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Viral Hepatitis B

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Asian Pacific Health Foundation

Hepatitis b is a global health threat this is a major cause of death every year maybe close to a million people it’s a combination of liver cancer at about 600 000 and then a large number of people dying of cirrhosis and its complications of course hepatitis b is an infectious disease it’s 100 times more infectious than hiv and it’s a leading cause of liver

Disease alongside hepatitis c liver cancer as you know is the second leading cause of cancer deaths in the world this is vaccine preventable the word hepatitis means inflammation of the liver it doesn’t always mean a viral infection and it doesn’t always mean alcohol so we really have to subdivide the word hepatitis into acute and chronic and what is the actual

Cause people with acute hepatitis b or chronic hepatitis b can present with a variety of different symptoms including jaundice abdominal pain abdominal distension edema even mental confusion so this is very important to take that history but link it back to the patient’s history and laboratory tests hepatitis b can cause acute disease of course and because

Hepatitis b is incurable once a person has cleared hepatitis b from their blood they still have residual hepatitis b in their liver but if they remain surface antigen positive that indicates chronic infection and the blood and the liver and that can lead to cirrhosis liver cancer liver transplant and death there are two main populations at risk for hepatitis

B there’s the group of patients that acquire it at birth from their mother and there are those that do or are exposed to high risk events as say adolescents or as adults if someone acquires hepatitis b as a newborn that infection is highly likely to be chronic long-term when an adult acquires hepatitis b they have a high chance of clearing surface antigen from

Their blood but as we mentioned before there’s often or always residual virus left in their liver so in the u.s the asia-pacific islander community is dominant in terms of at risk for hepatitis b infection caring hepatitis b and its complication but indeed the sub-saharan african population and east african population are at risk for hepatitis b as well and

You have to recall in this part of the world delta infection is common so delta antibody testing is very important we think there’s about 2.2 million people in the u.s with hepatitis b today denoted by surface antigen positivity when we talk about hepatitis b just like with any type of viral hepatitis we need to understand the tests that we do the tests we

Order how to interpret those tests this is really pretty simple the first test is hepatitis b surface antigen this is a protein made by the virus in the liver cells that’s pushed out into the blood and measured by the laboratory but surface antigen means current or active infection another test is called core antibody this antibody means exposure to hepatitis

B as we mentioned when someone’s been exposed to hepatitis b since it’s incurable it stays in the liver lifelong surface antibody indicates immunity or protection from hepatitis b but that protection is only of surface antigen and core antibody are negative so three tests three simple rules keep that in mind if you would when thinking about hepatitis b there

Is another type of viral hepatitis that can be carried with or super infection on top of hepatitis b that’s called delta hepatitis or hepatitis d this is the most deadly form of viral hepatitis that can affect the liver so people who have hepatitis b we believe at the hepatitis b foundation everybody should have a delta or d antibody blood test performed and

If positive that delta antibody indicates the person should be tested by another level of testing called pcr this way to measure the delta virus if it’s present yes or no so delta is treatable although a little bit more difficult to treat and delta is preventable if you vaccinate for b you prevent b you prevent this very deadly form of viral hepatitis there’s

A number of populations that need to be tested for hepatitis b we at the hepatitis b foundation based in doylestown pennsylvania think all adults should be tested for hepatitis b this hasn’t quite worked this way through the cdc or the preventative health services task force so we’re thinking about this we need to also think about special populations or risk

Testing so health care providers emergency workers patient who use iv drugs or other illegal drugs sex partners of infected individuals and people who practice high risk sex blood exposure individuals in countries born where hepatitis b is more common so we think about mongolia we think about latin america and the caribbean so the hispanic population is part of

This at-risk group inmates and staff at correctional institutions and all pregnant women need to be tested hepatitis b is spread by intimate contact and exposure to blood or body fluids but remember this is not spread by shaking hands or kissing or aerosol like the coronavirus this really requires intimate contact that could be tattooing in an unsafe environment

Or dental procedures in an unsafe environment think about this also about the issue of direct contact maybe with blood if you’re caring or someone’s caring for somebody with an open wound or an open sore and we already spoke about but i want to reinforce the risk of vertical transmission that means mother to baby transmission baby at birth let’s go into a little

