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Tag Archives: HBV

Hepatitis is Still the Silent Killer

August 4, 2014 hepbtalk

Great way to wrap up World Hepatitis Day events with a commentary from our viral hepatitis champions on Capitol Hill. A big thank you to Senator Mazie K. Hirono and Representatives, Michael M. Honda, Hank Johnson, and Bill Cassidy for their tireless efforts. Viral Hepatitis is a problem we cannot ignore!

Roll Call (online) By Sen. Mazie K. Hirono, and Reps. Michael M. Honda, Hank Johnson, and Bill Cassidy. July 31, 2014, 5 a.m.

Although the price of a revolutionary new hepatitis C treatment has made headlines recently, the real hepatitis crisis continues largely unreported. A more immediate problem for many Americans is not how much one hepatitis C treatment might cost; it is how many Americans are infected with viral hepatitis and do not even know it.

World Hepatitis Day, July 28, reminds us that more than 5 million Americans — or 2 percent of the population — are living with viral hepatitis. Yet the Centers for Disease Control and Prevention (CDC) estimates as many as 75 percent of these Americans are unaware they have the virus. This “silent killer” goes undetected because the virus often remains asymptomatic until it has already wreaked havoc on the liver, causing cirrhosis, end-stage liver disease, or liver cancer. According to the CDC, more than 30 percent of infected individuals will develop one of these conditions.

Meanwhile, since the majority of infected individuals don’t realize they have hepatitis, they do not take the necessary precautions and can unknowingly transmit the virus to others. More Americans die every year from hepatitis C than HIV.

Without effective intervention, it is estimated that deaths due to the hepatitis C virus will double, or even triple, in the next 20 years. Baby boomers — Americans born between 1945 and 1965 — make up 75 percent of Americans with hepatitis C, and are five times more likely to have the virus than the general population.

Hepatitis disproportionately affects communities of color. One in 12 Asian-Americans has chronic hepatitis B, and rates are increasing in African immigrant and Latino populations as well. Hepatitis C is twice as prevalent in African-Americans as in the general U.S. population. Despite the pervasiveness of viral hepatitis, and its potentially deleterious consequences for those infected, testing is not nearly as prevalent as it should be.

The Viral Hepatitis Testing Act, introduced both in the House of Representatives and the Senate, would create the first coordinated national system to address and combat viral hepatitis. It would expand hepatitis education, testing and care, with the priority of reaching those most at-risk. Most importantly, the legislation would help to halt the spread of viral hepatitis by strengthening health care coordination to ensure that patients who test positive are connected with the counseling they need to control their disease and prevent transmission. Through the Viral Hepatitis Testing Act, we can increase the number of individuals who are aware of their status from 25 percent to 75 percent in just two years.

Awareness is the antidote to this silent epidemic. Early diagnosis, determined through a simple blood test, can reduce the spread of viral hepatitis simply by making individuals aware of the infection and helping to connect them with education about the risks of transmission. Organizing our outreach and prevention to be culturally competent and available in different languages will help us reach those communities that are disproportionately affected. The CDC estimates that one-time testing of baby boomers alone would identify 800,000 undiagnosed hepatitis C cases nationwide, and prevent more than 120,000 deaths. We need action at the federal level to make viral hepatitis testing a national priority.

The true cost of viral hepatitis is not measured in the cost of one drug. It is how this epidemic will continue to grow if policymakers do nothing. We urge our fellow lawmakers to enact the Viral Hepatitis Testing Act and establish hepatitis awareness as a national priority.

We cannot ignore this problem.

Mazie Hirono is a Democratic United States Senator from Hawaii. Michael M. Honda is a seven-term Democratic congressman representing the 17th District of California, better known as Silicon Valley. Hank Johnson is five-term Democratic Congressman representing Georgia’s 4th District in the suburbs of Atlanta. Dr. Bill Cassidy is a three-term Republican Congressman representing the 6th District of Louisiana, including Baton Rouge and Houma.

