Hep B Blog

World Hepatitis Day 2012 in Cairns, Queensland, Australia

WHD 2012 Cairns: Hep Day Out friends - Yvonne, Rhondda, Murph & Allana

A personal reflection on WHD events from Guest Blogger Yvonne Drazic

WHD was again promoted and celebrated in style in Cairns with lots of dedicated people making it a great success. The key organizers were Rhondda, the Viral Hepatitis Health Practitioner from the Cairns Sexual Health Service, and Alanna and Julie from the Queensland Injectors’ Health Network (QuIHN). At present, the bulk of hepatitis B health promotion and patient support is done through these organizations as part of hepatitis C and HIV services because sufficient separate government funding for hepatitis B is not yet forthcoming.

Last year, Rhondda organized a fabulous free lecture about hepatitis B which, while aimed at health care professionals and medical staff, was open to the public and especially to people affected by or living with hepatitis B. The speaker was Dr. Benjamin Cowie, an infectious diseases physician from Melbourne with a special interest in hepatitis B. His passionate and compelling presentation evoked great feedback from the audience, many stating it was a real eye-opener. This year’s lecture was presented by Dr. Joshua Davis who spoke equally engaging about his efforts to address hepatitis B in Indigenous communities in the Northern Territory. The talk attracted an audience of more than 100 people. As an add-on to the lecture, Aboriginal and Torres Straits Islander health workers could move on to an event/workshop called Yarnin up HepB where they were able to discuss anything hepB – and get expert advice – from Dr. Davis. This was very well received although many participants were quite disturbed about the statistics of hep B in Aboriginal and Torres Strait Islander people.

This year the open day at Cairns Sexual Health Service was called “Hep Day Out”. It was designed to be fun with funky, colourful posters (created by the talented Murph) and a music jam session. Like last year, the day featured tours of the premises with screening opportunities, as well as the famous QuIHN van offering information, a scrumptious lunch and fun activities. Every visitor who took the tour and completed a short quiz received a cool t-shirt courtesy of Hepatitis Queensland (see photos) and a health pack. In addition, the resident psychologist was on site for people who wanted a chat and I was available for brain-picking for everyone who wanted to know more about hepatitis B. Invitations were distributed to migrant services and communities but unfortunately did not attract any visitors from these groups. Possibly the time was unsuitable due to work commitments but it could also be due to fear of stigmatization which may be increased in these populations. I am currently conducting research to explore barriers and other issues that may keep people from engaging in health-protective actions such as screening and monitoring. It will also help to find more effective ways of engaging with migrant communities and get a better turnout for next year’s WHD.

Overall, plenty of awareness was raised, many people were educated about viral hepatitis, and a fun time was had by all.

Dreams on Hold – A personal story of an aspiring medical student

The summer before starting medical school, most of my friends traveled and had fun. But I could not.

The months of June and July marked 60 days of complete horror—the lowest point in my life. First, my sister suffered 
a near-death medical complication. Then, for the first time in my life, I experienced discrimination due to an unexpected medical diagnosis.

My discrimination story started on June 20, 2011. The director of admissions at (X) Medical School notified me that
I had been accepted into their program and offered a generous scholarship to attend. Because of this scholarship and the potential to obtain in-state residence, I dropped the other medical school I had been considering, including a $2,500 enrollment deposit.

I began the grueling paperwork to matriculate to (X) Medical School. It took nearly a week to schedule doctor appointments, fill out health forms, get required blood work done, look for apartments, and apply for financial aid. The following week, I traveled across the country to finalize an apartment lease. I returned home less than 24 hours later, exhausted but having successfully signed a lease.

Then my doctor called and said, “You have hepatitis B.” The nightmare began after that call.

The next day, (X) Medical School’s Student Health Services demanded that I have further blood tests within three days; otherwise, their committee would not be able to review my file before the start of classes.

I completed all of the tests, and the results were sent to the committee within a week. I pleaded with the committee 
to keep me enrolled, and I even agreed
 to drop out of medical school if the antivirals did not work.

The response from (X) Medical School came one week before orientation started: I was deferred until next year.
 In addition, my scholarship was revoked. They demanded that I sign a contract accepting deferment with conditions, including no guarantee of readmission and I had to sign within a week of receiving this devastating news.

At that moment I had to juggle not only my new medical diagnosis, but also the fact that I had a lease that could not be cancelled or sublet, a full year without any plans, and uncertainties about my future.

The nightmare still lingers. However, 
I am slowly getting back on my feet. The antivirals are lowering my viral load. I am working in public health and reapplying to medical schools. My future is still uncertain.

Note: This story is one of the four cases that galvanized the Hepatitis B Foundation into action. At a June 2011 meeting convened by the CDC, the HBF and other national thought leaders worked with the CDC to update their 1991 hepatitis B recommendations for health care workers and students, which were just updated, July 2012. It is hoped that the newly Updated CDC Recommendations for the Management of Hepatitis B virus- Infected Health Care Providers and Students  guidelines and advocacy efforts of HBF and others will make a dent in hepatitis B based discrimination.  Please note that these newly revised guidelines strongly state that hepatitis B is not a condition that should prevent anyone from entering or practicing in health care.

