The holiday season is here once again! It’s often a time filled with love and happiness, but for those living with chronic illnesses like hepatitis B, this time of year can be uncomfortable and stressful. The most important thing to remember is that your health – physical and mental – should come first.
Alcohol is usually present at holiday gatherings and can be difficult to avoid. However, it is also extremely damaging to the liver – especially if you are living with a liver disease like hepatitis B. It may be tempting, but avoiding all alcohol, including small amounts, is best for the health of your liver. Focus on the conversation and catching up with your coworkers or friends instead of the drinks! If you feel pressured, you can carry around a cup of another beverage, such as sparkling water or juice, to bypass any questions about why you are choosing not to drink.
The holidays are also filled with sugary treats and foods that are high in unhealthy fats. Too many sugary, processed, and fatty foods
(and drinks) are harmful and can contribute to liver diseases such as Non-Alcoholic Fatty Liver. When combined with hepatitis B, liver diseases can make your risk of liver damage and liver cancer even greater, so it is extremely important to maintain a balance of healthy foods and exercise. A few treats here and there will not harm you, but moderation is key! Try eating smaller portions of dessert and keep holiday sweets out of your house to avoid temptation. If you were gifted a delicious, but unhealthy snack, share it with friends and family!
If you are preparing a meal or a dish for your celebrations, make it a healthy one! The American Liver Foundation has a great fact sheet on how to read the nutrition label on food packing. This will help you make better choices while you are food shopping. Try using healthier alternatives to ingredients, such as butter, that may be high in cholesterol or fats, and experiment with using more spices instead of salt to add flavor to the meal.
Be sure to stay active during the holidays! Exercise is one of the best ways to maintain a healthy weight and reduce the risk of liver cancer. Grab a friend and take a walk or head to the gym. This is a great way to keep your fitness routine, encourage your friends to stay healthy, and catch up with those you haven’t seen in a while! If you don’t want to leave the comfort of your home or if you prefer to work out alone, you can also stay active by following along to exercise videos on Youtube.
Remember that everything that you consume is filtered through your liver; your liver never gets a break! The lifestyle tips listed above may seem simple, but they have a large, positive impact on your health. Sticking to a regular healthy routine even during the holiday season will make it easier to continue those habits all year long! You can also check out our healthy liver tips to see what other actions can be taken to protect your liver.
For decades, hepatitis delta, the dangerous coinfection of hepatitis B, was thought to only affect about 5-10% of the estimated 292 million people worldwide with chronic hepatitis B infections. With limited data and funding for research related to this complicated virus, true prevalence data, diagnostic tools and skilled physicians to manage hepatitis B and delta coinfection have remained limited until recent years. Publications in 2019 by Miao, et al., Chen, et al., Shen, et al., are helping to reveal a possibly more accurate picture of the burden of coinfection, conducting meta-analyses comprising data from hundreds of thousands of hepatitis B patients and the general population. While it was previously thought that 15-20 million coinfections existed globally, this new research has suggested there may be between 48-74 million1,2,3. Although these studies analyzed data that classified the presence of hepatitis delta antibodies, which can be present in cases of both past or current infection, there is a strong correlation between their presence and likelihood of an ongoing infection. These new studies may place coinfection at upwards of 10-15% of those with hepatitis B, with some of the hardest hit areas facing coinfection rates greater than 30%, in regions like Central Asia, Eastern Europe, Central Latin America and West and Central Africa1,2,3.
Understanding hepatitis delta is vital to helping to identify coinfected patients, who require altered treatment and management plans, and who may progress to cirrhosis and/or liver cancer in periods as little as 5-10 years. Diagnosis and management for hepatitis delta is still a challenge in much of the world, but in the US, it is becoming easier than ever before, with Quest Diagnostics, a commercial U.S. lab, rolling out a new HDV RNA test, a game-changer for physicians to easily order the test and manage patients. HDV RNA testing was previously available only through the Utah-based lab, ARUP, and Boston’s Cambridge Biomedical, but had to be specialty ordered. As testing continues to become more widely available and affordable, hepatitis B patients can more easily access testing. The more patients who are diagnosed, the more evidence for the urgent need for improved treatments to combat the virus, which is currently poorly controlled by the only available treatment; pegylated interferon.
Luckily, the virus has attracted the attention of nine pharmaceutical companies from around the world, with each working on a different approach to better controlling, or even curing hepatitis delta. Two of these companies, Eiger Biopharmaceuticals (US) and Myr Pharma (Germany) are now in Phase 3 clinical trials, where patients are flocking to enroll in these trials, which present new opportunities to receive treatments that may be more effective in controlling their coinfection. Eiger’s clinical trials will test their new drug, Lonafarnib, in clinical trial arms with and without pegylated interferon and/or ritonavir, with sites open in many countries throughout the world. Myr’s clinical trial will test their new drug, Myrcludex B, in similar triple-treatment combinations. Their clinical trial sites are now open in Russia, and the drug is already being prescribed for “compassionate use” in France. The United States Food and Drug Administration (FDA) has even taken notice; issuing guidance for industry on the development of hepatitis delta drugs for treatment in October 2019. This provides a valuable set of standards and expectations for clinical trials in regard to ethics, trial design, and patient needs.
