Hepatitis B virus (HBV) is transmitted by contact with blood, semen or vaginal fluids. It is many times more infectious than HIV, so it is easily passed on during sex without a condom or other barrier protection. Oral sex is a risk if there are cuts, wounds or abrasions in the mouth. It can also be passed on from a mother to her baby during birth, although treatment for the baby at birth can prevent this. Like hepatitis C, hepatitis B is also a risk if injecting drugs and sharing needles and equipment.
Hepatitis B can lead to cirrhosis (scarring of the liver), liver cancer or liver failure if it is not diagnosed and managed. These serious liver-related complications from hepatitis B are a leading cause of death among HIV-positive people. Early diagnosis and treatment (along with 6 monthly check-ups) is imperative to prevent these outcomes.
Worldwide 240 million people have been infected with hepatitis B, and about 600 000 people die every year due to the consequences of hepatitis B. In Australia, there are an estimated 213,000 people living with chronic hepatitis B infection1 – nearly half of those are undiagnosed (untested). Chronic hepatitis B occurs in about 3% of gay men, and about 6% of HIV-positive men. Men who have sex with men (MSM)are about 10 times more likely to get hepatitis B than the general population.
Most adults (about 95%) who have been exposed to hepatitis B may naturally clear the virus during the acute (short-term) stage of the infection – because their immune system is able to mount an attack on the virus. Although some people with chronic (long-term) hepatitis B may experience an inactive (latent) state of the condition, with minimal liver health impacts, the condition can persist a lifetime as there is no cure. It may also ‘flare up’ at any time without you noticing symptoms or feeling unwell. With appropriate monitoring (every 6 months) hepatitis B can be treated when needed to help prevent serious liver damage. If you have hepatitis B, regular (6 monthly) liver function monitoring with your doctor or specialist is recommended.
Symptoms in the acute stage of hepatitis B infection might not occur, but if they do you may notice jaundice (yellowish eyes and skin, pale stools or dark urine), tiredness, nausea, vomiting, and abdominal, muscle and joint pain. Symptoms are uncommon in chronic infection – but they are similar to above, but may also include liver pain (in the upper right side of your abdomen, just under the rib cage).
Some of the antiviral treatments used for HIV also have activity against HBV, so both conditions can be treated at once with HIV antiviral treatments alone. Your HIV specialist can advise you about those treatments. For people who only have hepatitis B (but not HIV) other antiviral treatments may be used. Treatment may not be appropriate for everyone – depending on your liver health, stage of the condition and other health issues. Your doctor or specialist will advise when treatment is recommended.
A vaccine is available to prevent hepatitis B, and is highly recommended for HIV-positive and HIV-negative gay men. For the vaccine to be effective, you must have all three doses (injections) over 6 months. Once you are immune you cannot get hepatitis B, and you do not require a vaccine booster shot later.
Using condoms and dams (barrier protection) and not sharing sex toys (unless thoroughly washed in warm soapy water) will prevent exposure to hepatitis B. However, your best form of prevention is to be vaccinated for hepatitis B (and hepatitis A at the same time).
People who inject drugs should use new sterile fits (needles and syringes) and use their own equipment (spoons, tourniquets, filters, swabs), and dispose of injecting equipment in an approved sharps container. Avoid sharing personal grooming items (toothbrushes, razors, tweezers).
- Kirby Institute, Annual Surveillance Report, 2015-p12.
About Hepatitis B (HBV):
Video (Liver Health Checks): www.hepatitisaustralia.com/videos/
Hep B Support Group: http://hblist.net/
Hepatitis Queensland: 07 3846 0020 or 1800 437 222 or www.hepqld.asn.au