Chronic Hep B carrier?

Dear Reader,

It sounds as though your friend has "chronic" hepatitis B, meaning that she continues to carry the hepatitis B virus (HBV), and can possibly spread the disease to others, even though her symptoms have disappeared. In fact, she probably did not notice her symptoms — they're often as unremarkable as mild flu-like symptoms. Although unlikely, she may have even been infected with HBV as a child because the probability of becoming a chronic carrier is greater the younger a person is at the time of infection. Nearly 300,000 people are infected with Hep B each year. Of that, about one in ten becomes a chronic carrier — the others are acute cases, lasting from one to six months, during which time the person is continually infectious.

How and why your friend got this virus are not as important to her as is learning how to live a healthy life with Hep B. You have asked very good, pertinent questions about the disease, especially for anyone learning to live with it. What health risks does Hep B pose? How does it affect one's sex life? How effective is the vaccine?

The greatest health risk of chronic Hep B lies in developing long-term liver disease. About one-fourth of all people with chronic cases develop either cirrhosis of the liver or liver cancer. If your friend decides to have a child, she risks exposing the baby to HBV. She need not live in fear of these possible fates — liver disease is not a certainty, and babies can be successfully immunized. (A person can also develop acute hepatitis B; these cases usually last about six months, during which time s/he is continually infectious.)

However, knowing her HBV status, your friend has a responsibility to control the spread of Hepatitis B. That's not to say that the rest of us are off the hook! First of all, it is important to note that varying degrees of infectivity exist among chronic Hep B carriers. It's quite possible that your friend is not very infectious. This all depends on what antigens a person carries, and on whether s/he has developed certain antibodies. These antigens and antibodies can easily be detected by a specific blood test. If she hasn't already, your friend can have this test run so that her level of infectivity can be assessed by her health care provider.

Beyond that, your friend needs to be diligent about following safer sex guidelines (just like the rest of us!) — using condoms and dams during every sexual encounter. Moreover, she needs to inform her partner (and any future partners) that she carries Hepatitis B, and encourage them to receive the vaccine. And what about kissing? HBV can be transmitted through any mucous membrane (of an uninfected person) coming into contact with any infected bodily fluid, including saliva, semen, vaginal secretions, and blood. However, the highest concentrations of the virus are found in the blood. It should be up to your friend and her informed partner(s) to decide what risks they want to take.

As for her partner, he may have already been exposed. In such a case, it is usually recommended that the individual receive the Hepatitis B immune globulin (HBIG), a shot different from the vaccine, within two weeks of his/her last exposure. Additionally, her partner needs the Hepatitis B vaccine, which consists of three shots given at zero, one, and six months. It is important to receive the last shot, as that one packs the greatest protection punch! In general, the vaccine tends to provide immunity to about 90 percent of the adult population who complete the series, and to about 95 percent of vaccinated children.

Your friend can recommend her potential partners get the Hep B vaccine by talking to their primary health care providers!

You're a great friend for being informed and for informing your friend.