Hepatitis B

[woonwai]

Hoping for some advice. Bit of a background story..sorry..as I have a number of questions.

I have been with my partner for about a year and as clinical as this sounds, after a couple of months knowing him I requested for him to have a 'family' test..basically meaning STD etc test including HIV before I would go on the contraceptive pill (we had the same test together). Both our results are in my file, so can be viewed by me at any time. I thought we would go together to be told the results, but he wanted us to go alone and view both our results alone. Thinking back, i made a terrible mistake in assuming that I did not need to check for myself. I had already had a full check up after the break-up of my previous relationship, so i knew i had no infections, so when I asked him if all was ok, and he said something along the lines of being fine (i cant remember the exact thing he said) but you should check for yourself, I didnt bother, as I thought if he had any issue, he would tell me.

Since that time we continued to used condoms because I still hadnt found a contraceptive pill that sat well with me (cronic migraines after short term of using etc. Always have been sensitive to the contraceptive pill). But, this last month I have been taking a pill that seemed to give less side effects, so a couple of days ago I suprised him by saying we didnt need to use a condom. I guess you could say that in the heat of the moment, he took the opportunity, but then stopped, and after a while told me that he is scared of infecting me with Hepatitis B. Of course i was in shock.

He told me that when he saw his results, it showed he was postive for Hep B, and since then has been taking a tablet to cure it. He says that his body is recovering from the infection now.

He decided that he should take me to the hospital right away for a blood test to put my mind at rest. I had the test, showed negative, and was recommended to take a immunisation injection. The doctor mentioned something about 1 injection now and one injection later with another blood test then a check in six months at a cost of roughly 1200 baht per injection. However, the nurses kept saying something along the lines of my only needing this one injection (which cost 3500 baht) and that it was some kind of combined injection rather than just Hep B specific that boosts immunity. It was late in the evening and the doctor had already gone home, so I accepted the injection. I asked the nurse to give me the injections information leaflet but either deliberately or not, when she went to write down the doctors name and number for me and put in the leaflet, she gave it in an envlope minus the information.

So ..my questions are..

- is there some kind of new injection for Hep B plus other infections that boost immunity or do you think there has been some kind of mis-interpretation?

- My results showed negative, am I right in thinking that is the final result? Or could that moment of unprotected sex be unregisterable at present and may still show up as positive later.

- Does the injection provide some kind of antigens / immunity? Meaning, can my partner and I have sex in the future without a condom that will be risk free for me? (If things work out between us, I would like to consider having a family with him. So this aspect is important to me).

- My partner seems to want to bury his head in the sand about it, because when I asked him to give me more information, he said he didnt know. He said he didnt want to look into the detail and just wanted to do what the doc recommended. For better or worse, im more pro-active about health. Wanting to understand better. After I deal with my own health and understanding regarding this, i want to know how to help him too. I am googling for info as we speak, but anything anyone can say on that subject would be most appreciated also.

- Finally, although I have always trusted him, this has had two negative effects on me. One..that he didnt tell me something so very important that could have affected my health. (I know he feels badly, and I also know now why after the results he was distant for me for a while. I should have been given the opportunity of educating myself in how to protect myself if ever we had an "accident"/risk of infection. Although it hurts and I have some anger about it, I want to look past that). Two..I dont know much about Hep B, and Im ashamed to say that I am questioning if he has been faithful to me. He has always given me the impression that he has been honest and I have not had reason to doubt before. To put my mind at rest and to understand better, I wish to know about things like the incubation period. I dont know how acute his Hep B was after he recieved the results. We had the test together around 2 months after knowing each other. He told me at the time he hadnt had sex in a long time with anyone. I also trust that he hasnt had sex with anyone since knowing me. But of course, with now knowing he has Hep B I would like to know if the infection is something that he could have had for some time or not and that that was some kind of "flare up". I feel very ashamed to feel doubt like this, and 90% of me believes in him, but if i dont address that 10% doubt Im worried it will be something that will always sit uneasily within me.

I just wish to understand better.

Appreciate any advice offered.

Thanks for your time.

[FBN]

Hep B: I will try and summarise essential facts:

Incubation period can be up to 60 to 90 days from exposure

Infectivity and carrier status: It is essential to review your partner's test results. There is Hep B Anitbody which reflects immunity. Hep B (S) Ag (Surface Antigen) which indicates the actual presence of the virus in the blood; this alone, however does not mean that the patient is an infective carrier.

Infectivity depends on the presence of Hep B core antigen and Hep Be (envelope) antigen. Please check if the test involved a test for these 2. This is not normally done; only when the patient is Hep B Ag positive.

Read this: http://www.labtestsonline.org/understandin...tis_b/test.html

10% of people infected with Hep B does not develop immunity but become carriers and may be infective to other people.

Injections after exposure (immediate) may be only Hep B Immune globuline. In other words it will give you antibodies extracted from an immune subject but will not give rise to the development of immunity. Unfortunately, the Heb B vaccine will only result in effective immunity if given about 3 months after this injection. Please determine which you have been given.

