Hep B Blog

Monthly Archives: December 2015

Hepatitis B Advocacy, Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention, Liver Cancer, Living with Hepatitis B

Ten Things People with Hepatitis B Need to Know in 2016

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Image courtesy of Serge Bertasius Photography at FreeDigitalPhotos.net
Image courtesy of Serge Bertasius Photography at FreeDigitalPhotos.net

In 2015, doctors continued to unlock the mysteries of hepatitis B and uncovered promising new treatments. Armed with new information, here are 10 things we can do in 2016 to safeguard our health and help prevent the spread of hepatitis B.

  1. Get monitored regularly. No one likes a blood draw or to be reminded they have hepatitis B, but it’s important that you’re tested annually or more often if you have a high viral load and/or signs of liver damage. There’s no cure yet, but there are effective treatment options with more in the pipeline. So be brave, protect your health, and go to the lab for a blood test.
  2. If you’ve been prescribed an antiviral, don’t forget to take it. Taking a pill every day is tedious and it’s tempting to skip it, but failing to take your daily antiviral reduces its effectiveness and can lead to drug resistance. The hepatitis B virus is a master at mutating to escape whatever is attacking it. Forgetting to take your daily pill can lead to an uptick in your viral load and liver damage. Stay strong, take your daily pill, and keep that virus undetectable.
  3. Face it, antivirals are a long-term commitment. Until a cure is developed, antivirals—either tenofovir (Viread) or entecavir (Baraclude)—are the best treatment to quickly reduce both viral load (HBV DNA) and liver damage. But they work for only as long as we take them, and once we start, we are usually committed to years of treatment. Quitting antivirals before we’ve achieved undetectable viral load and lost the hepatitis B surface antigen (HBsAg) often results in a resurgence of both viral load and liver damage. Antivirals are a long-term treatment that help prolong our lives.
  4. Demand to be screened for liver cancer. Some experts say current medical guidelines that recommend when we should be screened for liver cancer  don’t go far enough to protect us. So take charge of your health and ask for a liver cancer screen, which includes a semi-annual blood test and an ultrasound.  Hepatitis B-infected Asian men (or of Asian descent) over age 40 years and Asian women over age 50 years, patients with a family history of liver cancer, patients with cirrhosis, and Africans over the age of 20 should all be screened. Think you’re not at risk for cancer because you take antivirals? Think again. Antivirals help reduce liver damage, but if you’ve had cirrhosis or are older, the risk of liver cancer remains.
  5. If someone promises a new cure or treatment that sounds too good to be true….it probably is. In our search to be rid of hepatitis B, we may be tempted to yield to clever marketing and try a supplement that promises to cure us. But first, do your homework and practice precaution. To check out an herbal supplement, visit the National Center for Complementary and Integrative Health’s website to see what scientific evidence exists for a supplement and talk to your doctor. There is no magic bullet that will cure hepatitis B. Experts hope to find one soon, but for now be patient and stay skeptical. If you want to safeguard your health, eat healthy foods and avoid alcohol and cigarettes.
  6. Experts say a cure is coming … so stay informed about new drug developments and clinical trials. There is lots happening on the research front. To find out what drugs are in the development pipeline, visit the Hepatitis B Foundation’s Drug Watch page for the latest news. You can also find out if you qualify for a clinical trial. Expensive blood work, treatment medications, and doctor’s visits are usually free-of-charge for those accepted into a study. The foundation features a list of hepatitis B-related clinical trials that are recruiting patients in the U.S. and around the world at its Clinical Trials page. You could become part of the cure.
  7. Pregnant with hepatitis B? Get your viral load tested and ask your doctor about antivirals. In November, the American Association for the Study of Liver Disease (AASLD) for the first time recommended that pregnant women with viral loads (HBV DNA) higher than 200,000 IU/mL (or 1 million copies/mL) receive an antiviral (either tenofovir or telbivudine) starting at their 28th week of pregnancy. The antivirals won’t hurt you or your baby and will reduce the risk that your baby will be infected with hepatitis B to nearly zero, as long as your baby gets the first dose of the hepatitis B vaccine and a dose of HBIG (hepatitis B antibodies) within 12 hours of birth.
  8. Fight discrimination against hepatitis B and know your rights. Hepatitis B should never be a barrier to the education or job you want. Sadly, ignorance and stigma remains in the U.S. and abroad. It depends on us, our friends, and our family, to stand up and fight for our civil rights. We can’t back down. If we don’t fight, who will?
  9. Practice safe sex and never re-use needles. Today, in some areas of the U.S., hepatitis B is increasing—even though a safe and effective vaccine exists. Unfortunately, not everyone is immunized and the infection is still getting transmitted sexually. In the midst of America’s heroin epidemic, it’s also spreading when syringes are re-used and shared. Do you want to end hepatitis B? Make sure your friends and family members know how to prevent sexually-transmitted infections (even if those conversations are challenging, their lives may depend on it) and support needle exchange programs in your region and state. Countless studies show that when needle exchange programs are available, HIV, hepatitis B and C rates decline! It saves lives and healthcare dollars!
  10. Be brave, disclose, and get your friends, family, and lovers screened for hepatitis B and vaccinated. Yes, it will be one of the hardest conversations you will ever have, but if you are infected with hepatitis B, you need to disclose your infection to people who may be at risk. If you just discovered you have chronic hepatitis B, which you may have contracted at birth, you need to tell your siblings and your mother and get them screened and immunized if needed. Dating someone, and about to take the next step? You need to disclose ahead of time and give them information and choices. It builds trust and it’s the right thing to do. You would want the same for yourself.

