As someone who doesn't have Hep B, and who knows very little about this virus, I have several questions about being in a relationship with a man who informed me he's an inactive Hep B carrier

Hi everyone,

I know similar topics exist, but I was hoping to start my own because I have so much I want to go through.

So I (female) ended up meeting a man who, about a month into knowing one another, informed me he’s an inactive Hep B carrier. He found out about his status as a teen when he was going to donate blood. He used to donate all the time but one day they told him he could not donate and should go see his doctor and that’s when they told him the news. He was born & raised in a third world country and while his mom says he was vaccinated as a child, he somehow caught it. He thinks maybe it was a bad dose, or even after being vaccinated, he just never developed immunity. He’s not sure how he got it, but he thinks maybe from a barber shop.

All that said, I’m not going to lie, I was initially very taken aback when he told me as I’ve always had this very silly and very irrational fear of developing an infectious virus. However, I made sure not to make it known that I felt that way.

That said, I did not want something like that to get in the way of a potential relationship with this man as I really like him so decided I should instead 1. check to see if I’m immune and 2. educate myself as I would still like to give this relationship a shot

I went to check if I was still immune and turns out I’m not. My mom is pretty sure I was vaccinated as an infant, and I probably was bc I was born in the US in '95 and at that point, it was the norm to get babies vaccinated for Hep B. That said, my PCP said it’s normal for the vaccine effects to go away over time so I went ahead and made an appointment to start the series over again (even if this relationship goes no where, I should be vaccinated!)

That said, I still have so many questions I’d like insight to:

  1. Once I’m vaccinated, what are my risks of catching it from him if he’s an inactive carrier?
  2. As an inactive carrier, does he have a viral load?
  3. Can his Hep B ever become active again?
  4. Would our future kids be at risk? Will it be more difficult for him to have kids?
  5. Do we always have to use protection, even after I’m fully vaccinated (we haven’t been sexually active and if I’m being honest, I would prefer to wait until I’m fully vaccinated to engage in any sexual activity, even if protection is involved)
  6. Do we have to take any precautions living together?
  7. Is he at higher risks of any illnesses?

Sorry, that’s so many questions but I’m hoping someone can answer.

I’ve also started asking him questions, but I’m trying to be gentle. Although, please note, he’s been SO open and honest about everything and has gone out of his way to make me feel comfortable and answer my questions, so it almost makes me feel guilty asking questions bc I don’t want him to think I find this to be a big deal…although I know it’s important for me to have these conversations with him.

He even sent me his most recent blood test results (which were from before we met & did not have a viral load on them) and he even had an abdominal scan of his liver this past year, and his liver was in good shape and was “unremarkable” according to the doc, which is great. Although, his scans did show a small cyst on one kidney which the docs said was no big deal, but that leads me to question #9) does that have anything to do with his hep b status?

Any responses are SO greatly appreciated. I’d also LOVE to hear from anyone in similar situations.

I would hate for something like this to get in the way of a relationship with a seemingly wonderful man (we’ve known each other for almost 2 months) so I need to just educate myself as I think my fears are largely based on ignorance and lack of knowledge.

Dear @Anon2023,

Thank you for your questions and being so proactive about seeking facts about HBV. So many people have been affected by misinformation or knee-jerk reactions and cause so much unnecessary heartbreak. I’ll try to address each of your questions below:

Once I’m vaccinated, what are my risks of catching it from him if he’s an inactive carrier?

If your antibody levels are >10mIU/mL after vaccination, you are essentially protected and there is no practical risk of you getting a chronic infection.

As an inactive carrier, does he have a viral load?

Every person with Hep B is different. Inactive carriers can have a detectable viral load, but these are generally quite low (<2000). This means there is minimal risk for transmission in most interactions, even with unvaccinated people.

Can his Hep B ever become active again?

Yes, which is why it is important to maintain monitoring for people with hepatitis B.

Would our future kids be at risk? Will it be more difficult for him to have kids?

There is little risk of transmission to children, as the major risk is mother to child transmission during birth. Casual contact, even hugging and kissing, hold essentially zero risk of transmission, particularly with such a low viral load.

Do we always have to use protection, even after I’m fully vaccinated (we haven’t been sexually active and if I’m being honest, I would prefer to wait until I’m fully vaccinated to engage in any sexual activity, even if protection is involved)

No, as mentioned in other threads, vaccination is highly protective and many people on this forum have had children with HBV-positive partners without getting HBV themselves.

Do we have to take any precautions living together?

Vaccination is the major thing, once you are protected, there are few other things that need to be done to limit transmission.

Is he at higher risks of any illnesses?

Liver cancer and liver damage risk is higher in people with hepatitis B, but this can be mitigated with regular monitoring (every 6 months to monitor and prevent any progression of liver disease).

Hope this helps,
Thomas

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@ThomasTu wow, thank you for answering all my questions! I don’t think you understand how much this means to me or how helpful this was. You were able to provide me with more clarity in this single post than I was able to get through hours of Google searches. I had some points I was hoping to clarify:

If your antibody levels are >10mIU/mL after vaccination, you are essentially protected and there is no practical risk of you getting a chronic infection.