Hep B vaccine usually involes 3 injections given at intervals as well as boosters depending on your anibody level that you develop.

The treatment of a carrier status usually involves the administration of an injection of interferon. This is an injection as well, not a tablet: http://cpmcnet.columbia.edu/dept/gi/intron.html

The immune response in Hep B is a bit complex and the terminology of the tests unfortunately so as well.

Please check the links and post again if anything is still unclear and we will try and help.

Take Care!!

[cathyy]

It sounds like you were given the immune globulin, to help prevent you from being infected after exposure. That was the best thing for the doc to do. You will need to be tested again to see if you were infected, after the immune globulin wears off and before you get any immunization shots. Getting the vaccination after that would be a very good idea, and that IS multiple shots, and it does take months to take effect.

You need to see the boyfriend's blood test results. This website explains the tests: http://www.hepb.org/patients/your_blood_tests.htm.

If he has become a chronic carrier you will want to consider whether or not you trust the vaccination enough to dispense with condoms. I suspect he may be a chronic carrier, as it is not uncommon in Thailand, and if he had an active infection he should have been at least slightly ill.

Edited December 22, 2008 by cathyy

[woonwai]

Thank you both so very much. This morning we both went back to the hospital to ask what the injection was that I was given and it was indeed the immune globulin. I really appreciate what you said about that Kathy, as I was in doubt about whether that was the correct choice given to me.

I do not remember my partner getting sick. At one point both several months back we both had some bad flu infections, so i wonder if maybe that could have been in conjuction with sickness from hepB He is taking a tablet form of interferon and has been self-medicating. We are going back to the hospital again tomorrow to speak to a specialist who wasnt available today, as I have stressed that it is too important to both of us for to not get proper advice and help.

Besides the health factor and getting informed, I am still having this terrible doubt that he may not be being honest with me (he says he has not been involved with anyone else since he met me). I really wish to put that doubt to rest..so any advice on that front would be appreciated. He said his last relationship involving sex was around 4 - 6 months or so before we met. No contact with anyone else since then apart from me, and no involvement with anyone else during the time he has known me. I would like to understand if this is possible, or if the dates just dont add up.

Sorry, but that is eating at me a bit.

Thanks again.

[woonwai]

Ok, i just now read that interferon can only be given by injection. I need to check what it is that he is taking. Will repost when I find out.

[cathyy]

Ribavirin capsules are given along with interferon injections to treat chronic hepatitis B or C that hasn't responded to just interferon. So, yeah, he needs to be getting interferon injections daily.

Chronic Hepatitis B

Interferon alfa-2b is effective in the treatment of adults with chronic hepatitis B virus infection and evidence of viral replication. The patient should have evidence of infection with hepatitis B virus, documented by the presence of hepatitis B surface antigen in the blood, for six months. The patients should also have evidence of virus replication, documented by the presence of hepatitis B e antigen in the blood. Ongoing inflammation of the liver should also be present as documented by an elevation in serum aminotransferase activities. A liver biopsy should also be performed prior to treatment. Patients with severe, decompensated liver disease (eg. encephalopathy, ascites, very high serum bilirubin, prolonged prothrombin time, etc.) should not generally be treated with interferon alfa-2b except in the setting of an approved clinical study.

The recommended dose of interferon alfa-2b for the treatment of chronic hepatitis B is 5,000,000 units daily, administered by subcutaneous or intramuscular injection, for a total of 16 weeks. The patient must be monitored carefully during the treatment period for side effects including flu-like symptoms, depression, rashes, other reactions and abnormal blood counts.

A meta-analysis of several randomized trials of interferon alfa-2b in the treatment of patients with chronic hepatitis B showed such treatment to be cost-effective (Wong et al. Annals Intern. Med. 1995;122:664-675). This analysis showed that treatment with interferon alfa-2b decreased viral replication, documented by loss of serum hepatitis B e antigen, in about 45% of patients compared to less than 10 % of untreated patients. About 8% of patients also lost hepatitis B virus surface antigen (cured) within one year of treatment compared to a rate of about 1% a year for untreated patients.

Interferon alfa-2b treatment of chronic hepatitis B requires careful medical attention. Consult a physician who has experience with this type of treatment for more information.

[Tolley]

I had hep B in the eighties although i never knew i had it until i got a blood test to go and work in the ME.

Apparently it is resolved according to the blood tests.

Does this mean I am immune now to hep B and are there any consequences for long term health having had hep B?

[Ijustwannateach]

The Red Cross Anonymous Clinic now offers inexpensive testing for the presence of Hep B and to confirm immunity to Hep B (they are different tests). I would assume they also offer immunizations.

[Sheryl]

I had hep B in the eighties although i never knew i had it until i got a blood test to go and work in the ME.

Apparently it is resolved according to the blood tests.

Does this mean I am immune now to hep B and are there any consequences for long term health having had hep B?