Hepatitis delta coinfection has also received more attention this year at international hepatology conferences such as at the European Association for the Study of the Liver (EASL)’s International Liver Congress in Vienna, Austria, the International Liver Congress in American Association for the Study of the Liver (AASLD) meeting in Boston, and HEP DART in Hawaii. This year has brought many milestones for hepatitis delta data, diagnostics, and clinical trials. With continued scientific research and interest, Hepatitis Delta Connect hopes to continue to support these milestones and drive awareness efforts.
References:
1. Zhijiang Miao, Shaoshi Zhang, Xumin Ou, Shan Li, Zhongren Ma, Wenshi Wang, Maikel P Peppelenbosch, Jiaye Liu, Qiuwei Pan, Estimating the global prevalence, disease progression and clinical outcome of hepatitis delta virus infection, The Journal of Infectious Diseases, jiz633.
2. Chen H, Shen D, Ji D, et al. Prevalence and burden of hepatitis D virus infection in the global population: a systematic review and meta-analysis. Gut 2019;68:512-521.
3. Shen D, Ji D, Chen H, et al. Hepatitis D: not a rare disease anymore: global update for 2017–2018. Gut Published Online First: 09 April 2019.
As a blood-borne virus, it is extremely difficult to track exposure to hepatitis B unless you are aware of somebody’s hepatitis B status. Exposure to the virus can occur at work, through sexual intercourse, unsterile tattoo or drug equipment, or even medical procedures with equipment that was not properly sterilized. Precautions – such as vaccination – should always be taken to avoid a possible infection, but timely actions can also be taken to prevent an infection if an exposure does occur.
Post- Exposure Treatment
If you believe you were exposed to hepatitis B, Post-Exposure Prophylaxis (PEP) is the key to preventing the development of a hepatitis B infection. The first step is to seek medical care as soon as possible and let a healthcare professional know that you may have been exposed to hepatitis B. If you do not have a regular doctor or they cannot fit you in for an appointment, you can also visit a hospital’s emergency department or health care center.
Be sure to be honest with the healthcare professional about how you may have been exposed to hepatitis B, as this will help them to determine your exposure risk and the correct actions to take. PEP is typically given in the form of one dose of the hepatitis B vaccine, but in certain circumstances, the healthcare provider will give one dose of the vaccine in addition to a shot ofhepatitis B immune globulin (HBIG) to provide additional protection. Even if HBIG is unavailable, you should still receive the a dose of the hepatitis B vaccine
Both vaccinated and unvaccinated individuals can receive PEP. However, recommendations for PEP can differ based upon the exposure and whether or not a person has been fully vaccinated. If the source of exposure is known to be hepatitis B surface antigen-positive (HBsAg), the healthcare provider will take the following steps based upon your vaccination status:
Source of exposure is known to be HBsAg positive and individual is unvaccinated – HBIG and hepatitis B vaccine are given as soon as possible within a 24 hour window. Complete full vaccine series as recommended after PEP.
Source of exposure is HBsAg positive and individual is partially vaccinated (less than 3 doses or less than 2 doses of Heplisav-B) – receive HBIG. Complete vaccine series as recommended.
Source of exposure is HBsAg positive and individual has proof of a completed vaccinate series – one dose of hepatitis B vaccine booster is given.
If the source has an unknown hepatitis B status, the recommendations are as follows:
Source has unknown HBsAg and individual is unvaccinated – receive first dose of the hepatitis B vaccine as soon as possible within a 24 hour window.
Source has unknown HBsAg and individual is not fully vaccinated – complete vaccine series.
Source has unknown HBsAg and individual has proof of completed vaccination – no treatment is needed.
The most important part of PEP is the time between the exposure and treatment. PEP is most effective at preventing hepatitis B if it is given as soon as possible after the exposure. This means that the treatment should be given within 24 hours of exposure.
Pregnancy and PEP
PEP is safe and recommended for both pregnant and breastfeeding mothers who have been exposed to hepatitis B; the vaccine will not harm the baby. For pregnant women who are HBsAg positive, PEP must be administered to the newborn to prevent the baby from developing chronic hepatitis B! In this case, the doctor delivering the newborn should be aware of the mother’s hepatitis B infection so that they can have HBIG and the vaccine on hand during the birth. After the baby is born, one dose of HBIG and the first dose of the hepatitis B vaccine should be given to the newborn within 12 hours of delivery. It’s important to note that HBIG may not be available in all countries. In this case, it is even more important to make sure that babies receive the first dose of the hepatitis B vaccine within 24 hours of birth. The newborn should receive the remainder of the vaccine according to the vaccine schedule.