I saw you mention in other posts something about if adults do catch Hep B then in 90% of cases it’s not chronic. What exactly is meant by that (although, forgive me, I may have misunderstood the context of your replies when you said that)

Every person with Hep B is different. Inactive carriers can have a detectable viral load, but these are generally quite low (<2000). This means there is minimal risk for transmission in most interactions, even with unvaccinated people.

Thank you. I did not know that with very low or undectable viral loads there was minimal risk for transmission even w/ unvaccinated people. Although, I don’t know his viral load and he doesn’t know his either. He seems to think that as an inactive carrier he simply doesn’t have a viral load however he said he will look into getting tested. That said, for people with low / undectable viral loads, what are the chances their viral loads will suddenly increase?

Yes, which is why it is important to maintain monitoring for people with hepatitis B.

Regarding Hep B becoming active again, how common is this for people with low viral loads

Vaccination is the major thing, once you are protected, there are few other things that need to be done to limit transmission.

Regarding living with someone whose positive, other than vaccination, what other precautions should be taken? I read some online, but those seemed more geared for relationships where the other party is not fully vaccinated.

Liver cancer and liver damage risk is higher in people with hepatitis B, but this can be mitigated with regular monitoring (every 6 months to monitor and prevent any progression of liver disease).

Do people with very low viral loads have the same risks?

Sorry for all the follow-up questions! I’ve just been desperate for clarity. Unfortunately my PCP was only able to provide limited insight since she’s not a specialist so I’ve been wanting to learn so much more. I don’t want my ignorance to get in the way of this relationship as he truly seems like a great man and is so much more than just his Hep B status. Plus, the more I learn, the more comforted I feel and I realize it’s not as big of a deal as I initially thought it was.

So glad I found this community. I continue to read through previous posts and everyone here just seems so great!

[quote=“Anon2023, post:3, topic:5135”]
Liver cancer and liver damage risk is higher in people with hepatitis B, but this can be mitigated with regular monitoring (every 6 months to monitor and prevent any progression of liver disease)
@ThomasTu I’m also very new at this and was wondering…if you are on medication ( antivirals) and check-ups every 6 months can you still progress liver disease?

@ThomasTu also, another thing I was curious about…my partner does not know his viral load, but I assume since he’s an inactive carrier it is low / undectable. Can he get his viral load checked as an inactive carrier? I saw someone on Reddit say it’s not recommended to get viral loads checked unless you’re on antiviral treatment. Is that true?

Edit: And, another thing - does repeated exposure increase the likelihood of getting infected even if vaccinated?

Hi @Gregory,
That is a good question. My thinking is that can possibly happen since taking antivirals does not 100% guarantee that nothing will happen. With that being said, taking antivirals really decreases that likelihood by about 80% though. The antivirals work by slowing down the virus from reproducing and decreasing the progression of liver disease. And in doing so reduces the risk of liver cancer or damage. Still important to maintain and attend the check-ups or follow-up appointments. I hope this is helpful. Best, Bansah1

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Hi @Bansah1 do you happen to know, what are the chances that an inactive Hep B carrier with a low / undectable viral load will have an increased viral load or reactivation of Hep B and will one day have to be on antivirals?

Hi,
Questions like this are a bit hard to predict. Hepatitis B is a complex virus that has a lot of surprises to pull when we think we have control of it. Because of this challenge, that is why continuous monitoring is key so the providers can catch any sudden changes. And if you are in a relationship with someone who is unvaccinated, I will recommend getting vaccinated to provide you the protection needed.

Sorry, if I am unable to answer your question but at least I hope this helps. Best, Bansah1.

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No worries at all, you were able to help - thank you!!

Hepatitis b is a very complex virus to predict which way it will go. I hope one of the scientists can chime in on this issue. Thanks.

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It really is! I’m trying to learn as much as possible so that I can feel comfortable continuing the relationship with the man I’m talking to. It’s just so complex, and there’s so much to learn. I also want to be able to support him and encourage him to be more proactive about his health. Don’t get me wrong, he’s a very healthy person, but he admit to not monitoring the virus as much as he should since he’s just an inactive carrier. And while I hope his status never progresses, one can never be too safe!

I understand what you mean. That is one thing I hope changes as many times some patients who are in the inactive state falls of their treatment. I hope he takes it seriously and remain under care no matter what. I have heard of people who have fallen off and when they sought treatment things were bad. Please encourage him to get back to seeing his provider. I have lost 2 people this year from this virus and as a carrier myself I take it seriously. It’s not a virus to play around with. Thanks, Bansah1.

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Glad to be able to help, @Anon2023! To answer your replies:

If a non-vaccinated adult is exposed to Hepatitis B, they have a ~90% chance to clear it within 6 months and not have any additional risk of liver disease progression based on that. In 10% of cases, however, they will not be able to clear it and they will have a chronic infection.

If the adult is vaccinated and has protective levels of antibody, the chance to clear it becomes ~100%.

Essentially, we don’t know what the chances are. I think this is hard to predict when viral loads can change and depends on many (unknown) factors.

These other precautions can also be taken to limit the chances of transmission.

