ll need to answer. Have easy-to-understand resources, like Hepatitis B Foundation website pages, fact sheets or blogs, flagged or printed and ready to share. Additionally, you need to be prepared mentally for all sorts of reactions (both yours and theirs). People may feel supportive, surprised, fearful, or even angry. It is a good idea to talk to others with Hepatitis B before you have this conversation, to get suggestions and advice.

Regardless of how the situation unfolds, please know that Hepatitis B does not define who you are or what you can do! And be prepared that your relationship may change. If you find that your prospective partner is not receptive, you may learn that you’re better off without this person, as there are many challenges occurring in a lifetime. It’s important to have a supportive partner!

This is possible, and not an uncommon scenario. There are several factors that may lead to this situation.

Hepatitis B Virus (HBV) viral load of the partner living with Hepatitis B may be undetectable. The lower the viral load in the blood of an infected individual, the less infectious they are. The likelihood of transmitting Hepatitis B virus increases with higher viral loads (HBV DNA). Please discuss with your doctor the benefits of antivirals in lowering viral load and potentially reducing the risk of transmitting Hepatitis B.

Type of sexual activity is another important factor. There are sexual activities that are associated with higher risk of Hepatitis B transmission than others due to the potential exchange of infected fluids (blood, semen and vaginal fluids). For example, anal sex is considered the highest risk sexual activity followed by vaginal intercourse. Oral sex and deep kissing have been reported to be less risky interactions in transmitting HBV. However, any activity that might involve abrasions or trauma may put a person at higher risk of transmission (consider the idea of bleeding gums or cold sores). If you have multiple partners or your partner is in the process of being vaccinated, condoms and dental dams are always recommended to reduce risk of transmission.

Timing of sexual activity may also play a role as sexual activity during the menstrual period poses higher risk of blood contact if the menstruating person is infected. This is why the use of dental dams or condoms is recommended.

Your partner’s Hepatitis B status. Your partner may have a current hepatitis B infection, resolved a previous infection, or may have been vaccinated in the past as a child. This is why, the Hepatitis B three- test panel (HBsAg, HBcAb total and HBsAb) is standard practice for screening to best understand one’s Hepatitis B status. Please encourage your partner to consider the Hepatitis B vaccine series if their screening reveals that they are susceptible. The Hepatitis B vaccine is safe, effective, and provides lifelong protection.

There have been several studies about symptoms of Hepatitis B, and these studies clearly show that people living with Hepatitis B commonly experience fatigue, tiredness, muscle pain, abdominal pain (especially above where the liver is), nausea and vomiting.

It is important that you share any symptoms you have with your doctor to help manage these symptoms, and people in your close circle (family and friends), so they can understand your daily challenges, and support you in the most appropriate way.

Even if a person has normal liver enzymes and low or undetectable Hepatitis B viral load, they might still feel symptoms related to their Hepatitis B – although not all healthcare providers recognize that people with normal lab tests can still feel sick from their Hepatitis B. Hepatitis B Foundation conducted a global survey about the lived experiences of Hepatitis B, and respondents from around the globe shared the physical symptoms they experience. It is also very important to ensure that other conditions are also ruled out such as non-alcoholic fatty liver disease, gastrointestinal issues or even H. pylori, all of which are also common globally and may have symptoms associated with them.

We are so sorry that your Hepatitis B infection is causing distress. Do understand that you are not alone! Many people living with Hepatitis B feel the same, but because hepatitis B is still stigmatized, and doesn’t receive the proper support that it deserves, people often feel isolated and alone. Know that there are things you can do to help yourself and others in this fight.

