Hepatitis B Transmission Risks in Couples - Family Medicine

Dr. Xu Li'an reply Family Medicine

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Hello, this is Dr.
Hsu Li-An's Family Medicine Column.
The article discusses what to do if you are a carrier of Hepatitis B.
"What should Hepatitis B carriers do?" This is a common question I encounter in family medicine clinics.
I usually spend over five minutes explaining to patients and their families how to protect their health and what follow-up examinations are necessary.
Investing time and effort in detailed guidance now can save more time and money in the future.
Patients and their families often first ask, "What dietary precautions should we take?" However, upon further inquiry, it becomes clear that their real concerns are about transmission through food: "Can food transmit the virus? Should we use separate plates? Can saliva transmit the virus?" For example, they might ask, "If he eats while feeding the child, can he transmit it to the child?" Such concerns may stem from earlier public health policies promoting the use of serving utensils, which only prevent Hepatitis A transmission and have no relevance to Hepatitis B, as Hepatitis B is transmitted through blood, while Hepatitis A is transmitted through food, water, and saliva.
Hepatitis B carriers coexist with the virus, as the virus enters their body without producing antibodies, residing in the liver and occasionally damaging liver cells.
The blood of Hepatitis B carriers contains the virus, and it can enter another host's body if it comes into contact with an open wound.
If Hepatitis B antibodies are positive, it indicates immunity, and there is no risk of transmission.
If both antigen and antibody tests are negative, it means the individual has never been infected or developed immunity.
In this case, prevention starts with the Hepatitis B vaccination, followed by avoiding contact with the carrier's blood.
This includes refraining from sharing razors, needles, tattoos, piercings, and engaging in high-risk sexual behaviors.
Regarding the daily precautions for Hepatitis B carriers, I usually emphasize three main points to avoid overwhelming patients and their families.
First, no alcohol: Drinking harms the liver, and since the virus is already causing chronic damage, adding alcohol accelerates the deterioration, leading to cirrhosis and liver cancer—essentially, "self-inflicted harm." Second, avoid taking medications indiscriminately: Although Hepatitis B is not transmitted through food, many foods and medications are processed by the liver, increasing its metabolic burden and potentially causing damage, especially unverified herbal remedies.
Many patients request liver-protective medications, but I advise them that the best way to protect the liver is not to take unnecessary medications.
Currently, there are no highly effective treatments, so I usually refer patients to a gastroenterologist.
I also advise patients to inform their doctors that they are Hepatitis B carriers, so the physician can be cautious with prescriptions.
If problems arise from herbal remedies suggested by neighbors or acquaintances, the responsibility falls on the patient, not the provider.
Patients should think carefully and not treat their bodies as experimental subjects, as this could lead to both financial loss and health deterioration.
Third, avoid excessive fatigue and try not to stay up late: Fatigue can worsen health conditions, allowing the virus to become more active and cause further damage, a phenomenon known as "working oneself into illness." Each time I explain this, I am grateful not to be a Hepatitis B carrier, as even I, as a doctor, find it challenging to adhere to this advice.
In addition to these three key points, regular follow-up examinations are crucial.
Patients should return to family medicine or gastroenterology clinics every six months for blood tests to check liver function and, if necessary, test for liver cancer markers (alpha-fetoprotein) and undergo abdominal ultrasounds.
This allows for early detection of liver changes and liver cancer, enabling timely intervention.
"Early diagnosis and early treatment" lead to better treatment outcomes.

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Reply Date: 2004/09/20