1) Do I need to be on a special diet?
NO.........however, most of us find a few things helpful: low fat non-greasy foods,limited sugar intake, and a limited amount of red meat. A normal healthy well balanced diet, with lots of plain water to flush toxins, is all that is normally recommended.
2) Should I take a multivitamin? If so, do I need one with added iron?
A daily multivitamin is recommended, but NO added iron. The Hepatitis B virus just loves iron, and sets up in your liver replicating that much faster when you are iron overloaded.
3) What kind of doctor should I be seeing?
Most of us find having both a primary care physician AND a specialist, works best. For a specialist, look for either a Hepatologist (Liver Specialist)or a Gastroenterologist who specializes in liver disease. Sometimes, you may need to travel to a bigger city to find one of these specialists, but with a chronic liver disease, such as Chronic Hepatitis B, this is the best thing for you to try to do.
4)What precautions should I take with "other" people?
Always be careful with any of your body fluids, particularly blood. The Hepatitis B Virus (HBV) has been found, in some degree, in all body fluids, but, by all means, is highest in the blood. Do not share personal care items such as toothbrushes, razors, nail clippers, nail files, anything that could even remotely have your blood on it. You won't give HBV to someone just by touching them, such as shaking their hand. The "other" person must have a portal of entry; in other words, an open wound in the skin or mucous membrane as a place for the virus to enter their body. Practice safe sex using condoms, which is NOT 100%, but better than nothing! Should you become aware of someone who has been exposed, if this is known within a two week period, they should receive a shot called HBiG AND start the vaccination series.Make sure that you tell your partner that you are infected and urge him or her ,or anyone who lives in your household, to get the 3 shot vaccination series for protection. Clean any blood spills with plain ordinary household bleach; a solution of 1:10. Again, the best way to protect others is to make sure they get the vaccination.
5) When and how should the vaccine be taken?
Any household members, and anyone that you have a close personal intimate relationship with should receive the Hepatitis B Vaccination series. The vaccine is now mandatory in most of the schools in the US. Newborns in many states are also started on the series shortly after birth, and ALWAYS when the mother is "e" antigen positive. The second dose is recommended at 2 months, and the third one at six months. Within 6-8 weeks after the third injection, the surface antibody level should be checked to verify that the vaccine worked. The antibody level should be positive and at a value of 12 or >. There is an abbreviated schedule for teenagers and an accelerated schedule for people at risk for HBV.
6) Can I kiss someone on the mouth without giving them Hepatitis B?
Normally, yes you can kiss someone on the mouth. BUT if you have an open sore or bleeding gums, and the other person has a tiny opening anywhere in the mouth or lips, it is, theoretically possible, to pass on the Hepatitis B virus. Again, just be conscientious and careful.
7) What kind of follow up do I need with Chronic Hepatitis B?
It is recommended that we have the following blood tests at least every six months: ALT, AST, Bilirubin, Albumin, Protein, PTT, AFP. Also, at least once a year, an Ultrasound of the Liver, with a CAT Scan done occasionally.
8) What are all of those tests for?
When the liver cells are being damaged, it will cause a rise in the level of certain blood enzymes; the ALT and AST. Bilirubin, Albumin, Protein, and PTT are tests done to check the FUNCTIONING of your liver. When the liver becomes chronically diseased,as in cirrhosis, the bilirubin level and PTT will rise, and the albumin and protein levels will fall. Many people with fibrosis or cirrhosis will also develop low platelets. AFP is a liver cancer screening test. The Ultrasound is an "x-ray" type procedure, and is used to screen for changes in the liver consistent with cancer, and, to a certain extent, cirrhosis. However, only liver biopsy will give you a definite answer.
9) What initial tests should I have done after finding out that I have Hepatitis B?
A liver profile, a Hepatitis B Panel, (HBV)DNA level, and either a CAT Scan or Ultrasound of the liver.
10)What are antigens and antibodies all about?
A simple way to begin to understand the complexity of antigens and antibodies, when dealing with HBV, is to remember that antigens are bad and antibodies are good. With acute HBV, and earlier in the course of Chronic Hepatitis B, the "e" antigen and the surface antigen are both positive. Over time, you will hopefully lose the "e" antigen. As long as this "e" antigen is positive, you are very contagious! This indicates that the HBV is replicating rapidly and you have a high concentration of the virus in your body. When only the surface antigen is positive, you are still infected, but not in as much danger of "passing" the virus on to others. When your body starts to fight off the virus, you develop antibodies. Usually, when you are showing a positive surface antibody, you have cleared the HBV.
There are exceptions to everything: there are some unusual conditions in some people, when the e antigen will be negative, but another special test, a (HBV) DNA level, is positive. This would indicate a mutation in the "normal" or wild type Hepatitis B virus particle.
Part of the natural history that has only recently been appreciated is spontaneous reactivation of chronic infection. This occurs in HBeAg-negative, anti-HBe-positive HBV carriers who had previously seroconverted into a nonreplicative phase, many years ago. The inactive virus spontaneously becomes active again, with the re-emergence of HBeAg and HBV-DNA, with or without loss of surface antibody.
Usually a significant spike in ALT activity, sometimes associated with symptomatic 'acute' hepatitis, manifested by jaundice, nausea, flu-like illness and fever will occur. WHEN A PATIENT IS HAVING A SPIKE IN ALT, HE IS MOST LIKELY TO RESPOND TO TREATMENT. Spontaneous reactivation may occur in 15% to 20% of previously nonreplicative patients. Any time that you are considering treatment or want to be sure that you have cleared the virus, a (HBV) DNA level should be drawn.
11)What treatment options are available?
In the United States, the FDA approved treatments are Interferon, Epivir (lamivudine), and Hepsera (adefovir),Baraclude (Entecavir), pegylated interferon(Pegasys), and Tyzeka (telbivudine). In many other countries, there is an additional drug approved for HBV treatment, Zadaxin (thymosin alpha). Interferon and pegylated interferon are "shots" and Epivir and the rest are "pills". None are 100% effective as a complete cure. At best, the antivirals (pills) are used primarily to decrease the viral load, or HBV DNA level. There are problems with these medications: Interferon can, in some people, cause some very nasty side effects. Epivir can, and usually does over time, cause a mutation in the virus, making it ineffective and can also cause a cross resistance in other antiviral medications. Renal function should be monitored while taking Adefovir. Interferon can be prescribed for up to 16 weeks, and pegylated interferon for 48 weeks, and Epivir and Adefovir from 1-3 or 4 years.
12)When do I need to have a liver biopsy?
As a baseline evaluation tool, any time that you and your doctor are considering treatment, and when there is a change in your liver as evidenced by lab tests, ultrasound/CAT Scan, and/or symptoms.
13)What drugs are available or in the works?
An excellent resource for checking what drugs are available, currently undergoing clinical trials, etc., check out this link to Hepatitis B Foundation Drug Watch
14)How can I find a doctor who treats Hepatitis B?
To find doctors in your area who treat Hepatitis patients, check out this link to Hepatitis Central