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The Public Health Popularity Contest: Why You’ve Never Heard of Hepatitis B

July 30, 2014 hepbtalk 4 Comments

Please welcome guest blogger Charlotte Lee, a pre-med Duke University Senior who has a passion for global health. Charlotte recently learned first hand how viral hepatitis disproportionately impacts her community and how it tragically touched her own family.

I walked into the first day of my internship ready to take on what I thought were the major public health crises of the world – malaria, AIDS, avian flu. Instead, my supervisor gave me a hefty stack of literature on hepatitis B. Sure, as a premed student I knew that hepatitis had something to do with the liver, but I was shocked to find out that hepatitis B was the most common serious liver infection in the world—one that chronically affects over 350 million people worldwide, including 1 in 12 Asian Americans—and I had never heard of it.

As a 21-year old Asian American who is passionate about global health, I felt cheated to only now discover that there is an infectious disease disproportionately affecting my community. Somebody should have told me about this! To then find out that it was completely vaccine-preventable – somebody should have told everyone about this!

About halfway through my internship, I found out that my grandfather died from viral hepatitis that he contracted through a blood transfusion. Suddenly the disease had a face, and it was a smiling man with wide rimmed glasses who used to sit me on his lap and feed me popcorn. It now feels like my duty to spread the word.

Hepatitis B is transmitted through blood or body fluids and causes deadly liver disease, including liver cancer, in 1 out of every 4 chronically infected people. Meanwhile, the famous West Nile Virus causes serious illness in less than 1% of infected people.

So, what makes this disease so easy to ignore? Hepatitis B is unfortunately an invisible disease; it can take up to 20-30 years before symptoms appear, at which time cirrhosis or liver cancer may have already developed. Hepatitis B is a silent killer and it affects a population invisible to the media and policy. Anyone can get hepatitis B; however, people born in countries outside the US that have not instituted a strong hepatitis B testing and vaccine program have a large population (2 out of 3 people) who are unaware they are infected. Most get the disease at birth from their mothers who are chronically infected with hepatitis B. Many are impoverished and disenfranchised. Asian Americans make up more than half of hepatitis B cases in the US, but those from many other countries around the world are also at risk for having the disease.

However, the “it won’t happen to me, so I don’t care” rule doesn’t work for all diseases. Most people in the US don’t consider themselves at risk for AIDS, malaria, or tuberculosis, yet those diseases have plenty of name recognition.

One thing that AIDS, malaria, and tuberculosis all have in common is their deadliness. AIDS killed 1.47 million people in 2010. But did you know that viral hepatitis (hepatitis B & C combined) killed 1.44 million that same year?

Its symptomless nature also makes it hard to visualize. While other diseases invoke graphic images of illness, hepatitis devastates the liver. Most people probably don’t really know where their liver is located.

What frustrates me most is that it is a preventable disease, one that we can eradicate. The hepatitis B vaccine is one of the safest and most effective immunizations available, and it protects you for life. The CDC recommends all babies receive the vaccination at birth, yet many major hospitals in NYC are not immunizing newborns, with some vaccination rates as low as 20%.

Hepatitis B needs public health champions to get it into the spotlight. Policies need to be passed to fund much-needed education, surveillance, and treatment programs. Doctors should be educated about it, tests should be automatically ordered, and the government should pay for everyone to be vaccinated. This system doesn’t yet exist, but thankfully there are people working tirelessly towards it.

Monday was World Hepatitis Day 2014. This year, the Viral Hepatitis Testing Act was introduced in the House and Senate to provide $80 million over three years for prevention, testing, and linkage to care. This is the second term this bill has been introduced, and now it’s time to pass it. Locally, the New York City Council just introduced a $750K viral hepatitis initiative for 2015. And just last week, Councilwoman Margaret Chin was on NBC talking about the first ever NYC Hepatitis B Awareness Week. My internship will soon end, but advocacy never rests. There is always more to be done.

Charlotte Lee is a premed Duke University senior, where she studies Public Policy with minors in Global Health and Chemistry. This summer, she has been working on hepatitis B policy issues at the Charles B. Wang Community Health Center in New York City, where she was co-coordinator of the first-ever NYC Hepatitis B Awareness Week. She is passionate about health disparities and aspires to be an OB/GYN and women’s health advocate. Her biggest claim to fame is that she may have discovered a new species of sand fly last summer in the Peruvian Amazon (confirmation still pending).

