Hep B Blog

Monthly Archives: December 2018

Living with Hepatitis B

New Year’s Resolutions: Taking Control of Your Hepatitis B Infection

If you are living with chronic hepatitis B, you may feel as though you are not in control of your health, but that’s not true! Small changes to your daily life can go a long way towards improving your liver health and may even prevent liver damage from occurring. Here are five New Year’s resolutions to help you start 2019 off right!

  • Kick Your Old Habits to the Curb: Still smoking? Time to leave that behind! Old habits can be hard to break, but staying healthy is important. Did you know that insurance plans in the United States must cover smoking cessation programs through preventive care under the Affordable Care Act? This means that copayments and coinsurance can’t be applied to these programs. Taking the first step is better for your liver and your wallet!
  • Cook More: Cooking can be a lot of work, but it can also be fun! Regularly eating fast-food and highly processed meals are bad for your liver and can leave you feeling lethargic, so try switching things up. Consider signing up for a cooking class with your friends or family to learn some new tricks in the kitchen. You don’t have to make every meal from scratch; start by making one or two fresh meals a week and increase them as you feel more confident. Don’t know where to start? Try one of these recipes – desserts included!  There is no standard diet for chronic hepatitis B patients, but the American Cancer Society’s low fat, low cholesterol, and high fiber meal ideas are a good, general diet to follow.
  • Write it Down: It can be difficult to remember all of the things
    Courtesy of Unsplash

    that you have to do and important tasks – like scheduling your doctor appointments – can get lost in the shuffle. Make 2019 the year that you start to write things down. Physically writing items down increases your chances of remembering them, so skip the Notes application on your phone and grab a piece of paper!

  • Make Some Time For Yourself: Stress is bad for every part of your body – including the liver – so it is important to make some time for yourself. Set a few hours aside each week to do an activity that you enjoy. If you have the resources, you may want to consider planning a vacation or taking a small weekend trip. Even if you can’t get away, set a goal to spend more time outdoors. Green spaces, such as an urban park or a forest, have been known to lower stress levels and can help manage weight, which is an important part of maintaining liver health.
  • Get Active: Exercising more might be one of the most common New Year’s resolutions, but it is also one of the most important ones! If you’re tired of going to the gym or bored with your old routine, try your hand at an exercise you hadn’t considered before. Yoga, pilates, running, and kickboxing are just a few
    Courtesy of Emma Simmons on Unsplash https://unsplash.com/photos/mNGaaLeWEp0 

    examples of fun workouts that you can add to your exercise catalog and can be done outside of a typical gym setting. If you’re looking for affordable exercise options, be sure to check out some of the free exercise videos you can find on YouTube. You can also try hiking at your local park or joining a local community center!

New Year’s resolutions can be difficult to keep, especially if you are trying to do them all at once. The important part is to begin! If you are having trouble meeting your goals, pick one to start with and add another goal once it becomes a part of your routine.

Hepatitis B Diagnosis & Monitoring, Liver Cancer

Fighting the Doom and Gloom: Screening Saves Lives!

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blood tubes

By Anu Hosangadi

Liver Cancer Connect’s “Fighting the Doom and Gloom” series is highlighting some of the advances in prevention, screening, and treatment that are helping to increase survival among people with liver cancer. Previously, we talked about how prevention works. Now we’ll explain how screening and surveillance save lives.
Continue reading "Fighting the Doom and Gloom: Screening Saves Lives!" →

Hepatitis B Treatment, Liver Cancer

Fighting the Doom and Gloom: It Takes a Team

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universal-health-care-medical-team

By Anu Hosangadi

People generally think liver cancer is non-treatable and non-curable. But that perception needs to change. Diagnosis and treatment of liver cancer have improved so much in the past 20 years that it can be cured if caught early and managed by an experienced health care team. Liver Cancer Connect’s “Fighting the Doom and Gloom” series explains how the right treatment plan  and teamwork offer the best chances for a cure.  Continue reading "Fighting the Doom and Gloom: It Takes a Team" →

Hepatitis B Prevention, Relationships

My partner has been diagnosed with hepatitis B. Can transmission be prevented by vaccination?

Courtesy of Google Images

A hepatitis B diagnosis can be scary and confusing for both you and your loved ones, especially if you are unfamiliar with the virus. Hepatitis B is known to be sexually transmitted, and you may wonder how you can continue your relationship with someone who has been infected. The good news is that hepatitis B is vaccine preventable. This means that after you complete the vaccine series, you cannot contract hepatitis B through any modes of transmission; you are protected for life!