People with very low viral loads have less risk of liver disease and liver cancer progression. It is still worthwhile to maintain regular monitoring to make sure any changes are picked up and managed appropriately.

Hope this helps,
Thomas

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Hi @Bansah1
Thanks you.
I see!!
Wow. I guess that’s why it’s said people with chronic HBV are at high risk of getting liver cancer or damage… 20% chance is pretty high .

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Thank you for taking the time to address my concerns! A few more follow-up quetsions:

  1. Regarding your very first point, does that mean most people who have Hep B / are carriers don’t get it as adults, but rather as children? i.e. is it very rare get chronic Hep B as an adult?

  2. Does repeated exposure increase the likelihood of becoming infected? For example, does repeated intercourse without the use of a condom increase the chance that your body will not clear the infection?

  3. Can inactive hep B carrier get their viral loads tested? Or is it just assumed they all have low viral loads?

  4. Also, one thing I’m not too comfortable with is that he doesn’t know his viral load. I imagine / assume it’s pretty low, but, if he can get it checked, I figured it would be nice to know… not just for my sake, but for his too. He said a couple of years ago his doctor told him “it’s almost like he didn’t even have it” which makes me assume his viral load is undectable, or at least very low. But it would still be nice to know, for the sake of us both.

That said, am I right to understand that the risk of transmitting HepB with a very low or undectable viral load is as close to zero as possible, even for an unvaccinated person, and that I could potentially be more at risk by going to the dentist, nail shop, etc. than I would be from him, whether I was vaccinated or not? I’m a little confused bc this source here on HepB.org stated "Having an undetectable viral load might reduce or eliminate the chance of transmitting the virus to someone during unprotected sex; research is still trying to assess whether a person with an undetectable viral load in the blood is able to transmit the virus through sex." which made it seem that way. If I Have Hepatitis B, Why Doesn't My Partner? - Hepatitis B Foundation

However, this source from the Hep B foundation in New Zealand made it seem like the chances aren’t as slim as the HepB.org source did as they stated “A man with an undetectable viral load, for example, can still spread infection as his semen will contain HBV.” Hepatitis B and sexual activity | The Hepatitis Foundation of New Zealand

  1. What happens if I don’t develop immunity to Hep B? I read some people will redo the series and just never develop immunity :frowning: I got vaccinated as an infant and am no longer immune. I’m concerned maybe my body just won’t develop immunity.

Thank you again for taking the time to answer my questions @ThomasTu ! Can’t express my gratitude enough, this has been overwhelming to navigate so I’m thrilled that I found this community :slight_smile:

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Yes, don’t get me wrong, he’s proactive about his health and goes to the doctors but it seems like he actually doesn’t know too much about his status other than what doctors told him several years ago. That said, he did used to work for a gov agency here in the US for several years and they would conduct some of the most thorough tests on them bc it involved flying planes, so he tells me if he had any severe issues, they would have picked it up then. But, it’s been a couple years since he worked there so I feel like it would be beneficial for him to regularly monitor

Oh cool. Nice to hear that he will be getting a follow up soon. Very important.

Hi @Gregory,
You are correct and I agree with your statement that 20% is still pretty high. Hopefully, there are more and better antivirals in the pipeline that can help close that gap down more. We remain hopeful. Best, Bansah1.

Regarding your very first point, does that mean most people who have Hep B / are carriers don’t get it as adults, but rather as children? i.e. is it very rare get chronic Hep B as an adult?

The first line is correct, the majority of people with chronic infections were exposed as children. It is relatively rare to get as an adult, but not so rare that you should neglect to get vaccinations if you haven’t already

Does repeated exposure increase the likelihood of becoming infected? For example, does repeated intercourse without the use of a condom increase the chance that your body will not clear the infection?

I’m not sure about this, as repeated exposure would probably increase your anti-HBs antibody levels as well. I think the scientific data on this is not clear.

Can inactive hep B carrier get their viral loads tested? Or is it just assumed they all have low viral loads?

They can have very low viral loads, and sometimes they are undetectable. But they still should get their viral loads tested to monitor any spikes or reactivation in viral replication.

Also, one thing I’m not too comfortable with is that he doesn’t know his viral load. I imagine / assume it’s pretty low, but, if he can get it checked, I figured it would be nice to know… not just for my sake, but for his too. He said a couple of years ago his doctor told him “it’s almost like he didn’t even have it” which makes me assume his viral load is undectable, or at least very low. But it would still be nice to know, for the sake of us both.

Yes, to get viral load tested at least once a year is the general consensus for good monitoring.

This is likely right.

You can just keep getting boosters and eventually get to immunity. I had a colleague who required 9 boosters before getting to protective levels. There are also some new vaccines being developed that are more immunogenic and are more likely to generate protective levels.

Hi @gregory, sorry to miss this question. @Bansah1 is correct that there is an average reduction of 80%, but it is from a baseline liver cancer/cirrhosis risk of ~25% over the lifetime of someone with untreated HBV infection. There may be populations where this protection is higher, e.g. if you start taking them earlier before a lot of the liver damage has occurred.

Hope this helps,
Thomas

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Thanks you for the explanation! @ThomasTu