Living with Hepatitis B

Cambodian Orphan Finds New Life in Minnesota

July 23, 2014 hepbtalk

A lovely story and a happy ending for a young Cambodian orphan with hepatitis B.

By MATTHEW STOLLE, Post-Bulletin Posted July 19

When Chung Eang Lip was 7, his father took him to the market in Phnom Penh, Cambodia, and abandoned him.

For three days, Lip wandered the city’s streets, hungry and calling for his mother. Lip’s last memory from the ordeal was waking up and seeing his mom hovering over him.

“I was really sick. I didn’t have anything to eat for those three days. I only remember that when I opened my eyes, I saw my mom and that’s all,” said Lip, whose mom took him back to their rural home.

By 13, both of Lip’s parents were dead, and he was largely on his own, living with an older brother. What most people regard as normal family life — or what passed for it in Lip’s life — was largely a thing of the past.

Or so he thought.

Nucleoside Analogues’ Benefits in HBV Vary

July 7, 2014 hepbtalk

This informative article from Internal Medicine News, July 1, 2014, analyzes two studies from the July issue of Gastroenterology, and looks at the impact of antivirals on the incidence of liver cancer, the need for liver transplantation and the risk of death in chronic HBV patients. The potency of the antiviral made a significant difference and supported current practice guidelines recommending the use of entecavir and tenofovir as first line drugs for the treatment of chronic HBV. Be sure to also read the accompanying editorial by Dr. George Papatheodoridis.

Internal Medicine News Digital Network, July 1, 2014, article written by DENISE NAPOLI.

Nucleoside analogues are effective at preventing hepatocellular carcinoma in hepatitis B, but all are not equal when it comes to overall mortality and liver transplant, according to two new studies in the July issue of Gastroenterology.

In the first study, Dr. Chun-Ying Wu of the National Yang-Ming University, in Taipei, Taiwan, and his colleagues examined the long-term protective effects of nucleoside analogue therapy among chronic hepatitis B patients (doi.org/10.1053/j.gastro.2014.03.048).

They conducted a retrospective nationwide cohort study using data from Taiwan’s National Health Insurance Research Database, collecting records from 1997 through 2010 on patients with chronic hepatitis B.

Click here to read Internal Medicine News article and editorial in its entirety.

Hepatitis B Treatment, Liver Cancer

HBV Journal Review – July 2014

June 30, 2014 hepbtalk

HBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the  latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

Ground-Breaking Study Finds Antiviral Treatment Does Reduce Cancer Risk
Sequential Treatment of Antivirals Followed by Interferon Spurs HBeAg Seroconversio
Is the Current Recommended Dose of Entecavir Too Low for Some Patients?
Measuring Liver Stiffness, Spleen Size and Platelets Can Predict Cancer Risk
Tenofovir Effective in Patients with Lamivudine Resistance
Entecavir and Adefovir Combo Works Best in Lamivudine-Resistant Patients
When Is It Safe to Stop Antivirals? Experts Still Not Sure
Liver Stiffness Test Identifies Which Patients Develop Liver Damage After Treatment Stops
Study Suggest Hepatitis B Immunization Could Cut Diabetes Risk by Half
Herbal Medication Treatment Linked to Liver Failure in Patient with Hepatitis B

HBV Journal Review

July 1, 2014
Volume 11, Issue 7
by Christine M. Kukka

Ground-Breaking Study Finds Antiviral Treatment Does Reduce Cancer Risk

For the first time, an authoritative study has found that antiviral treatment appears to reduce the risk of hepatitis B virus (HBV)-related liver cancer. Even though treated patients had more liver damage, their cancer rates were similar to untreated, healthier patients.

Researchers from the U.S. Centers for Disease Control and Prevention examined the health records of 2,671 hepatitis B patients treated at four health centers across the U.S. between 1992 and 2011. Half of the patients were Asian-American and about 31% (820) had been treated with antivirals. The treated patients tended to have more liver damage, were older, male and less likely to be Asian-American than untreated patients in the study.