Continue reading "Ten Things People with Hepatitis B Need to Know in 2016" →

Hepatitis B Diagnosis & Monitoring, Hepatitis B Treatment

Buyer Beware: When Someone Claims to Have a Hepatitis B Cure, It’s a Counterfeit Drug

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Image courtesy of africa, at FreeDigitalPhotos.net
Image courtesy of africa, at FreeDigitalPhotos.net

Twenty years ago when I found out my daughter had chronic hepatitis B, I would’ve purchased any drug I could find to cure her.  I asked her doctor if she could join a pediatric clinical trial for lamivudine. I just wanted her cured as soon as possible. Fortunately, cooler heads prevailed.

My daughter didn’t need treatment then, and she doesn’t need it today. Her doctor was wise enough not to try an antiviral with an unknown track record that was later found to cause high rates of drug resistance. It would have caused more harm than good.

When we want hard to believe in something—especially a medicine that is advertised to cure hepatitis B–we end up listening to our hearts and not our heads.

Many people touched by hepatitis B around the world don’t have an expert to be the voice of reason and wisdom when they hear about false, counterfeit, or untried treatments for hepatitis B. Sadly, there is a steady increase in false marketing claims on Facebook and other websites using testimonials and marketing ploys to sell a counterfeit hepatitis B cure to we who are vulnerable, frightened, and desperate for a quick cure.

We at the Hepatitis B Foundation know this all too well. The public can post on our Facebook and blog pages. Often, unscrupulous people pitching ineffective cures will try to post a personal claim endorsing some doctor’s or herbalist’s new cure. Here’s a recent, verbatim example of a post to our Facebook page:

“Just wanna express my moment of joy for (having) been cured from the deadly HEPATITIS B.  I have been infected with the Disease over three years and already lost hope (because) I have already tried so many ANTIVIRAL treatment…. one day while making more research online, I came across a testimony of a patients Dr … cured from GENITAL HERPES and I decided to give the said doctor a call….”

As you might expect, the writer claims to have been miraculously cured by the doctor using an antiviral drug called hepantivir, for example. But this drug has no scientific credentials. It has never been studied or tested or reported on in medical journals. But “experts” promise it will cure hepatitis B for $800.

We at the foundation remove these posts as soon as we discover them. These herbal supplements and counterfeit drugs can look very official, with medical-sounding names and packaged to appear like true pharmaceutical products.  The advertising often features a photo of a doctor to appeal to a local audience. But they’re fake, and some of these “products” can even make you sicker than before you started the alleged, miracle drug.

In 2013, a study by the United Nations Office on Drugs and Crime that focused on Africa and South-East Asia suggested the counterfeit drug market in Africa was worth about $4 billion (USD).  A report found that in 2009, in Nigeria, 60 out of 225 (27 percent) antimalarial medications failed chemical analysis, and in Ghana, 14 out of 17 (82 percent) antimalarial drugs followed suit.

