Hepatitis is an inflammation, or swelling, of the liver. Alcohol, drugs (including prescription medications), poisons, and some viruses can all cause hepatitis. Hepatitis B is a liver disease caused by the hepatitis B virus (HBV).

Worldwide, 350,000,000 people are infected with HBV, and 10% of these are also infected with HIV.  In the U. S., about 1.25 million are infected with HBV, and about 20% of these are also infected with HIV. 

Most people, about 90%, fight off the infection themselves and usually recover within a few months. While they will never get HBV again, their blood test will always show that they have been infected.

15 – 40 % of people with chronic HBV develop serious complications including liver damage (cirrhosis or scarring) or liver cancer, usually after many years. In the most serious cases, a person may need a liver transplant. People with chronic HBV infection also become carriers and can pass the virus on to others.

There is very little woman-specific information about HIV/HBV co-infection. However, it is known that, although people with both HIV and HBV have less inflammation in the liver, they have higher rates of HBV-associated liver disease. Several studies have also shown that HBV infection could increase the risk of liver toxicity for people taking HIV medications.

HBV is more contagious than HIV. It is transmitted through infected blood and other body fluids (semen, vaginal secretions, breast milk, tears, and saliva). HBV can be transmitted through:

• Unprotected sexual contact with exchange of genital fluids or saliva
• Sharing injection needles or 'works'
• Sharing needles that are used to apply tattoos
• Receiving a transfusion of blood, blood products, or organs before 1975
• Mother-to-baby transmission (in pregnancy)
• Open sores

People with HBV infection may also be at risk for infection with hepatitis C virus (HCV) or HIV.

Many doctors recommend that people infected with HIV should also be tested for HBV, because people who are infected with both viruses may need to have special treatment and special monitoring of their infections.

HBV may cause no symptoms at all when it is contracted. A blood test for the Hepatitis B Surface Antigen (HBsAg) is the only way to be certain if someone is infected.  A diagnosis of chronic Hepatitis B infection is made if the HBsAg test is persistently positive for longer than 6 months

Signs and symptoms of HBV may include:

• Jaundice (yellowing of the skin, eyes, and mucous membranes)
• Dark-colored urine
• Stool that appears pale and clay like
• Weight loss
• Extreme fatigue that can last weeks or months
• Loss of appetite
• Joint pains
• Itchy red patches on the skin
• Nausea
• Diarrhea
• Fever and chills

If you have HBV, your doctor will run other tests such as:

• HBV viral load: To measure the amount of HBV in the blood
• Liver enzyme tests (especially ALT and AST) to monitor liver inflammation
• Liver biopsy (possibly) to detect liver damage

There is also a new test called FibroScan™ that takes only 10 minutes and may be as useful as liver biopsy in diagnosing HBV. The test is not yet approved in the U. S., so it is available only through clinical trials (see http://www.clinicaltrials.gov ).  However, it is likely to become more widely available in the near future.

Many people with chronic HBV who have low HBV viral loads, normal liver enzyme levels, and little liver damage may not need treatment, but they should be monitored regularly.

Four drugs are currently approved in the U. S. to treat HBV:

• Pegasys or PEG-Intron (pegylated interferon)
• Epivir (3TC or lamivudine)
• Hepsera (adefovir)
• Baraclude (entecavir)

In addition, three other drugs that are approved for treatment of HIV also have activity against HBV.  This is important because, if you are infected with both HBV and HIV. and you are being treated for your HIV with one of the drugs below, your HBV infection could get worse if you should stop taking the drug

.

• Emtriva (emtricitabine)
• Truvada (emtricitabine + tenofovir)
• Viread (tenofovir)

Studies have shown that therapy with two drugs that are active against HBV may be more effective than therapy with just one anti-HBV drug.  The combination of Viread and Epivir was shown to be more effective than Epivir alone for treatment of HBV in patients who were also infected with HIV.

These drugs may cause side effects. Some of them should be avoided by pregnant or breast-feeding women. Talk to your doctor about managing side effects and tell him or her if your symptoms get worse. Several new drugs for HBV are also being studied.