World Hepatitis Day Reflection: Asian Institute of Medical Sciences, Hyderabad Pakistan

Thank you to Prof., Dr. Muhammad Sadik Memon, MBBS, FCPS (Gastro), FCPS (Med), MACP, MAGA,  for his personal reflection from World Hepatitis Day, 2012 events in Pakistan.

In order to raise awareness on World Hepatitis  Day, Saturday, 28th of July 2012, the Department of Gastroenterology and Hepatology of the Asian Institute Of Medical Sciences, organized a public awareness and open discussion seminar.

Gastroenterologists, family physicians, GPs, postgraduate students and para- medical staff all participated in the open discussion.

The program was started in the name of “Almighty Allah” and a recitation from the Holy Quran.

Dr Iqbal Haroon, Director of Hajiyani Hospital, was the moderator of the open discussion.

“It  is closer than you think” was the theme of this year’s World Hepatitis Day, and the open discussion focused on raising awareness on the different forms of viral  hepatitis: what they are, how they are transmitted, who is at risk, and the various methods of prevention and treatment.

Professor, Dr. Sadik  Memon, organizer of this event,  said that in Pakistan, many patients have lost their lives at the hands of quacks, so Pakistan needs the strictest possible laws to fight against these quacks, and must eradicate these deadly liver diseases.

Dr. Sadik Memon further described how in Pakistan millions of people are infected with HBV . He added that every 10th to 12th individual in the Pakistani population is infected with hepatitis B or C ,which far exceeds the numbers from the last big earthquake  in Pakistan. It is essential that Pakistani doctors unite to save human lives and spare them of these deadly diseases.

The most important aspects of prevention are hepatitis B vaccination, the screening of blood products, sterilized equipments and better hygiene standards in barber shops.

Dr. Waqar, focal person of the Government Hepatitis Program, discussed the efforts of the Sindh government regarding the hepatitis program.  He said that thousands of peoples from Sindh are receiving free interferon and anti- viral therapy from Zakat and Bait-ul-mal funds.

Before the end of open discussion Dr. Aamir Ghouri gave thanks to the audience, the guests of honor, and also the Roche Pharmaceutical company for sponsoring such a wonderful event in this blessed Month of Razman.

After completing the open discussion, DUA, (prayer) was performed for patients who are suffering from liver diseases by the Asian  Institute of Medical Sciences staff. Another open discussion was followed by Iftaar dinner. It was a memorable World Hepatitis Day.

Diagnosed With Hepatitis B? Symptoms? Learning the HBV Basics

The tricky part about hepatitis B symptoms is that there are often no symptoms. That is why hepatitis B is referred to as a “silent infection”. This can be a little confusing to people newly diagnosed with HBV – whether it is determined you have an acute or chronic infection.

If you have a new, acute infection, there is a good chance you will be one of the roughly 69% with no notable symptoms. You may feel a little under-the-weather or a little more tired then usual, or you may notice no difference at all. You may learn about your infection through blood work following a possible exposure, or following screening from a blood donation. Since 90% of adults infected with hepatitis B will clear the infection – most with no medical intervention, it is possible for you to be infected, clear the virus, and never even know until blood work shows evidence of a past infection.

Then again you may be one of the roughly 30% who do have symptoms. You may experience flu-like symptoms such as achy muscles and joints, a low-grade fever and fatigue. Because your liver plays a role in digestion, you may experience a loss of appetite, feel a little nauseous, or experience pain in the upper right quadrant of your abdomen. You may have dark, tea colored urine. Then again, these symptoms may not be so severe that you take much notice. It’s okay, because these symptoms typically do not require treatment. However, if you are symptomatic, or you are concerned, please see your doctor, and he will run blood tests to be sure your liver is safe.

Here are the important symptoms that you need to have checked-out immediately: jaundice, severe nausea and vomiting, and bloating or swelling of the abdomen. If you have any of these symptoms, you need to seek immediate medical attention. Your doctor will want to run lab work, which will likely need to be repeated while you are symptomatic and as you recover, to monitor your condition and be sure you are safe. At this time, your doctor will determine the next steps –perhaps you will need to be admitted to the hospital for fluids and observation if you are severely dehydrated, or more likely, you’ll recover at home with regular lab work and follow-up with your doctor.

If you notice that your skin or the whites of your eyes are yellow, then you are suffering from jaundice. This is due to a build-up of bilirubin in the blood and tissues. Your liver is an amazing organ and one of its responsibilities is the filtering out of your body’s bi-products or other toxins from your blood, maintaining them at healthy levels. Jaundice is very unsettling to those that have it because it is noticeable by others. Normal coloring will return once the body is able to rid itself of the buildup of these toxins.

Although rare, (approximately 1%) acute hepatitis B can result in life-threatening, fulminant hepatitis, which can lead to liver failure. Fulminant hepatitis requires immediate medical attention.

