Hepatitis B

Hepatitis B is passed on by contact with the blood, semen, saliva, or vaginal fluids of an infected person. It is easily passed on during unprotected sex (including oral sex), by sharing injecting equipment, and from a mother to her baby during delivery. It can also be passed on through infected blood getting into an open wound, through tattooing or body piercing done with contaminated equipment, or through using items such as toothbrushes or razors contaminated with infected blood. Hepatitis B is many times more infectious than HIV.

Hepatitis B can be avoided by using a condom during vaginal or anal sex, using a condom or dental dam during oral sex and not sharing sex toys or injecting equipment.

A vaccine is available to protect you against hepatitis B. This usually consists of a course of three injections, given over several months. If you are uninfected, and a test shows that you do not have natural immunity against it, you should be vaccinated. The vaccine is effective in people with HIV, but you may need one or more additional doses, especially if you have a lower CD4 count. People with HIV can lose their immunity to hepatitis B as their immune system weakens, and should have their level of immunity checked regularly. Your HIV clinic should monitor this.

Diagnosis

You should be tested soon after your diagnosis for hepatitis B, to see if you have been infected with the virus. This is done with a blood test.
In the UK, pregnant women should be screened for hepatitis B. Babies born to mothers with hepatitis B can also be vaccinated soon after birth to prevent the infection being passed on.

Many people do not notice any symptoms at all. Hepatitis B might only be diagnosed through routine health monitoring.
However, when you first become infected with hepatitis B, you may develop jaundice (yellowing of the eyes and skin), lose your appetite, have pain in the abdomen, nausea or vomiting (feeling or being sick), muscle and joint aches or fever. Symptoms usually last between one and three months.
These symptoms can be very serious or, in very rare cases, fatal.
Early in the infection, most people will clear the virus without treatment and develop protective immunity. However, in about 10% of adults, hepatitis B continues to reproduce in the body long after infection. These people become chronically infected with hepatitis B, meaning that they continue to be infectious, although they may not experience any symptoms at all, or not for many years.
People with HIV, especially if they have a low CD4 count, are less likely to clear the virus naturally than people without HIV, and to develop chronic hepatitis B.
Some people with chronic hepatitis B eventually develop chronic liver inflammation and have, therefore, increased risk of liver disease (cirrhosis) or cancer of the liver.

Monitoring the health of your liver

 
Everyone with HIV should have regular tests to monitor the health of their liver. These tests are especially important if you have hepatitis B. If you are co-infected with hepatitis B, doctors will closely monitor your liver function using blood tests. Ultrasound examinations may also be performed, particularly if your liver shows signs of damage. Sometimes, people also need a liver biopsy, where a tiny piece of tissue from the liver is removed for investigation.

During the initial period of infection with hepatitis B, it's important to take lots of rest, drink plenty of fluids, and to avoid alcohol and recreational drugs. If your symptoms are severe, you can take painkillers to relieve them. However, it’s important not to take paracetamol, or other drugs processed by the liver,

Treatment is available for hepatitis B if your body does not clear the infection itself. If you are HIV-positive and have chronic hepatitis B infection, you must receive care from a doctor skilled in the treatment of both HIV and hepatitis.

Several drugs are available for the treatment of hepatitis B. These include interferon alfa, adefovir (Hepsera) and the anti-HIV drug 3TC (lamivudine, Epivir). Some other anti-HIV drugs are also active against hepatitis B: tenofovir (Viread) and FTC (emtricitabine, Emtriva).

Which treatment is chosen will depend on whether you also need treatment for HIV. You should only take anti-HIV drugs that are effective against hepatitis B as part of an HIV treatment regimen. This is because of the risk of developing drug resistance, which might limit your options for HIV treatment later.

If you are co-infected with hepatitis B, you should talk to your doctor about how hepatitis treatment might affect your anti-HIV treatment options. Anti-HIV drugs can be used safely and effectively in people with hepatitis B. People with hepatitis B are recommended to start HIV treatment when their CD4 count is around 500 – earlier than people without hepatitis. In some situations, it may be suggested you start earlier than that, if you also need treatment for hepatitis B.