Researchers, reporting in the June issue of the journal ofClinical Gastroenterology and Hepatology, found that 67 (3%) of the 2,671 patients developed liver cancer over the study period. Twenty of the 820 patients treated with antivirals developed cancer, compared to 47 of the 1,851 untreated patients.

Treated patients with viral loads less than 20,000 IU/mL had a significantly lower risk of cancer than untreated patients with similarly low viral loads.

Antivirals appeared to confer some protection against liver cancer even in patients with fibrosis (liver inflammation) and cirrhosis (liver scarring), suggesting that viral loads may be the primary culprit behind liver cancer. By suppressing viral load, liver cancer was avoided in many of these high-risk patients with serious liver damage.

Researchers wrote, “…We found that antiviral treatment had a beneficial effect across a spectrum of viral load levels (and disease severity.)”

Source: www.ncbi.nlm.nih.gov/pubmed/24107395

Sequential Treatment of Antivirals Followed by Interferon Spurs HBeAg Seroconversion
Chinese researchers found that hepatitis B “e” antigen (HBeAg)-positive patients who were treated first with the antiviral entecavir (Baraclude) and then with pegylated interferon achieve a higher rate of HBeAg seroconversion (loss of HBeAg and development of “e” antibodies) than patients treated with only entecavir.

Continue reading the HBV Journal Review…

Hepatitis B Treatment, Liver Cancer

Antiviral Therapy May Lower Risk of Liver Cancer – MedicalResearch.com Interview with Dr. Stuart Gordon MD

June 16, 2014 hepbtalk

Thank you MedicalResearch.com for this interview and insights by Dr. Stuart Gordon, MD, Gastroenterologist, Henry Ford Hospital, Detroit, MI.

MedicalResearch: What are the main findings of the study?

Dr. Gordon: In a large American cohort of Hepatitis B patients, those who took antiviral therapy had a significantly lower risk of developing liver cancer than those who did not take such therapy.

MedicalResearch: Were any of the findings unexpected?

Dr. Gordon: Similar findings have been noted in other parts of the world, but not in american populations. In addition, this report showed that the protective effect of antiviral therapy (against developing primary liver cancer) was found not just among patients with cirrhosis, who are at greatest risk, but also among those with lesser degrees of liver fibrosis. This finding was rather unique.

MedicalResearch: What should clinicians and patients take away from your report?

Click to read interview in its entirety

Hepatitis B Treatment, Liver Cancer, Living with Hepatitis B

Antiviral Therapy May Prevent Liver Cancer in Hepatitis B patients

June 10, 2014 hepbtalk

Useful confirmation of what we already thought was true. Good news…

(HealthNewsDigest.com) – DETROIT, June 9, 2014 —

Researchers have found that antiviral therapy may be successful in preventing hepatitis B virus from developing into the most common form of liver cancer, hepatocellular carcinoma (HCC).

That was the finding of a study published in the May issue of Clinical Gastroenterology and Hepatology. Investigators from Henry Ford Health System in Detroit, Geisinger Health System in Danville, Pa., and Kaiser Permanente in Honolulu, Hawaii and Portland, Ore. participated in the study, along with investigators from the Centers for Disease Control and Prevention in Atlanta.

According to the first-of-its-kind analysis of more than 2,600 adult participants with hepatitis B, those treated with antiviral therapy had a significantly lower occurrence of HCC during a five-year follow up period. Overall, 3 percent of patients developed HCC during the study’s timeframe. But patients who received antiviral therapy were 60 percent less likely to develop HCC than untreated patients.

“The results of this study allow us to reassure our patients that we are not just treating their viral levels, but that antiviral therapy may actually lessen their chance of developing liver cancer,” said the study’s lead investigator, Henry Ford Health System’s Stuart C. Gordon, M.D., who worked closely with Henry Ford Senior Scientist Mei Lu in Detroit. Continue reading here.