Their deceit is cruel and criminal, especially when it targets frightened people who may have no access to treatments or advice. In the U.S., drugs must be approved by the U.S. Food and Drug Administration. To win that approval, randomized, clinical trials that compare outcomes of treated patients to untreated patients (the control group), are needed to prove a drug actually does helps people. This is the gold standard of medical evidence.

That careful FDA review does not, however, apply to herbal supplements. One day, some of these supplements may indeed be found to have beneficial effects to protect the liver against hepatitis B after rigorous study and experiments. But that research hasn’t happened yet.

The U.S. National Institutes for Health has published a directory about what scientific research has discovered about common herbal supplements. Probably the most popular herbal supplement pitched as a liver remedy is milk thistle, and its extract silymarin. The NIH milk thistle report found, “Previous laboratory studies suggested that milk thistle may benefit the liver by protecting and promoting the growth of liver cells, fighting oxidation (a chemical process that can damage cells), and inhibiting inflammation. However, results from small clinical trials of milk thistle for liver diseases have been mixed, and two rigorously designed studies found no benefit.”

A true scientific evaluation is what we need to hear, even when we desperately want milk thistle or another supplement to be the cure. There is no magic bullet that is going to cure hepatitis B. It is a complex infection with no cure at this time. Experts are making great strides and hope to find a cure in the next few years, but now, this is the time to let our heads make healthcare decisions, instead of our vulnerable and hopeful hearts.

So be patient. Don’t fall for false promises, even when they’re accompanied by professional-looking photographs and emotional testimonials. If it sounds too good to be true, it probably is.

More information about counterfeit medications:

Quality Matters: Battling the Epidemic of Illegal Online Drug Sellers and Counterfeit Medicines  Of the 35,000-50,000 active online drug sellers, 97 percent do not comply with U.S. laws and 50 percent of medicines sold online are fake or counterfeit, according to the Alliance for Safe Online Pharmacies (ASOP Global), an international non-profit headquartered in Washington, D.C. with operations in Europe and Asia.

These counterfeit medications are often manufactured in unsafe conditions; contain too little, too much or no active pharmaceutical ingredients; and, in many cases, have been found to contain dangerous substances like floor wax, rat poison, concrete, chalk, boric acid, road tar, paint, anti-freeze, and other toxins. This means that consumers worldwide are just a click away from buying products that may cause harm, treatment failure or even death. Read more…

Fight the Fakes Campaign:  Fight the Fakes is a campaign to raise awareness about the dangers of fake medicines. The campaign gives a voice to those who have been personally impacted and shares the stories of those working to put a stop to this threat to public health. It seeks to build a global movement of organizations and individuals who will shine light on the negative impact that fake medicines have on people around the globe and to reduce the negative consequences on individuals worldwide.

As part of this effort, Fight the Fakes is collecting and sharing the stories of those who are impacted by fake medicines and are speaking up. The website also serves as a resource for organizations and individuals who are looking to support this effort by outlining opportunities for action and sharing what others are doing to fight fake medicines.

Hepatitis B Diagnosis & Monitoring, Liver Cancer

The Importance of Advocating for Our Health, and Facing Our Fears

Image courtesy of Stuart Miles at FreeDigitalPhotos.net
Image courtesy of Stuart Miles at FreeDigitalPhotos.net

Early detection of cancer saves lives. Whether it’s breast, liver, or skin cancer, when it’s found and treated early, our survival improves markedly.

But here’s the rub. We intellectually know that early detection works, but performing those self-breast exams or getting screened for liver cancer carries a huge risk – what if something is found?

Every trip to the doctor or lab reminds us of our mortality, especially when we have hepatitis B. We have to take that risk and acknowledge our mortality, even when the healthcare system doesn’t make it easy.

A few months ago, the Hepatitis B Foundation assembled national experts to discuss how well the system worked to identify and treat liver cancer, which is now one of the top causes of cancer deaths. Worldwide, today hepatitis B causes 45 percent of liver cancers.

Their findings, published in the April 2015 issue of the Journal of the National Cancer Institute, paint a dismal picture of a healthcare system that often fails us, our family members, and our friends who live with hepatitis B and are at risk of liver cancer. Not only are providers failing to screen a large percentage of at-risk patients, when they find liver cancer, their treatment is often inadequate and inconsistent across clinics.

Who should be screened for liver cancer? Hepatitis B-infected Asian men (or of Asian descent) over age 40 years and Asian women over age 50 years, patients with a family history of liver cancer, patients with cirrhosis, and Africans over the age of 20 should all be screened.

