Robert's HBV Page - Question & Answer Page

Questions and Answers - General

Note: This page is intended for those who need "quick" answers to complex issues. For a more complete story, please refer to the other pages on this site. As I am not a physician, the recommendations I may make are not intended to be used as personal medical advice. I can only urge one, if in doubt, to discuss one's questions with a trained health care provider.

Commonly Asked Questions and their Answers

General | Transmission | Vaccination | Treatments

What are the differences between various hepatitis viruses?
The following information has been taken straight from Reuters.

WASHINGTON (Reuters) - Here is a brief description of them:

Hepatitis A - The least severe of the hepatitis infections, hepatitis A can cause jaundice, fatigue, abdominal pain, nausea and diarrhea. It is passed in contaminated food and water. Death is rare -- about 100 a year in the United States. There are an estimated 125,000 to 200,000 new hepatitis A infections every year in the United States. Hepatitis A often clears up on its own.

Hepatitis B - One of the world's most common infectious diseases, hepatitis B affects about 350 million people and kills about one million people a year. It is most commonly transmitted by sexual intercourse and intravenous drug use. There is a vaccine and also a combined hepatitis A/hepatitis B vaccine.

Hepatitis C - Only discovered in 1988, it is a leading cause of cirrhosis and liver cancer. It is the main cause of liver transplants in the United States. It is not as infectious as hepatitis A or B, but is spread through blood and shared needles. Symptoms include nausea, jaundice, fever, and tenderness around the liver, but there are often no symptoms.Once infected, vaccines do not help. No known cure exists, but drugs such as interferon alfa and ribavirin seem to help. A report in January 2000 in the New England Journal of Medicine warned that people with hepatitis C faced a dramatically higher risk of dying if they eat food infected with hepatitis A.

Hepatitis D - It is associated with hepatitis B infection. People with both hepatitis B and D have an 80 percent chance of chronic liver disease. Drug users face the highest risk of infection.

Hepatitis E - Only three known strains have been identified globally. It is a major cause of liver failure in developing nations. Passed in the feces and blood, infection is devastating to pregnant women, killing 10 to 20 percent of women infected in their third trimester.

Hepatitis G - Very rare, it causes up to 2,000 infections a year, but most victims have no symptoms. It is transmitted in infected blood and repeated exposure to hepatitis C seems to be a risk factor.

How long is the incubation period for HBV?
The hepatitis B virus incubation period is typically from three weeks to six months. If one has been recently infected, it will show itself in the serum within this time. However, this does not correlate to the disease state as there are many people who are infected, but show no symptoms (i.e. asymptomatic).

How long can one be infected with HBV?
Most individuals who are infected as an adult (over 18) tend to resolve their initial acute infection within six months, living the rest of their life free of HBV. This happens to approximately 90% of infected adults. About 9% of infected adults end up becoming chronic carriers, producing varying amounts of HBV for the rest of their lives. Chronic carriers are the ones most at risk of serious liver complications later in life. The remaining 1% of infected adults undergoes serious (i.e. fulminant hepatitis) liver damage and failure within a few short months/weeks. The percentage changes for infected children. It has been estimated that 50% - 80% of children infected with HBV become chronic carriers.

What is chronic hepatitis B? How do I know if I had it? (I was diagnosed from my blood sample, but my doctor told me that my liver is healthy.)
Chronic hepatitis B is a prolonged infection of the virus in your liver. You'll know you had it by the fact that you'll still have it. Chronic hepatitis B infected individuals typically do not recover on their own, but many have been cleared of the virus after various treatments.

When in the course of HBV should screening for HCC begin, and how often should screening take place?
Typically, individuals found to have chronic hepatitis B infection are monitored and treated with various therapies such as interferon-alpha treatment. As HCC does not develop in all infected individuals, it is not common to screen them for cancer. It is more likely that they would suffer from cirhossis later on than HCC. But, my knowledge of the development of HCC is also limited at this point (which is also why the page for hepatocellular carcinoma on my website is not posted yet.)

Have you heard of the Delta virus? Do you know its affect on the hepatitis B virus?
The Delta virus (also known as hepatitis D virus) is a satellite virus of the hepatitis B virus. Simply put, the Delta virus cannot replicate in a patient unless that individual is infected with hepatitis B. It appears that the delta virus infection can be reactivated by HIV infection. Typically, delta infection is indistinguishable from hepatitis B infection alone. However, chronic delta virus infection leads to more serious complications than simply hepatitis B virus alone. As soon as I "finish" updating the pages to a decent level (ie. removing all those 'More to come shortly" statements), I shall be adding a section on hepatocellular carcinoma (liver cancer) and the Delta virus (since it is related to HBV).

What would make a blood donor who does not use drugs and had no sexual relations with infected individuals, come up positive for hepatitis b antigens?
Though blood transfusion and sexual contact are the most likely routes of transmission for HBV, they are by no means the only routes. Some studies add the term "household contact" onto the list of possible routes of transmission. Contact with blood (perhaps, by dealing with someone with HBV who was cut) can lead to viral transmission. Also, saliva has been reported to carry some hepatitis B virus. One does not need to use intravenous drugs or be involved in sexual activity to contract HBV. (See Epidemiology)

Does this mean they have Hep B?
Most likely, but not necessarily. If a person had been recently vaccinated, the hepatitis B surface antigen may be present in the blood at detectable levels (depending upon the type of assay used to detect them). (See Diagnosis)

If the person has Hep B, what steps should be taken?
The next steps would be to verify the results of the first test. One could also have a physician do blood work looking for the HBe antigen in the blood. If the infected individual shows no symptoms of infection, that person is likely able to clear the virus. Most people with HBV infections manage to fully recover. (Last report quoted about 95% infected individuals recover after mild symptoms) However, if jaundice or other forms of complications arise, it may become necessary to do a needle biopsy of the liver to examine and verify the extent of liver damage.

Is there any possible way for an alcoholic with a fatal liver disease to actually vomit pieces of his liver? Not only clotted blood, but actual pieces of the liver?
I have not read of any cases of a patient with liver disease to be actually vomitting pieces of liver.

Why I am not allowed to donate my blood?
From my understanding of the donation process, they do not accept blood from those who have been exposed to major, potentially serious blood-borne transmittable diseases such as HBV. Though you are likely seemingly free of the virus, there may be a few lingering viruses in your system which may infect other people if they were to receive your blood.

Does smoking have any effect on Hepatitis B?
Aside from the usual problems related with smoking, smoking lowers the efficiency of the immune system to combat foreign invaders. This includes hepatitis B. Though I'm not aware of any specific study looking at smoking vs. hepatitis B infection, it is not likely to help and more likely to aggravate the situation.

Have you heard of hair loss after receiving the vaccines for Hepatitis B? I have been referred to both the New England Journal of Medicine and the Lancet. I need this information for some young males, who will turn down the opportunity to receive this if it means balding.
Yes, I have read the articles about hair loss after reading the vaccines for hepatitis B. I should point out that the hair loss appears to be VERY uncommon and not permanent as hair grew back after about a month. Hepatitis B is also not the only vaccine which reports of hair loss. Only a handful reports of hair loss versus the millions who have been vaccinated. It really depends on whether these young males would rather take the 1:1000000 risk (approx statistic) of losing their hair to the 1:3 risk (approx from WHO statistic) of contracting hepatitis B at some point.