If you have antibody positive but negative for both Hep B core antigen and Hep Be (envelope) antigen then yes, you have immunity. If test did not include both of these then you need to have these tests done.

FBN please correct me if I am wrong but to my understanding a person who has made a full recovery and is not a carrier is not at increased risk of complications such as cancer of the liver and cirrhosis. (Carriers however are and this is one reason why there is a hgher incidence of these problems in Thais).

As the modes of transmission are the same, anyone who has contacted Heb B should also be tested for HIV.

[Jimbob1]

There is a lot of panic and mis-information about HepC ....

I have had it and treated for it and clear now....

It isn't a sexually transmitted disease it is passed through blood so using a syringe, tooth brush, razor and any blood to blood transfer can infect a person. Living with and having unprotected sex with someone doesn't instantly infect you.

Being infected doesn't mean you can show signs of sickness and a large percentage of infected people show no signs.

I had some discomfort and had a small gallstone removed without being diagnosed and that was 2 years before.

I had treatment of a Weekly injection of Interferon and daily hand full of Rivaviron pills ... this is a much improved Interferon from earlier days where it was a 3x a week injection and the Rivaviron is to boost the action of the injection .... it was a 12 month treatment where I felt like I had the Flu 3 days a week after the injection and I had some bad side effects but discontinuing treatment for me was never an option as cirrhosis of the liver and liver cancer was not what I wanted to experience ...

Happily now I have beaten the HepC and living a normal life again.

I hope that information is helpful for you ..... good luck .... Jim.

[woonwai]

jim, do you mean Hep C or Hep B?

-------

In regards to the situation with my bf, at his request we decided to wait until after Christmas was over before going back to the hospital. Probably a good idea anyway as I have now had time in my head to calm down a bit. We plan to go on Monday now. I will be happier once i know he is definately on the correct treatment and on the road to recovery.

Will post later on what the doctor says, for those interested in the info.

Thanks to all so much again for advice given.

[woonwai]

..oh and jim..thank you for that info, and im really so very glad for you that you were able to beat it.

[FBN]

I had hep B in the eighties although i never knew i had it until i got a blood test to go and work in the ME.

Apparently it is resolved according to the blood tests.

Does this mean I am immune now to hep B and are there any consequences for long term health having had hep B?

If you have antibody positive but negative for both Hep B core antigen and Hep Be (envelope) antigen then yes, you have immunity. If test did not include both of these then you need to have these tests done.

FBN please correct me if I am wrong but to my understanding a person who has made a full recovery and is not a carrier is not at increased risk of complications such as cancer of the liver and cirrhosis. (Carriers however are and this is one reason why there is a hgher incidence of these problems in Thais).

As the modes of transmission are the same, anyone who has contacted Heb B should also be tested for HIV.

Correct Sheryl.. About 10% of people contracting Hep B will remain carriers and then 10% of this group may develop liver cancer later.

Hep B can develop and progress to recovery almost without any severe symptoms. People usually do not develop jaundice as with Hep A. Low grade fever, tiredness and usually a fairly distinct intolerance for alcohol may be the only symptoms.

The OP should also have an assessment done for Hep C. Blood banks now report that Hep C is at least as common as Hep B in donated blood. (Middle East, personal communication).

[Jimjim]

My partner had Hep B, I never got it, and am now immune. I had had one injection before but now I have had both or three (i got immunized for both A and B, and one of the injection courses is 2 shots and the other is three but I can never remember). Even if you did get it, chances are slim, though not nil, that it will progress.

[Nostraforce]

immunization and booster shots are available at the red cross clinic for half the price OP payed at the hospital. I read up on it, hep B is a fairly common 3rd world disease, not so common in thailand these days as anymore, but in some 3rd world countries up to 30% of the population is infected. Most common way of transmission in these countries is infection at birth through the mother or while playing as young kids through blood contact with other carriers. Basically it's a permanent liver inflammation.

[Jimjim]

Basically it's a permanent liver inflammation.

Only if it progresses, which it only does in about 5% of cases. Most people's bodies build up immunity to it and are fine within 6 months. If you haven't become immune after 6 months, then you're in for some problems.

Edited December 30, 2008 by Jimjim

[woonwai]

jimjim, im a bit confused about something and maybe you can help clear it up. You say you should become immune by six months, but could hep b be dormant in your body for a long time before coming out? Or, after incubation, is it an instant issue requiring treatment. Im really unclear about how hep b is most typically contracted and about the incubation period and if it can be dormant in the body.

As for an update on my bf, his doc hasnt been available recently, so we went to the hospital where he had a new blood test instead. We will go see the doctor to talk with him about the results as soon as we can get an appointment with him. Will post about it after we get back from the appointment.

[Nostraforce]

It does not matter if the virus would be still inside your body or not, after 4 vaccinations (month 0, month 1, month 2 and month 6) you will have enough antibodies in your body to kill the virus for the rest of your life.

[mitebbots]

Does someone have Entecavir (Baraclude) info in Thai, maybe a .pdf file? Have not been able to find anything in Thai yet.

Thank you