However, it is important to remember that the vaccine will only work if a person has not been previously infected. Therefore, it is necessary to take certain steps after your partner’s diagnosis to protect yourself from becoming infected.

The first step is to visit the doctor and get tested, even if you think that you do not have it. Since hepatitis B often has no symptoms for decades, testing is the only way to know your status. The doctor should perform the Hepatitis B Panel test – a simple blood draw that shows hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb or anti-HBs), and hepatitis B core antibody total (HBcAb or anti-HBc). Looking at these three blood test results together will show if you have a current infection, have recovered from a past infection, or if you need to be protected through vaccination. Once you receive your results, this chart can help you understand what they mean.

Preventing Transmission through Vaccines:

If you test negative for HBsAg, HBsAb, and HBcAb, you are not protected from hepatitis B and are considered to have a high risk of contracting the virus from your partner or other means. To prevent transmission, you will need to begin your vaccination series as soon as possible.

The hepatitis B vaccine is a 3-shot series taken over the span of 6 months. The first shot can be given at any time. The second dose should be given at least one month after the first shot, and the third and final dose should be separated from dose 2 by at least two months and dose 1 by at least 4 months.  While there is a minimum amount of time required between doses, there is no maximum amount of time. If you miss your second or third shot, you do not have to start the series over again; you can pick up where you left off! If your partner is pregnant and was diagnosed with hepatitis B, extra precautions need to be taken to prevent transmission to the child. Two shots will need to be given to the child in the delivery room: the first dose of the hepatitis B vaccine and Hepatitis B Immune Globulin (HBIG), if recommended and available in your country.  You can learn more about pregnancy and hepatitis B here.

After completing the series, a quick blood test called the “antibody titer” (anti-HBs titer) test can confirm that you have responded to the vaccine. This test, which should be given at least one month after you receive the third dose, will be greater than 10 mIU/mL if you are protected from hepatitis B. Like the vaccine, your doctor can administer the titer test.

Hepatitis B is spread through direct contact with blood. HBV  is also a sexually transmitted disease, so it is important to practice safe sex by using condoms throughout the duration of the vaccine series until the antibody titer test confirms that you are protected. While you wait for your body to create its defense, there are other steps that you can take to avoid transmission such as not sharing toothbrushes or sharp objects like razors.

The hepatitis B vaccine is the only way to fully protect yourself from the virus. Preventive measures such as using condoms can help prevent hepatitis B transmission, but without vaccination, there can still be some risk.

If you do not have a doctor or are worried about the cost of testing or vaccination, you can still get tested and vaccinated! In the United States, Federally Qualified Health Centers provide the hepatitis B vaccine at low- or no cost to individuals without insurance or with limited plans. You can search for a health center near you here. Internationally, you can search our Physicians Directory and the World Hepatitis Alliance member map to identify member organizations in your country that may have advice on doctors in your area. In addition, keep a lookout out for local health fairs and screenings; they may provide free vaccinations or testing for hepatitis B!

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Talk with Dr. Block: An Expert’s Insight to A Hepatitis B Cure – Part 2

In the last Talk with Dr. Block blog post, hepatitis B expert Timothy Block, Ph.D., co-founder, and President of the Hepatitis B Foundation, sat down to discuss the status of a hepatitis B cure and how the foundation is contributing to the cure efforts. In this second installment, he provides an inside look into what a cure could possibly look like and a potential cure timeline!

This is the final post in a two-part series.

 We keep hearing that a combination of drugs will be necessary to cure HBV. What will these therapies look like?

 

A combination of drugs is likely not necessary for everyone. We already know that a small number of people who are treated with one drug can do fairly well.  However, most people will likely need a combination of drugs only because of precision medicine. Precision medicine allows a healthcare specialist or provider to develop treatments on an individual scale based upon an understanding of that person’s response to the disease. Some patients might respond better to specific drugs and specific doses due to differences such as age or underlying health conditions. We should take advantage of precision medicine and match specific drugs with the specific clinical state that someone is in. I do not believe that an immunomodulator, or medications that help to regulate the immune system, will be necessary for most people. It may, however, accelerate a cure and help us create a cure cocktail that will be effective in a large number of patients.

A functional cure for hepatitis B will likely be defined as the absence of the hepatitis B virus in the cells. This means that the person will have a sustained loss of surface antigen (HBsAg negative) and undetectable viral load (HBV DNA).  I look forward to a time where we have drugs that are both functionally and clinically curative. It is difficult to say if the cure will be in pill form, an injection, or an infusion. The hope is to eventually have a cure that will be taken orally for a short amount of time like the hepatitis C cure. More research needs to be done in order to truly determine what form the cure might take.