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HBV Journal Review – June 2014

June 3, 2014 hepbtalk

HBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the  latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

Belatedly, National Panel Recommends Screening At-Risk Patients for Hepatitis B
Genotypes and Mutations Define the Course of Hepatitis B Infection
Older Patients Who Lose HBeAg After Treatment May Relapse
Tenofovir Proves Ineffective in Patient with Multiple Drug Resistance
Nearly All HBeAg-Negative Patients Relapse After Antiviral Treatment Stops
Studies Find Hepatitis Infection Does Not Increase Pancreatic Cancer Risk
Screening Pregnant Women for High Viral Loads Is Cost Effective
Hepatitis B Appears to Impede Fertility
Despite Low Viral Load, Infected People Can Still Infect Family Members
Good News: HBV Infection Rates Lower Than Expected Among Korean-Americans
Green Tea May Be an Effective Antiviral

HBV Journal Review

June 1, 2014
Volume 11, Issue 6
by Christine M. Kukka

Belatedly, National Panel Recommends Screening At-Risk Patients for Hepatitis B

Ten years after it recommended against screening the “general population” for hepatitis B, an independent national task force that creates prevention guidelines for primary care providers has finally recognized that certain high risk groups in the U.S. should be screened for hepatitis B.

Their recommendations, recently published in the Annals of Internal Medicine, come after numerous studies faulted primary care providers for failing to screen patients for hepatitis B and missing opportunities to treat patients for liver disease and immunize family members against hepatitis B virus (HBV) infections.

Other health care organizations, including the U.S. Centers for Disease Control and Prevention (CDC), the Institute of Medicine, and the American Association for the Study of Liver Disease, have been recommending for years that primary care doctors screen high-risk patients for hepatitis B, which has infected up to 2.2 million Americans.

The U.S. Preventive Services Task Force (USPSTF) recently issued clinical guidelines recommending that doctors screen the following patients for hepatitis B:

People from countries that have hepatitis B rates exceeding 2% (which includes Asia, Africa, Central Europe and parts of Central and South America).
U.S.-born people whose parents immigrated from countries with high rates of HBV infection.
HIV-positive people, injecting drug users, men who have sex with men, and
Household contacts of people infected with HBV.

The task force’s guidelines suggest that because an effective vaccine to protect against the infection and effective treatments for hepatitis B are now available, they decided to issue these recommendations. However, both the vaccine and effective treatments have been available for more than a decade.

“In the 2004 recommendation, the USPSTF focused only on the general population,” the authors wrote in the recommendations. “In the current recommendation, the USPSTF focused on high-risk populations as it considered new evidence on the benefits and harms of antiviral treatment, the benefits of education or behavior change counseling, and the association between improvements in intermediate and clinical outcomes after antiviral treatment.” The task force noted that it, “…found inadequate evidence that education or behavior change counseling reduces disease transmission.”

Source: www.uspreventiveservicestaskforce.org/uspstf/
uspshepb.htm

Genotypes and Mutations Define the Course of Hepatitis B Infection
Researchers are increasingly finding that HBV genotypes or strains—and the mutations that they generate—can determine the severity of a patient’s infection.

Each of the world’s 10 genotypes and their mutations have different characteristics that can increase risk of cirrhosis and liver cancer, determine whether an infection becomes chronic, and basically determine a patient’s destiny, according to a recent study, published in the May issue of the World Journal of Hepatology …

Continue reading the HBV Journal Review…

Hepatitis B Diagnosis & Monitoring

New USPSTF Recommendation on Hepatitis B Screening for People at High-Risk

May 28, 2014 hepbtalk

Truly historic news! Those living with chronic hepatitis B will be identified sooner and learn more about their HBV infection. They can live full lives by improving their health through regular monitoring, treatment when necessary, and adopting healthy lifestyles that benefit the liver. Symptoms may not occur for decades so many are completely unaware of their infection. If you believe you are at risk, please talk to your doctor about being screened for hepatitis B.

By Ronald Valdiserri, M.D., M.P.H., Deputy Assistant Secretary for Health, Infectious Diseases, and Director, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services

On Monday, May 26th, the U.S. Preventive Services Task Force (Task Force) published its final recommendation statement on screening for hepatitis B virus (HBV) infection in individuals at high risk. This recommendation includes adults and adolescents who are not pregnant and who have not been vaccinated, as well as other individuals at high risk for infection.