What is the screening? A semi-annual ultrasound and blood tests to detect liver cancer are recommended, but this approach is only 70 to 80 percent effective in identifying liver cancers. This means 20 to 30 percent of people at risk of cancer won’t get diagnosed. And there are other problems.

A recent, large study of 5,000 insured hepatitis B patients in the U.S. who did not have cirrhosis found that only 6.7 percent of them had been screened properly, based on recommendations, over the four-year study. And these are the patients with insurance who have good access to healthcare. Liver cancer screening among uninsured people is downright abysmal, and usually performed only after liver cancer has progressed to an inoperable and untreatable stage.

About 60 percent received partial screens and 34 percent had not been screened at all. Those least likely to be screened lived in rural areas (where doctors had little hepatitis B expertise and were unfamiliar with current guidelines) or were coinfected with HIV.

While ultrasound exams are affordable, relatively easy to perform and widely available, the success of this screen depends entirely on the operator’s skill and experience. If the operator is having a bad day or is not trained in identifying liver cancers, small nodules or tumors can remain unnoticed, at a time when they’re in the early, treatable stage.

And then there’s obesity. Especially in the U.S., many patients with viral hepatitis and/or fatty liver-related cancer are overweight, and obesity reduces the accuracy of ultrasounds.

The advantages of blood tests is they are widely available, relatively affordable, and generally require only a blood sample. The disadvantages is they are not highly accurate, especially when tumors are small (and still treatable). The most well-studied and commonly-used blood test is the alpha fetoprotein (AFP) test, but it is so unreliable that current guidelines says that an ultrasound must be used with it.

You might think with so much stacked against early detection of liver cancer, why bother? Because we owe it to ourselves and our families and friends.

Even when faced with an imperfect healthcare system, we need to overcome our fears, find out our risk factors, and ask for screening even when our doctors fail to recommend it.

The study, Hepatitis-Associated Liver Cancer: Gaps and Opportunities to Improve Care, was written by experts from the Hepatitis B Foundation and its Baruch S. Blumberg Institute, the Alaska Native Tribal Health Consortium’s Liver Disease and Hepatitis Program, Drexel University’s School of Public Health, the Fox Chase Cancer Center, and the University of Toronto.

Hepatitis B Diagnosis & Monitoring, Hepatitis B Treatment, Living with Hepatitis B

There’s Hope for a Hepatitis B Cure at the HEP DART 2015 Conference

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IMG_1387This year’s  HEP DART conference brought together liver specialists and researchers from around the world to review and brainstorm about the latest research to find a cure for hepatitis B.

Biopharmaceutical companies presented data that showed their cutting-edge treatments, which use micro-RNAs and other innovative approaches to reduce the virus, appear promising. Much of this research, however, is in early, pre-clinical stages and focuses on laboratory-grown liver cells or laboratory animals, though a few are in Phase I and Phase II trials.

Joan Block, co-founder and executive director of the Hepatitis B Foundation, reported the following news in hepatitis B research from the conference, which was held in Hawaii from Dec. 6-10.

HepDart 2015 marks the 20th anniversary of this conference, and about 600 attendees from 20 countries attended. In opening remarks, Dr. Patrick Marcellin of France noted that the cure for hepatitis C is a huge medical breakthrough, now, he noted we are faced with finding a cure for hepatitis B.

This year’s HepDart meeting included nearly two days devoted to hepatitis B drug development—which shows the new momentum around finding a cure hepatitis B by the scientific community. During previous HepDart meetings, there was almost no discussion about new hepatitis B treatment. But this year, there are more than five companies presenting new hepatitis B drug findings, Block reported.

Researchers at the conference continued to lament the lack of resources spent to research and develop a cure for hepatitis B. They noted the U.S. government has spent $17.5 billion treating HIV. A fraction of that has been spent on finding cures for hepatitis B and C, which infects up to 6 million Americans.

Despite the lack of financial investment in finding a cure, Joan Block reports that the consensus at the conference is that a cure is indeed possible. Despite barriers to achieving a cure because of the complexity of the hepatitis B virus, “the feeling is that there are many targets in the life cycle of the virus and that a combination of a direct-acting antiviral along with an immunomodulator (to boost the immune system) will be the most likely route to success,” she reported.

