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Getting Hip to Hep

November 2001

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

In the shadow of the AIDS epidemic there exists an infection transmitted the same way that may also cause severe illness and death. Larry Kramer, the well-known AIDS activist, is dying from hepatitis B. His picture and story in a recent edition of Newsweek dramatically illustrated the physical struggles he faces as a result of his hepatitis infection. Hepatitis is nothing to minimize.

Hepatitis B is a disease of the liver caused by infection with the hepatitis B virus (HBV). Like HIV, the most common routes of hepatitis B virus transmission in the United States are through unprotected sex and blood-to-blood contact, such as injecting drug use. While the routes of transmission are the same, HBV is approximately 100 times more infectious than HIV. Fortunately, there is a safe, effective vaccine to prevent hepatitis B. In fact, hepatitis B is the only vaccine-preventable sexually transmitted disease.

Only a blood test can tell for sure if you have hepatitis B, so you should talk to your doctor if you have symptoms of hepatitis (e.g., tiredness, stomach ache, joint pain, yellow skin or eyes) or if you think you have had direct contact with someone who has hepatitis B.

You can recover completely from hepatitis B, or you can go on to develop chronic infection. Chronic hepatitis B is a life-long liver disease which occurs in approximately 10% of people who get hepatitis B virus infection. These individuals stay infected for life, and can spread hepatitis B virus to others. In the United States, 1.25 million people have life-long (chronic) hepatitis B. Not all people who have hepatitis B look or feel sick; they can have the virus and not have symptoms or know they're sick.

Life-long infection increases your chance of getting cirrhosis, or scarring of the liver or liver cancer. Each year in the United States, about 75,000 people of all ages get hepatitis B and about 5,000 die of chronic (life-long) liver problems caused by hepatitis B virus infection. If you have had other types of hepatitis, such as hepatitis A or hepatitis C, you can still get hepatitis B. Supportive, symptomatic care is the mainstay of treatment for acute hepatitis B. There are no specific drugs available for treatment of acute disease. There are medications to treat chronic hepatitis B, which work for only a minority of people. Of particular concern for individuals who are HIV-positive, HIV treatment protocols may need to be interrupted in the event of an acute HBV infection, since many HIV drugs are hepatotoxic. That is why prevention is so important. Hepatitis B vaccine is the best protection against HBV.

Prevention of HBV Infection

Vaccination: A safe and effective three-dose vaccine against hepatitis B has been available since 1981. Millions of people have received the vaccine worldwide. For healthy individuals, you do not need booster shots after you complete the three-dose series.

If you are HIV infected, the CDC recommends testing for antibody response after completion of the vaccine to confirm protection. Most HIV-positive individuals will respond to vaccination. However, some will not, and the percentage of HIV-positive individuals who will not respond to the three-dose series is not known. The ability to mount immunity after vaccination depends on the individual's CD4 count, with more immune-compromised people being less likely to respond to vaccination. If you do not respond to vaccination (shown in a post-vaccination lab test), you may consider an additional vaccine series. More doses of the vaccine are not harmful, and studies in healthy individuals have shown that an additional vaccine series can provide immunity for approximately 50% of people who are not initial responders.

This is probably also true for immunocompromised people, but exactly how many would acquire protection after more doses is unknown. If after a second series you are still not protected, you should be tested for an existing chronic infection. If you are determined to be a non-responder and therefore susceptible, you should be counseled about your lack of protection and your continued risk for infection.

In immunocompromised individuals, vaccine protection may wane over time, which would be determined by a lab test. If you are immunocompromised, the need for booster doses should be assessed by annual antibody testing and a booster dose given when antibody levels decline below 10 mIU/mL.

You are at high risk of hepatitis B and should get vaccinated if

  • your sex partner has hepatitis B;

  • you are a man who has sex with men (MSM);

  • you have had a sexually transmitted disease;

  • you have sex with more than one partner;

  • you shoot drugs;

  • you live with someone who has lifelong hepatitis B;

  • other factors (e.g., you have a job that exposes you to human blood, you are a kidney dialysis patient); or

  • you live or travel for more than 6 months in countries where hepatitis B is common.

To date, use of the vaccine and vaccine coverage in most of these populations has been low. Interestingly, however, research has indicated that medical care, including visits to physicians and availability of insurance, are at high levels in at least one of the groups at risk (MSM), suggesting that MSM access medical services on a regular basis. In addition, MSM often also receive regular HIV counseling and testing, indicating that opportunities for immunizing MSM against hepatitis B do exist. A national program for integrating hepatitis prevention in to existing HIV, STD and drug treatment settings has begun, which is addressing barriers to providing vaccine to high-risk groups and is promoting a comprehensive approach to health care for high-risk individuals.

Finally, there are some things you can do to protect yourself from infection with any blood borne or sexually transmitted pathogen:

  • Practice safer sex: If you are having sex, but not with one steady partner, use latex condoms correctly every time you have sex, and get vaccinated against hepatitis B. Men who have sex with men should be vaccinated against both hepatitis A and hepatitis B.

  • Don't share anything that might have blood on it: Never share anything that might have blood on it, such as a razor or toothbrush. If you shoot drugs, get help to stop or get into a treatment program. Don't share needles, syringes, cookers, water, or rinse cups. Get vaccinated against hepatitis A and hepatitis B.

For more information, visit our Web site at

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

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This article was provided by AIDS Survival Project. It is a part of the publication Survival News.
See Also
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