   How long do you anticipate someone will need to be treated?

A person would likely need to be treated for a few years. I base this time frame on the lifespan of an infected cell and how long I think it would take to safely replace the infected cells with healthy, uninfected cells. However, it is important to remember that people with chronic hepatitis B differ by the number of infected cells they have in their liver; some people may have most of their liver infected while others might have a smaller portion of their liver infected. The replication of the virus in the body and immune response also differ from person to person. Due to these factors, treatment will likely be administered by some form of response-guided therapy (RGT). This type of treatment means that a doctor will monitor the patient as they take the medication and adjust it as needed. Some patients will respond rapidly to the drugs and will be able to end treatment sooner than others.

 

When can we anticipate a combination of therapies resulting in a cure?

 

I’m very optimistic. At the moment, it looks like we might see the approval of one to two new drugs for hepatitis B or hepatitis Delta between the next 18 months and 2 years. The approval of these potential drugs is dependent upon the research conducted in clinical trials, but there are several drugs set to enter Phase 3 of their trials, which is promising! I expect that entry inhibitors – antiretroviral drugs that block a virus from infecting a healthy cell – will be among the first round of new drugs to be approved by the Food and Drug Administration (FDA). It is difficult to say if they will be a cure, but they will likely be a big step in the right direction!

Disclaimer: The information provided in this article is based upon recent research and updates in the field. Please note that timelines and specific information regarding hepatitis B drugs are estimations and are subject to change as new research emerges.

Hepatitis Delta (HDV), Living with Hepatitis B

Ask An Expert: Managing Hepatitis Delta During Pregnancy

 

  What is the standard treatment for hepatitis delta and how long is it taken?

 

Although there are no standard guidelines for the treatment of hepatitis delta, pegylated interferon has been shown to be effective for some patients. It is usually administered via weekly injections for 1 year or more and is able to cure roughly 15-40% depending on the length of time that treatment is administered. Although many patients see declines in their hepatitis delta virus levels, most do not maintain long-term control following the conclusion of treatment.

Can pregnant hepatitis delta patients be treated with interferon?

 

Interferon has not been proven to be safe for administration during pregnancy and should not be administered. It may be harmful to the baby.

 

What is the best way to manage a hepatitis delta infection during pregnancy, if interferon cannot be used?

 

A liver specialist may continue to manage the hepatitis B infection during pregnancy through antiviral treatment. The American Association for the Study of Liver Diseases (AASLD) recommends antiviral treatment during the third trimester of pregnancy for women with high hepatitis B viral loads.

How can hepatitis B and delta transmission be prevented to the baby?

 

Because a hepatitis B infection is required for someone to become infected with hepatitis delta, transmission from mother to child can be prevented with the hepatitis B vaccine. Centers for Disease Control and Prevention (CDC) guidelines recommend the first dose within 12 hours of birth, along with and a dose of HBIG (hepatitis B immunoglobulin), followed by the additional 2 vaccine shots; one at 1 month and the final one at 6 months old. The vaccine, along with HBIG and hepatitis B antiviral treatment (if necessary) greatly reduce the risk of transmission to the baby. In resource-limited countries, the World Health Organization (WHO) recommends the first dose of the hepatitis B vaccine within 24 hours of birth, followed by the additional shots on the recommended schedule. Once the vaccination series is completed, the baby should be protected for life against hepatitis B and delta.

If hepatitis delta cannot be treated during pregnancy, do most women have progression of their liver disease during pregnancy?

 

 While some women may see progression of their liver disease, due to the relative short length of pregnancy, most women do not show clinical signs of advancing liver disease.

 

What treatment should follow delivery? 

 

 

Following delivery, the mother may resume interferon treatment as long as she is not breastfeeding. Interferon treatment while breastfeeding could be harmful to the baby. As for all patients, keeping up-to-date on the latest hepatitis delta clinical trials could provide access to new, experimental treatments that may be more effective. For a global list of clinical trials for hepatitis delta, visit the clinicaltrials.gov web page.

It is very important for all pregnant women who are hepatitis B and delta positive to be managed by a liver specialist who is familiar with managing coinfected patients. For assistance in locating a specialist near you, please visit our Physician Directory page. For additional questions, please visit www.hepdconnect.org or email connect@hepdconnect.org.

Baruch S. Blumberg Institute