In the short term, experts may be looking at a “functional” cure. For example, some of the new experimental drugs appear to increase the chances of clearing the hepatitis B surface antigen (HBsAg) with a finite duration of treatment. “Although this wouldn’t take care of (lingering) cccDNA or viral integration into liver cells, it would be a significant advance in treatment,” she said.

Day 2 of HepDart focused on targets within the virus, new therapies and possible cures. Experts explored whether any of the new drugs could produce a functional cure (similar to a resolved hepatitis B infection with loss of surface antigen) versus producing a complete cure that totally eradicates the virus from the liver (including cccDNA). Loss of cccDNA is referred to as the holy grail of the HBV cure.

“The parsing of the word ‘cure’ is frustrating to patient advocates,” she reported, “but the feeling is that the hepatitis B virus life cycle is very complex so an incremental or functional approach might be most feasible.

“Everyone wants a complete cure, including the scientists working on hepatitis B,” she noted, “however, a functional cure might be the most realistic goal in the next 10 years.”

A functional cure means patients will have to take one of the new drugs for only a limited period of time–compared to the current long-term reliance on antivirals that patients take in order to keep their viral loads down and prevent liver damage.

The downside of a functional cure is the potential for reactivation if a person, later in life, needs to take immune-suppressing drugs, such as chemotherapy, to fight cancer. However, this can be managed with antivirals if necessary. This is a similar situation to those who spontaneously recover from an infection.

To underscore the complexity of finding a cure, the image below shows the different targets in the hepatitis B virus life cycle that companies are examining to find a cure.

IMG_1423

There are many promising targets that are being pursued by scientists in academia, NIH, biotech companies and the Hepatitis B Foundation. At this point, the small interfering RNA (siRNA) technology is most advanced. However there are compounds in the pipeline for each category (see below), which is very exciting. Please refer to the Hepatitis B Foundation’s Drug Watch Page for complete list of drugs in development.

“The research work continues,” Joan Block reported, “and there is reason for optimism.”

Dr. Marion Peters - HepDart 2015
Dr. Marion Peters – HepDart 2015

The Hepatitis B Foundation president, Dr. Tim Block chaired a special session at HepDART to discuss what new endpoints will be needed to evaluate the efficacy of the new drugs coming down the pipeline. This will include immunological, virologic, and clinical endpoints for both a functional cure and complete cure.  The clinical endpoint goals might differ based on the phase (immune tolerant, immune active and inactive phase) the patient is in at the time of treatment with these newer agents.

HBF president, Dr. Tim Block
HBF president, Dr. Tim Block

Late breaking update from HepDART!

  • Arrowhead’s hepatitis B surface antigen (HBsAg)-lowering drug (ARC 520) looks promising according to the company’s presentation at HepDart. A single injection of the siRNA first in class type drug lowered HBsAg 10-fold in hepatitis B “e” antigen (HBeAg) positive people. The study was small (a few individuals) but impressive.
  • Arrowhead’s ARC 520 may also be telling us something about chronic HBeAg-positive hepatitis B versus HBeAg-negative hepatitis B. They suggest that the amount of HBsAg in the blood of people with HBeAg-negative hepatitis B may come from “integrated” hepatitis B in the liver, not from “cccDNA.”  This has profound implications for treatment.
  • Novira’s oral drug is a first-in-class capisd inhibitor and was able to lower HBV DNA levels by as much as 100-fold in the small number of people in the initial human trial, according to their presentation at HepDart. Novira was recently acquired by the pharma giant J&J.

“Excitement is really building as the first new hepatitis B drugs come into the clinic,” said Joan Block.

Living with Hepatitis B

Cold and Flu Season Is Here. If You Live with Hepatitis B, You Need a Flu Shot. Now.

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Image courtesy of Sura Nualpradid at FreeDigitalPhotos.net
Image courtesy of Sura Nualpradid at FreeDigitalPhotos.net

Flu season is here and if you or a family member lives with chronic hepatitis B, it’s time to get a flu shot as soon as possible!

Why? According to an article in the November 2015 issue of the medical journal Vaccine, chronic hepatitis B patients who get a flu shot have a lower rate of flu-related hospitalizations than patients who skip the annual flu vaccine. Continue reading "Cold and Flu Season Is Here. If You Live with Hepatitis B, You Need a Flu Shot. Now." →

Baruch S. Blumberg Institute