The other possibility is that you are actually chronically infected, and that your infection is not new. You may have been living with HBV since birth or early childhood. Your hepatitis B infection may be a complete surprise to you.  You might ask, “How could I have this infection all of these years and not even know it?” Once again, HBV is a silent infection.  For those chronically infected, obvious symptoms may not occur for decades. The liver is a hard-working, non-complaining organ, but you don’t want to ignore your HBV and put yourself at increased risk for cirrhosis, liver failure or liver cancer. Believe it or not, the sooner you learn about your HBV infection, the better, so that you get regular monitoring, seek treatment if necessary, and make lifestyle changes that are good for your liver and overall health.

Whether you have symptoms or not, there are a few things you need to remember. You must go back to your doctor for further lab work to determine if your HBV infection is acute or chronic. If you are still surface antigen positive (HBsAg+) after 6 months, then you have a chronic infection and need to see a liver specialist to learn more about your hepatitis B infection. The other thing you must do is take precautions so you do not transmit hepatitis B to sexual partners and close household contacts.  And finally, be sure to take care of your liver by eating a well-balanced diet, avoiding alcohol, and talk to your doctor or pharmacist about prescriptions or OTC drugs that may be hard on your liver.

Dr. Tom London – Hepatitis B and Liver Cancer

Hep B Talk is pleased to introduce Guest Blogger W.Thomas London, MD. Dr. London is internationally renowned for his many decades of work on hepatitis B and liver cancer, which started with his joining the research team  that discovered the hepatitis B virus. Dr. London has been at the forefront of liver cancer prevention and has written extensively about hepatitis B from the perspective of an epidemiologist, a clinician and a virologist. As founder and director of the Liver Cancer Disease Prevention Division at Fox Chase Cancer Center in Philadelphia, PA, he  developed one of the first successful community-based strategies to help people reduce their cancer risk through the early detection of chronic HBV infection. Dr. London has received the Distinguished Interdisciplinary Research Award  from the American Cancer Society and the Distinguished Scientist Award from the Hepatitis B Foundation where he currently serves as Vice-Chair of the Board and as the Senior Medical Advisor.  

Liver cancer, hepatocellular carcinoma (HCC), is the 3rd most common cause of death in the world.  Little attention was paid to HCC in the United States until recently because it was thought to be rare, but now it is one of the few cancer types that is rising in incidence (number of new cases per year). It is now the most rapidly increasing cancer in men in the US. The prognosis of HCC is poor; one year survival in the United States from the time of diagnosis is only 50%.  Detection of tumors when they are very small, less than 2 cm in diameter, and can be removed surgically is the best chance for cure.  Liver transplantation is often done if there is more than 1 tumor and the cancers are less than 3 cm in diameter.  Unfortunately, most HCCs are diagnosed when they are too large for successful surgical resection or transplantation.

Chemotherapy for HCC has been disappointing. Recently, the drug, Sorafenib (Nexavar), has been shown to be active against HCC, but it only extended survival time by a few months.  Thousands of drugs have been developed by the pharmaceutical industry for a great variety of conditions.  Of these, 983 have approved by the FDA.  That is they were tested in clinical trials, found to be safe and were beneficial for the purposes that they were approved

Scientists at the Hepatitis B Foundation and elsewhere have raised the question, are there drugs on the currently approved FDA list that are used for other purposes that might have a role in the treatment or prevention of HCC?  Recent publications suggest 2 candidates.  One is metformin (Glucophage), which is derived from the French lilac, and has been used in Europe since 1958 to treat Type 2 diabetes and in the United States since 1995. The other is propranalol, which is used to treat patients with cirrhosis who have varicose veins in the lower end of their esophagus (esophageal varices).

Diabetes is a recognized risk factor for HCC, particularly in persons who are obese and have a fatty liver. (Diabetics are also at increased risk of acquiring hepatitis B). Because patients with diabetes are often treated with metformin, investigators in China and France have looked at whether treatment with metformin lowers the risk of developing HCC.  By examining the records of diabetic patients who were treated with metformin or not, they observed that the risk of HCC was lower in the treated patients.  Furthermore, an experimental study of liver cancer in mice showed that metformin reduced the number and size of liver tumors.

Propranolol is used to lower the pressure in the portal vein and thereby in esophageal varices.  A group of physicians in France looked at the occurrence of HCC in patients with hepatitis C and esophageal varices who received propranolol treatment and those who did not.  There was about a 75% reduction in the incidence of HCCs in the propranolol treated patients.  Propranolol blocks receptors for epinephrine (adrenalin) and nor-epinephrine on cells in the body.  Such receptors are particularly rich on the surface of tumor cells, including HCCs. Experimentally propranolol has been effective in reducing the size and number of  several different kinds of tumors.

The studies that have been done so far are intriguing, but they are not conclusive.  Neither drug has been studied in a clinical trial to either treat established HCCs or to prevent HCC from occurring in the first place.  Such studies are in the planning stages.  Keep watching for progress on this front.