Educate yourself about Hepatitis B. Knowledge is power, and when you have the power, you can defeat the disease by taking the right steps to support your health. To start, you will need to regularly monitor your Hepatitis B infection and the health of your liver and discuss with your doctor whether you need to take antivirals. Here are several resources to increase your knowledge about hepatitis B:

1. Hepatitis B Foundation website is a comprehensive link to all areas related to Hepatitis B. From there you can connect to numerous resources including preventing, diagnosing, treating and managing Hepatitis B, along with language chapters in different languages.
2. Learn about the physical, social, and emotional impact of living with chronic Hepatitis B, and how this impacts people like you around the globe and what to do about it.
3. Hepatitis B Foundation Blog: this is a great resource for day-to-day life issues that matter to Hepatitis B patients, like disclosing to a partner, learning about the virus and ways to get involved, etc.
4. Hepatitis B Information Guide is a good resource for quick information about Hepatitis B and might be helpful to share with others.
5. HBV Patient Education Hub (CME Outfitters)
6. CDC Hepatitis B Patient Education Resources: This website has a great deal of information in the form of questions and answers.

Make a conscious decision to live a healthy lifestyle to support your liver. You’ve got this; you are in control! You can support your liver by not drinking alcohol, not smoking and maintaining a healthy weight by eating a well-balanced diet and getting regular exercise. Here is more information on how to maintain a healthy liver. Also, be very careful with medications or herbal remedies and supplements. Some supplements and herbs can do more harm than good.

Think about who you would like to inform about your diagnosis and when. You don’t have to disclose your Hepatitis B status to the entire world, but we all have people in our close circle, with whom we would like to share our tough moments.

Finally, if you feel you cannot get the help and support from your partner, family or circle of friends, please consider seeking professional help from a trained counsellor or trusted community leader. Please talk to your doctor to refer you to a professional consultant.

Please know that people with Hepatitis B have bright futures and long lives ahead of them – they can go to school, have careers, date, marry, have children, and live a normal life. We know it is hard to stay optimistic, but it is important to always keep a positive attitude. Do that and you’ll live a happy, fulfilling life!

Individuals chronically infected with Hepatitis B, who were infected at birth, and who do not receive any medical intervention or treatment, can have up to a 25% lifetime risk of developing liver cancer. The risk is highest for people with other risk factors – such as people who have cirrhosis, or a family history of liver cancer. The annual risk of developing liver cancer among people with Hepatitis B is less than 1% in people without cirrhosis and 2-4% in people with cirrhosis. However, the risk of liver cancer can be significantly reduced with early detection of Hepatitis B virus, treatment with antivirals if advised by your doctor, and making healthy lifestyle choices. Careful and early management of a chronic Hepatitis B infection can avoid the progression of liver disease to cirrhosis, where there is the greatest risk for liver cancer. Regular screening for liver cancer, also known as liver cancer surveillance, can detect cancers early when they may be curative. Know your status and get tested for Hepatitis B. Please keep in mind that feeling healthy and having no symptoms DOES NOT mean there is no infection, or consequent serious liver problems. So, ask your doctor to test you for Hepatitis B, and if you’re living with Hepatitis B, ask your doctor about liver cancer surveillance.

There are several ways you could reduce your risk of liver cancer. First, start by learning about Hepatitis B, and what people living with Hepatitis B should do regularly to maintain a healthy liver.

• Make sure to visit your doctor regularly to check your liver enzymes (ALT/AST), viral load (HBV DNA), platelet count and other liver function tests along with an ultrasound (every 6 months or at least annually). Ask your doctor about using simple blood tests to look at your Fibrosis-4 Index (FIB-4) for liver fibrosis.
• Discuss treatment with antivirals with your doctor.  (First line antivirals include tenofovir (TDF), tenofovir (TAF) and entecavir). These antivirals are effective at suppressing and controlling the virus, reducing liver damage resulting from the inflammatory response to the virus, and lowering the risk of developing liver cancer. Learn here about other important questions to ask your doctor.
• Make healthy lifestyle choices! You can make lifestyle choices that will put you in control during your journey with Hepatitis B. You can support your liver by not drinking alcohol, not smoking and maintaining a healthy weight by eating a well-balanced diet and getting regular exercise. Here is some information on how to maintain a healthy liver. Also be very careful with other prescription and over-the-counter medications or herbal remedies and supplements. Herbal remedies and supplements are not tested or regulated for purity and safety. Some supplements and herbs can do more harm than good.
• Join the Hep B Community! There, you will be able to engage online in discussions with scientists, clinicians, and people living with chronic hepatitis B from around the world, exchanging ideas, and experiences and knowledge about hepatitis B.