HIV in Canada: A primer for service providers

Hepatitis B Virus

Key Points

  • The primary mode of hepatitis B transmission in Canada is sexual contact.
  • The consistent and correct use of condoms can reduce, but not eliminate, the risk of acquiring or transmitting hepatitis B.
  • Testing for hepatitis B among HIV-infected people and for HIV among hepatitis B-infected people is essential.
  • A vaccine is available to protect against hepatitis B.

Hepatitis B can be transmitted through the blood and bodily fluids (e.g., semen, vaginal fluid, saliva) of a person with hepatitis B. Hepatitis B is about 100 times more infectious than HIV. The most common routes of transmission are the following:

  • sexual contact
  • sharing of needles and other drug-using paraphernalia (e.g., straws, pipes, spoons and cookers)
  • sharing of personal care articles such as razors, scissors, nail clippers or toothbrushes
  • exposure to blood or bodily fluids in the workplace
  • transmission from a mother to a newborn infant

Hepatitis B is a liver disease caused by the hepatitis B virus. The early stage of infection lasts about six months and is called acute infection. The majority of adults are able to clear the virus from their body during acute infection and develop lifelong immunity. Hepatitis B chronic carriers are at risk of developing serious liver complications such as cirrhosis and cancer. About one-quarter of chronic carriers will develop chronic liver inflammation, which increases their risk of liver disease or cancer of the liver.

In 2015, the reported rate of hepatitis B infection was 13.2 per 100,000 Canadians (4,741 cases). This is down slightly from 2011 when the rate was 16.2 per 100,000 (5,576 cases).

There are several blood tests that can determine if someone has been exposed to hepatitis B and if an infection is acute or chronic. Most people infected with hepatitis B, both acute and chronic, experience few to no symptoms. This is especially true for young children. In adolescents and adults, between 30% and 50% of acute infections will present with clinical symptoms such as jaundice, fatigue, abdominal pain, nausea and joint/muscle aches. Chronic carriers generally do not experience any symptoms, but they will remain infectious for life if they do not receive treatment. This makes it more difficult to ensure timely diagnosis. Because HIV and hepatitis B share routes of transmission, it is essential that people who have been diagnosed with either HIV or hepatitis B be tested for the other virus and provided with appropriate prevention counselling. The risk of acquiring or transmitting hepatitis B can be reduced, but not eliminated, with the consistent and correct use of condoms.

There is no cure for chronic hepatitis B infections; however, treatments are available to reduce the hepatitis B viral load and protect against liver damage.

A vaccine is available to protect uninfected individuals against hepatitis B. On the basis of recommendations from the Canadian Hepatitis B Working Group, all provinces and territories have implemented a school-based hepatitis B vaccination program for Canadians aged 9 to 13 years. It is estimated these programs could prevent 63% of acute infections and 47% of chronic infections. Additionally, the hepatitis B vaccine is recommended for all individuals who are at increased risk of hepatitis B infection, including people who use injection drugs and people who engage in high-risk sexual behaviours. This vaccine is safe for people living with HIV.

It is quite common for people living with HIV to be co-infected with hepatitis B because these two conditions share routes of transmission. Hepatitis B co-infection does not affect HIV disease progression or severity but it can limit treatment options for people living with HIV. HIV can have both positive and negative impacts on hepatitis B in co-infected individuals. HIV lessens the liver damage caused by hepatitis B because it weakens the immune response that destroys hepatitis B-infected cells in the liver. However, this weakened immune response also means that there are higher levels of the hepatitis B virus in the blood of co-infected people and these individuals are thus more infectious than people with hepatitis B mono-infection.

Resources

Hepatitis B – CATIE fact sheet

Hepatitis B Infection in Canada – Public Health Agency of Canada (PHAC)

Hepatitis B: Get the facts – PHAC fact sheet

Sources

  1. Public Health Agency of Canada. Hepatitis B: Get the facts. Available from: http://www.phac-aspc.gc.ca/hcai-iamss/bbp-pts/hepatitis/hep_b-eng.php
  2. NAM. NAM aidsmap. Hepatitis B. Available from: http://www.aidsmap.com/Hepatitis-B/page/1045181/
  3. Public Health Agency of Canada. Brief report: hepatitis B infection in Canada. Available from: http://www.phac-aspc.gc.ca/id-mi/hepatitisBCan-hepatiteBCan-eng.php
  4. Public Health Agency of Canada. Notifiable diseases online. Available from: http://diseases.canada.ca/notifiable/ [accessed September 13, 2017].