PEP for Healthcare Workers
It’s important to note that occupational procedures have a different set of guidelines, although the timeline and standard PEP treatment recommendations remain the same. Healthcare institutions should always have infection control guidelines and precautions in place to prevent an exposure, but accidents can still occur. All healthcare workers who are exposed to hepatitis B at work should follow the standard protocol for the post exposure process, as explained by the CDC guidelines. The workplace is also responsible for making sure that all employees have access to PEP and all other post-exposure procedure materials as soon as possible after the exposure.
After the 24 Hour Window and No Access to PEP
If you are unable to receive PEP within the recommended time frame, you should still visit a healthcare provider to receive treatment as soon as possible. The CDC estimates that treatment may be effective at preventing infection if given up to 7 days after the initial exposure, but not enough research has been done to confirm how effective PEP is if given after that timeline. The earlier PEP is received, the more likely it is to be effective.
The World Health Organization also recommends that standard first-aid be appliedimmediately to all cuts and wounds that may have been exposed to infected blood. The standard first aid includes 1) letting the wound bleed freely and; 2) washing the wound immediately with soap, gel, or hand-cleaning solution. Be sure to treat the wound gently, and to not use harsh solutions or soaps when cleaning the area. WHO also provides instructions on how properly cleanse eyes, the mouth, and unbroken skin after a potential exposure.
If you believe that you were exposed to hepatitis B and never received PEP, you should be tested to know your hepatitis B status. It takes up to 9 weeks for the hepatitis B virus to show in the bloodstream. Therefore, it is important to get tested for the hepatitis B 3 panel blood test(HBsAg, HBcAb, HBsAb) at least 9 weeks after the exposure to determine if you have been infected. If you remain uninfected after that time period and are HBsAb negative, the completion of the hepatitis B vaccine series is strongly recommended.
Each year, World AIDS Day is held on December 1st to raise awareness about HIV and AIDS. HIV/AIDS still remains a large problem, with nearly 40 million people living with the infection. Hepatitis B (HBV) remains a large issue as well, with 292 million people living with the chronic infection. Despite the inadequate amount of resources or attention that hepatitis B receives, it is important to talk about it whenever we discuss HIV/AIDS. Why? Any individual already living with hepatitis B or HIV can also contract the other infection. This is called a coinfection, and it can have serious consequences if not addressed. Let’s look at HIV/HBV coinfection by the numbers:
Globally, 10% of those living with HIV are also living hepatitis B
Courtesy of New England Journal of Medicine’s article titled: HIV–HBV Coinfection — A Global Challenge
Coinfection rates can beas high as 25% in countries where both infections are common
Up to 50% of injection drug users have an HBV/HIV coinfection
Chronic hepatitis B progression can be up to 5 times faster in coinfected individuals compared to those living with just hepatitis B
HIV vs Hep B: What’s the Difference?
HepatitisB is a viral infection of the liver that can increase one’s chances of liver disease and liver cancer. HIV is a virus that attacks the immune system and kills the cells that are needed to fight off disease and infection. Though they are two different viruses, they can be spread in similar fashions: direct contact with infected blood, via sexual transmission, injection drug use, and through mother to child transmission during childbirth. Hepatitis B is primarily spread through mother-to-child transmission, HIV is most commonly spread by unprotected sex. Among those living with a coinfection, sexual transmission and injection drug use are the most common modes of transmission. Because of the similar transmission routes, it is recommended that people living with HIV be tested for hepatitis B and hepatitis C and those living with hepatitis B should be tested for HIV.
Hepatitis B may be up to 100 times more infectious than HIV, but it also has a highly effective vaccine! Family members and sexual partners of people living with hepatitis B who have not been infected can protect themselves in just 2 or 3 doses. HIV does not have a vaccine, but people can take precautions to prevent transmission – like not sharing sharp personal items – such as razors, needles, or toothbrushes – and practicing safe sex (use a condom), or through HIV pre-exposure prophylaxis (PRep). Those precautions can also prevent the spread of hepatitis B. While HIV and hepatitis B do not have cures, they both have highly effective treatments. You can learn more about HIV and hepatitis B treatments by clicking the links.
HIV/HBV Coinfection
If you are living with hepatitis B, it is important to get tested for HIV as well. Coinfections are very serious, and can sometimes complicate treatment. Worldwide, HIV/HBV coinfection has become an increased priority because research has shown that conditions associated with hepatitis B and C are now among the leading causes of hospital admission and death in people living with HIV.
Left untreated and unmanaged, HIV/HBV coinfections can cause rapid progression of liver disease and liver damage, leading to serious complications at younger ages. There is also a higher risk of liver damage from anti-retroviral therapy (HIV treatment) in individuals living with hepatitis B than in those living with just HIV. Though some HIV treatments may also help treat hepatitisB, treatment options can vary based upon the person and the progression of the infections, so it is very important to discuss your options with your healthcare provider. Those living with hepatitis B, HIV, or HIV/HBV coinfection should always be closely monitored by a knowledgeable doctor.
Living with a coinfection can be scary, but with proper management and care, you can lead a healthy life! Check out this videofrom Jason – one of our #justB storytellers – on successfully living with an HIV/HBV coinfection, and how he has learned to overcome challenges.