Bit more depth about the long-term effects of hepatitis b so someone might go into a provider’s office and just have elevated liver enzymes and not have any symptoms at all we have discovered that hepatitis b can cause just general symptoms what we call constitutional symptoms fatigue malaise it’s not feeling well not having much energy but later as this causes

Scarring in the liver and scarring when it’s in its more severe form it’s called cirrhosis can then result in liver failure fluid on the belly swelling on the ankles mental confusion abnormal coagulation elevated liver function called a bilirubin or a low albumin or abnormal clotting liver failure leading to transplant or death liver cancer liver cancer can

Occur without liver failure it can occur in people with cirrhosis including patients with cirrhosis and advanced or far reached liver disease at this time we’re going to take a little deeper dive into vaccination this is called a vaccine preventable disease this virus is discovered in the late 1960s vaccine developed in the 1970s and a more global rollout of the

Vaccine took place between the 1980s and currently this can prevent hepatitis b infection and therefore it’s an anti-cancer vaccine originally we had these three dose hepatitis b vaccines and there’s two of them still available globally in the u.s we’ve been very fortunate recently you have the addition of a two dose vaccine it has an equal safety profile but

Much higher antibody response after two doses so you can imagine that compliance and adherence with a two dose regimen is very very substantial and this is what i use in my practice we have to think about treatment for hepatitis b in two different compartments or two different sections acute hepatitis b most of the time it resolves although occasionally patients

Go into liver failure and need a liver transplant and of course those acute hepatitis b patients need to be checked for delta or hepatitis d as we mentioned previously chronic hepatitis b is not curable but it’s suppressable that means we can lower the amount of virus in the blood and probably lowering the virus level in the liver as well when we lower the virus

Level we decrease the risk of cirrhosis transplant death and liver cancer we have three first line medicines used in the us and around the world and second line medicine should not be used so first line is three different medicines one’s called tdf type of tenofovir there’s a more advanced tenofovir called taf it has less risk of bone and kidney problems that

We can see with tdf and the third is entecovir these medicines are dosed once a day and are highly effective at suppressing virus occasionally these treatments actually clear surface antigen from the blood i don’t like to use the word cure but we have talked about this as functional cure but remember every patient every individual remains with a little bit of

Hepatitis b in their liver even if they clear surface antigen these medicines are very safe resistance is zero or close to zero with them and long-term medicine is required though just like maybe you would have with diabetes or high blood pressure it’s a chronic disease so taking the medicine long term is needed we need patients to be compliant adherent to take

Their medicine on schedule and if they stop the medicine they must tell their provider to be monitored for flares or more significant liver injury if the virus comes back it’s extremely important to be tested for hepatitis b we mentioned that we think at the hepatitis b foundation that all adults need to be tested for hepatitis b and children and adolescents

In special settings this is a silent disease silent meaning if there are symptoms they’re not pointing directly to the idea of hepatitis b so testing this three test panel that we discussed very simple inexpensive and it really would link people to care or to vaccine if they needed it or in those unusual patients who have this special core antibody education

About risk for reactivation and also education that they don’t need vaccine why we need action today hepatitis b we believe acute new infections in the us could be as high as 80 000 and since it’s incurable most people clear but still have residual virus this is very important but when they have acute infection they can transmit it to other people same thing

With chronic disease we’re thinking that in the us there’s 2.2 million individuals who have hepatitis b surface antigen today and the number of people dying from hepatitis b could be in the five to fifteen thousand range sometimes people aren’t tested so we’re really not sure about what the real incidence and prevalence of hepatitis b is the cdc has written a

Beautiful plan with health and human services to come up with a roadmap for hepatitis b elimination by 2030. it’s a very aggressive very wonderful very detailed plan that was just released recently but testing is essential if we don’t test we don’t find the chronic disease we don’t test we can’t find the individuals who need vaccination and protection globally

We think there’s 292 million people infected with hepatitis b as we mentioned previously i want to emphasize it could be up to a million deaths from hepatitis b so we need testing linkage to care linkage to treatment as essential next steps there are many new medicines in the pipeline that may result in a higher functional cure rate and may also result in a true

Cure getting rid of the virus completely remember this is a vaccine preventable disease you

Transcribed from video
Viral Hepatitis B By Robert Gish