Your reference for hepatitis C in Quebec
Hepatitis B is a serious liver infection caused by the HBV (hepatitis B virus). The transmission of the HBV can happen during sexual contact (vaginal, anal or oral), through infected blood or other body fluids.
Most people infected won’t display any symptoms or will experience yellowing of the skin (jaundice) before they fully recover. Only 10% of the people infected will develop chronic hepatitis B that can over time lead to cirrhosis, cancer, and even death in some cases.
Treatments can be offered depending on the seriousness of the infection and its complications.
HBV directly impacts the liver.
A safe an efficient vaccine is available since 1982 can prevent hepatitis B. The vaccine is typically given as 3 injections and it can prevent infections in 99% of cases for people under 15 years old.The efficacy drops to 60% for people over 50. That’s why it’s recommended to get vaccinated as early as possible.
The WHO (World Health Organization) recommends vaccination to be done at birth. In Quebec newborns can be vaccinated starting at 2 months.
Among people already infected with HIV, the risk of developing chronic hepatitis B is between 25 and 40%. Hepatitis B is the most common and deadliest sexually transmitted and blood-borne infection (STBBI). 2 billion people, or one in 3 people, have been in contact with the virus. There are currently 350 million people living with chronic hepatitis B. It is responsible for 2 million deaths every year, which makes it the second leading cause for cancer after tobacco.
These figures are all the more shocking given that there is a safe and effective way to protect yourself against this disease: the vaccine.
The hepatitis B virus is extremely contagious: : 10 times more than the HCV (hepatitis C virus) and 100 times more than HIV. The virus can survive for up to 7 seven days without a host.
HBV is transmitted through contact with infected blood and other body fluids (semen, vaginal secretions, breast milk)
Unvaccinated people can be contaminated by:
- Sexual contact (vaginal, anal or oral) with a person infected with HBV.
- Sharing of needles or other injection and snorting equipment (spoons, straws..)
- Direct contact with the blood of a person infected by HBV.
- Pregnancy and or childbirth, from the pregnant person infected by HBV to their newborn
- Sharing of razors, toothbrushes, scissors, tweezers, piercings, earrings...
- Tattooing, piercings and acupuncture done without the necessary hygiene (single use or sterilized equipment).
You can’t be infected with HBV through food, water, or sharing toilets.
The incubation period for HBV can last between two to six monthsduring this period, no symptoms are felt, the HBV virus triggers acute hepatitis, which usually goes unnoticed. It may be accompanied by more or less marked symptoms in 20 to 40% of people : fatigue, fever and chills, dark urine, watery stools, yellowing of the eyes and skin (jaundice), pain in the right side which may radiate to the back, and sometimes pruritus (itching).
Acute hepatitis lasts eight to twelve weeks. During this period, even if there are no symptoms, the amount of virus in the body is very high: the virus is present in the blood, sperm and vaginal secretions. After these few weeks, nine out of ten people eliminate the virus.
We don't treat hepatitis B,, if it is acute.
In blood test results, HBs antigen (markers of the virus) will then be replaced by anti-HBs antibodies meaning the infection has been curedand the patient is now immune to HBV. But the infection becomes chronic for 10% of infected people Hepatitis B then becomes chronic and more or less active. The HBs antigen remains present and there are no anti-HBs antibodies. This is why it is always necessary to carry out a serological check six to eight weeks after the onset of acute hepatitis.
Immunocompromised people (patients undergoing anti-cancer chemotherapy, haemodialysis patients, AIDS sufferers, etc.) contaminated by HBV have a considerably higher risk to develop chronic hepatitis. The discovery of acute or chronic hepatitis should be followed by screening and vaccination of the people around you.What are the symptoms of chronic hepatitis B? Is it a notifiable disease?The vaccineHepatitis B and HIV co-infectionCan chronic hepatitis B be treated if you are co-infected with HIV/HBV? Is there a Post-Exposure Prophylaxis (PEP) against HBV?
Most people living with chronic hepatitis B are not don't feel anything or only have a few mild symptoms. Some evoke signs that are not characteristic: fatigue, nausea or vomiting, joint and muscle pain.
20 to 30 % will experience complications to their liver than can lead to cirrhosis cirrhosis. Their risk of developing liver cancer is considerably higher than normal.
After several years of infection, some people develop extra-hepatic symptoms, which can affect other organs.