Click here to better Understand the details of the Task Force Recommendations.

After reviewing the evidence, the Task Force recommends screening people who have the following risk factors for HBV infection:

People born in countries and regions with a high prevalence of HBV infection, such as Africa, Southeast Asia, Pacific Islands, China, Middle East, Eastern Europe, and the northern countries in South America;
U.S.-born persons not vaccinated as infants whose parents were born in countries or regions with a high prevalence of HBV infection;
HIV-positive people, injection drug users, men who have sex with men, and those living with or having sex with someone with HBV infection; or
Patients with weakened immune systems or undergoing treatment for kidney failure (hemodialysis).

There are still as many as 2.2 million people in the United States chronically infected with hepatitis B and 15 to 25 percent of those individuals die from liver disease including liver cancer. “Screening can identify people who have chronic HBV infection, and the good news is that treatment can help prevent liver cancer in these people,” says Task Force member Dr. Douglas K. Owens of Stanford University.

The Task Force’s final recommendation statement has been published online in Annals of Internal Medicine , as well as on the Task Force Web site . A fact sheet [PDF 151KB] explains the recommendation statement in plain language.

“The Task Force’s new Grade B recommendation in favor of HBV screening for persons at high risk for infection – people who are more likely to get infected or to pass on the infection – provides us with another important tool to use as we pursue the goals of the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis,” observed Ms. Corinna Dan, Viral Hepatitis Policy Advisor at the HHS Office of HIV/AIDS and Infectious Disease Policy. “In the weeks and months ahead, federal and nonfederal stakeholders alike will incorporate this recommendation into efforts detailed in the Action Plan to improve viral hepatitis testing, care and treatment to prevent liver disease and cancer.”

See more at:

Hepatitis B Advocacy

Operation Storm Philadelphia City Council : The Aftermath

May 14, 2014 hepbtalk 1 Comment

Hepatitis B Foundation Intern and Guest Blogger Limi Lo shares her personal reflection of last week’s advocacy event when hepatitis B partners and advocates stormed Philadelphia City Council

A few months ago, I was sitting in my public policy class learning about advocacy. In simple English, it means, “to fight for a cause that you believe in.” As much as I understood what it meant, I never thought I would take part in a real advocacy event until I attended the City Council resolution presentation on May 8th, 2014. The event was held at the Philadelphia City Council during a city council session, and included supporters from Hep B United Philadelphia (lead by the Hepatitis B Foundation), HepCAP, and Philadelphia County Medical Society. Together, supporters came out and advocated for better viral hepatitis care in the greater Philadelphia area. City Councilman David Oh had introduced a resolution declaring May as Hepatitis Awareness Month and calls for all high-risk Philadelphians to receive appropriate testing and proper care for viral hepatitis.

The event not only provided me with a valuable learning experience, but more importantly, it was a life changing experience. I was able to witness community partners, students, professors, and other advocates coming together to help raise awareness and fight for a substantial cause (to improve hepatitis care). There were dozens of posters held high and being displayed: “Be proactive, get tested today”, “know more hepatitis”, and “Give hope to your family”. These messages were inspirational in addressing the need for city leaders to pay greater attention for the silent epidemic of viral hepatitis. Throughout the event, the atmosphere was filled with positive energy and a sense of hope was tangibly present—a hope that, in Philadelphia, all high-risk individuals can access screening tests, vaccines, and care for viral hepatitis.

Since beginning my practicum with the Hepatitis B Foundation, I’ve gained a variety of hands-on experience to raise community awareness, such as through screening events, providing linkage to care and now, participating in public health advocacy. I am grateful to be working with passionate and motivated individuals that want to make a difference in their community. Although, there is still much work to get done in improving the care for viral hepatitis, I can already feel the positive impact we are making as a community. The City Council event was a major stepping stone in advocating the cause at a local level and it was a huge success. I know in the near future, more and more people will become aware of the hepatitis issue and attention will be brought up to the federal and state level. But until then, let’s all be heroes and help save lives through advocacy.

Baruch S. Blumberg Institute