Talk with your doctor about treatment options and continue to be monitored on a regular basis to prevent or minimize liver damage. Besides medical treatment, you can improve the health of your liver by:

• Avoiding alcohol
• Eating a healthy diet
• Getting moderate exercise
• Reducing stress
• Being cautious about using drugs, including prescription, over-the-counter, and street drugs (Even drugs containing acetaminophen, Tylenol, should be used under a doctor's supervision as they may cause liver damage)

It is best to talk to your doctor about treatment options when you are infected with both HIV and HBV. The risk of developing abnormal liver function tests while you are receiving anti-HIV treatment is higher if you are also infected with HBV. If you are infected with both HIV and HBV, you may want to avoid taking the following drugs for your HIV:  Videx™, Zerit™, Viramune™, and Ziagen™. If you are being treated for your HCV with ribavirin (also known as Copegus™,Robetol™, or Virazole™), you may also want to avoid taking Retrovir™. You may also want to want to avoid the combinations of Norvir™ plus Crixivan™ or Norvir™ plus Aptivus™,and the combination of Viread™ plus Hepsera™.  

HBV vaccinations are recommended for all newborns, infants, all children aged 11--12 years and children and adolescents aged less than 19 years who were born in countries in which HBV prevalence is high or intermediate (view the CDC worldwide prevalence map). It is also recommended for men who have sex with men, people with multiple sex partners or a diagnosis of a sexually transmitted disease, injecting and non-injecting drug users, and people with clotting-factor disorders (for example, hemophilia).

Fortunately, if you have never had HBV, it can be prevented. Getting vaccinated for HBV is the best protection against the virus. In order to be fully protected, three injections are required over the course of several months. There is also a combined vaccine that will protect you from both HBV and hepatitis A (HAV). It is important to follow through and get all your shots in order to be fully protected.

The HBV vaccine is recommended for HIV+ people However, the CDC warns that HIV infection can reduce the response to the HBV vaccine. HIV+ people who are vaccinated should be tested for HBV antibodies one to two months after the third vaccine dose. Revaccination with more than the regular three doses may be necessary for people who do not respond right away.

The CDC also advises that people who don’t respond to additional doses may remain susceptible to HBV infection. These people should take further precautions to prevent becoming infected with HBV such as using condoms, not sharing needles, and making sure that tattoo artists use sterile needles.

Babies born to women carrying HBV are at high risk of contracting HBV immediately after delivery. The risk is compounded in women who are co-infected with HIV. It is now recommended that all pregnant women be tested during the first three months of pregnancy for HBV. The HBV vaccine is safe during pregnancy and is recommended for the infant if the mother tests positive during pregnancy.

1		National Center for HIV, STD and TB Prevention .  Viral Hepatitis B Fact Sheet.  Accessed at http://www.cdc.gov/ncidod/diseases/hepatitis/b/index.htm on May 25, 2006.
2		Lok AS, McMahon J. (AASLD Guidelines: Recommendations for Treatment of Chronic Hepatitis B)Chronic Hepatitis B: Update of Recommendations. Hepatology. 2004;39:857-861.
3		Keeffe, EB, Dieterich DT, et al. A treatment algorithm for the management of chronic hepatitis B virus infection in the United States. Clin Gastroenterol Hepatol. 2004;2:87-106.
4		Benson C, et al. Treating Opportunistic Infections Among HIV-Infected Adults and Adolescents. MMWR. December 17, 2004; 53(RR-15).
5		Ziol M, Handra-Luca A, Kettaneh A, et al. Non-invasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology. 2005;41:48-54.
6		Lok, Anna SF and McMahon, Brian J.  American Association for the Study of Liver Diseases Practice Guideline:  Chronic Hepatitis B: Update of Recommendations.  Accessed at http://www.cdc.gov/ncidod/diseases/hepatitis/b/aasld_update_chronichep_b.pdf on May 25, 2006.
7		MMWR Recommendations and Reports December 23, 2005 / 54(RR16);1-23.  A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States  Accessed at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5416a1.htm on May 25, 2006.
8		Nelson M, Bhagani S, Fisher M, et al. A 48-week study of tenofovir or lamivudine or a combination of tenofovir and lamivudine for the treatment for chronic hepatitis B in HIV/HBV coinfected individuals. Program and abstracts of the 13th Conference on Retroviruses and Opportunistic Infections; February 5-8, 2006; Denver, Colorado. Abstract 831.