Attention : Les lésions provoquées par le VHB peuvent être importantes même si l’on ne ressent aucun symptôme.
Yes, HBV is a notifiable disease in Canada. As soon as the result is known, the healthcare professional must inform the provincial public health authorities.
A list of sexual partners and family members should be drawn up. to get in touch with them, and to encourage them to get tested. Under no circumstances will the person's name be revealed. These people will only be informed that they have been in contact with an infected person, and invited to be tested and vaccinated if they are not.
In Quebec, PVSQ is a community organization that offers a fast, confidential and free service for notifying partners.
A safe and effective vaccine prevents infection. Available since 1982, it consists of three injections. It protects 90-95% of those vaccinated. Before the age of 15, efficacy is 99%. After age 50, it falls to 60%.
we recommend that children be vaccinated as soon as possible, preferably at the same time as other infant vaccinations. In Quebec, newborns can be vaccinated from the age of 2 months.. Vaccination against hepatitis B at birth presents no risk whatsoever.
The vaccine considerably reduces the number of cases of chronic hepatitis B, cirrhosis and liver cancer. In the ten years following vaccination, a simple blood test is required to check the vaccine's efficacy. If this is not the case, a boost will be necessary.
If your sexual partners are not vaccinated or if you don't know their vaccination status, systematic condom use is essential to prevent HBV contamination. And in any case, to protect you from all other sexually transmitted diseases. And babies too, all people meeting one of the following conditions should be vaccinated :
- Pre-teens (aged 11-13), before their first sexual encounter;
- People with high-risk behaviors (sex without a condom, multiple partners, needle sharing)
- People living or traveling in regions with high rates of HBV infection (Africa, Asia, South America, Eastern Europe).
- Health professionals.
- People living with HIV
If you are affected by HIV, you must systematically ask your doctor for HBV PCR testing (if you think you may have been in contact with HBV), because simple tests for antibody tests are not sufficient for a reliable diagnosis in HIV-positive individuals. The common mode of transmission of HIV and HBV results in a high prevalence of HBV in HIV+ people, especially if their CD4 count is low.
Indeed, more than 80% of HIV-positive patients have been in contact with the hepatitis B virus. HIV infection worsens the prognosis of chronic hepatitis B. It accelerates liver cell degradation and leads to a poorer response to treatment.
There are drugs that act on both viruses
We only treat people who have developed cirrhosisor those with elevated liver enzymes of at least 2 times normal (ALT, alanine aminotransferase,), or older patients being infected for over 30 years and presenting extra-hepatic manifestations (outside the liver). The most common examples are periarteritis nodosa and glomerulonephritis.
Treatments only control disease progression by suppressing viral reproduction in the liver of most treated patients. However, the treatment may be necessary for years, or even for life.
Interruption of treatment may be accompanied by a rebound in B viral replication, leading to retreatment.
Pour les patients.tes co-infectés.ées par le VIH et le VHB, le VHB n’accélère pas la progression du VIH et n’empêche pas une bonne réponse au traitement antirétroviraux.
There are two types of treatment:
- Interferon-alpha, which works by increasing the body's immune activity against the hepatitis B virus, is effective in inhibiting HBV infection in around one-third of patients treated. It is effective in inhibiting HBV infection in around one-third of patients treated.
- Les antiviraux (analogues nucléosidiques) qui inhibent directement le virus en l’empêchant de se reproduire : Lamivudine (heptovir), Viread (tenofovir) and Baraclude (entecavir).
In people co-infected with HIV and HBV, it is recommended to choose anti-HIV therapy with Truvada (tenofovir + FTC) or 3TC (lamivudine), as these treatments are also effective for HBV.
Someone who has had unsafe sex or other risky behavior , (for example, sharing needles or accidental pricking with contaminated equipment) may receive a dose of gamma globulins (antibodies). The antibodies are administered by injection, in a 24 to 48 hours following risk behaviour.
For more information, don't hesitate to consult your doctor or healthcare professional.
Text - Laurence Mersilian, July 2005, revised September 2021
Sources :
- Hepatitis B virus infection in HIV-infected patients, Y. Benhamou, hepato-gastroenterology department Groupe Hospitalier Pitié-Salpêtrière (Paris)
- Canadian Liver Foundation
- SOS Hepatitis
- AIDS MEDS
