Hep B Blog

Which is Worse Chronic Hepatitis B or C? What Do You Think?

From HBF’s expert Guest Blogger, Dr. Thomas London

If you ask doctors in the United States, or patients with liver disease, or the average person on the street, the answer that you usually get is that Hepatitis C is worse.  Hepatitis C has a bad reputation in the media and with the public. We, at the Hepatitis B Foundation, tend to think that hepatitis B is the worse disease, but until now we have not had any basis for that answer. Now we do.

Recently a group of investigators from Johns Hopkins University published a paper with the title “Comparative Risk of Liver-Related Mortality from Chronic Hepatitis B Versus Chronic Hepatitis C Virus Infection”.  The answer from this publication is that hepatitis B is more likely to cause liver related death than hepatitis C.  It is worth dwelling on how the authors came to this conclusion: unexpectedly, the AIDS epidemic triggered the studies, which made the conclusion possible.

Acquired immune deficiency disease (AIDS) was first reported in the United States in 1981. The disease appeared to be deadly, and it was thought-to-be confined to homosexual men. In fact, it was initially called Gay Related Immune Deficiency or GRID.  Although it was soon proven that this new immune deficiency disease was not limited to gay men, it is true that men who had sex with men (MSM) accounted for most of the early cases.  In the 1970’s there were several reports that MSM had a high incidence of hepatitis B.  For the initial clinical trial of the then new hepatitis B vaccine, MSM in New York City were selected as the study population because of their high risk for hepatitis B infection. In the trial about 27% of the unvaccinated population became infected with hepatitis B virus (HBV) within 18 months, whereas less than 3% of the men who received the vaccine became infected over the same time interval.  This result proved the efficacy of the vaccine.

Fast forward to 1984 before the virus causing AIDS was clearly identified, several researchers suggested that a variant of hepatitis B was the cause. A group of investigators proposed a prospective study of MSM who had been tested for hepatitis B and a newly reported anti-HIV antibody, but who did not have immune deficiency disease.  By following the men over time, the thought was that it would be possible to observe which infection – HIV or hepatitis B or a combination of both – led to AIDS.

MSM were recruited from 4 cities in the USA (Baltimore, Chicago, Pittsburgh, Los Angeles); thereafter called the Multicenter Cohort Study (MACS).  Over four time intervals from 1984 to 2002, 6972 MSM were enrolled.  The men were followed until 2010, on average for more than 8 years. Serum samples were collected every 6 months, frozen and stored.  Although the hepatitis C virus had not yet been identified in 1984, all the samples were later tested for HIV, HBV and hepatitis C virus (HCV).  All deaths were recorded as were all liver related deaths.

The results were surprising. Comparable numbers of men were infected with HBV and HCV, but MSM with chronic hepatitis B were twice as likely to die a liver related death as the men with chronic hepatitis C.  The statistical analyses were carefully done to account for the treatments of HCV, HBV, and HIV that were used during the course of the study.  Immunodeficiency further increased the risk of liver death in the men with hepatitis B over that in the men with chronic hepatitis C.

The study showed that in the two and a half decades after 1984, hepatitis B infection was more serious than hepatitis C. Now, in 2012, this difference is even greater. Chronic hepatitis C has become a curable disease.  Chronic hepatitis B is manageable, but not yet curable.  This means that hepatitis B, which was already a worse disease than hepatitis C before the new therapies for HCV, is now a much more important unsolved health problem.

– Dr. Tom London

Who’s at Risk for Hepatitis B? Learning the HBV Basics

 

Are you or someone you know at risk for hepatitis B? You might be more at risk than you think, and since hepatitis B is vaccine preventable, it makes sense to be screened and vaccinated for HBV.  Hepatitis B causes 80% of primary hepatocellular carcinoma worldwide, and the survival statistics for liver cancer are particularly grim – yet another reason to avoid an infection with HBV if at all possible.

It is important to note that everyone is susceptible to hepatitis B. It does not discriminate.  It infects, babies, children, teens, adults and seniors. It has no racial or religious bias, though it is certainly more prevalent among certain ethnic groups –mainly because it is endemic to the homelands of these communities. For example, if you look at the prevalence map for hepatitis B, you will see that in most of the world, hepatitis B is at an intermediate, (2-7%) or high HBsAg prevalence (>8%) level.  Looking at the numbers, 2 billion people in the world, that’s 1 out of 3 people, have been infected with HBV and nearly 400 million are chronically infected. That represents three-quarters of our world. Even if you aren’t living in these parts of the world, you may be traveling to some of these areas for work or pleasure, or you may be first generation, or your parents and other family members were born in HBV endemic areas.  Since there are often no symptoms for HBV, and screening and vaccination may be lacking in many communities, HBV is transmitted from one generation to the next, and many are completely unaware of their HBV status – until it’s too late.

Other at-risk groups for hepatitis B include the following: (not noted in a particular order)

  • Health care providers and emergency responders due to the nature of their work and potential for exposure.
  • Sexually active heterosexuals (more than 1 partner in the past six months)
  • Men who have sex with men
  • Individuals diagnosed with a sexually transmitted disease (STD)
  • Illicit drug users (injecting, inhaling, snorting, pill popping)
  • Sex contacts or close household members of an infected person (remember, you may not know who is or is not infected)
  • Children adopted from countries where hepatitis B is common (Asia, Africa, South America, Pacific Islands, Eastern Europe, and the Middle East) and their adopted families
  • Individuals emigrating from countries where hepatitis B is common (see above)
  • Individuals born to parents who have emigrated from countries where hepatitis B is common (see above)
  • ALL pregnant women – because infants are so vulnerable to HBV (90% of infected infants will remain chronically infected, and HBV is very effectively transmitted from infected mother to baby.)
  • Recipients of a blood transfusion before 1992
  • Recipients of unscreened blood and blood products – sadly an issue in many parts of the world.
  • Recipients of medical or dental services where strict infection control practices are not followed – sadly another issue in parts of the world.
  • Kidney dialysis patients and those in early renal failure
  • Inmates of a correctional facility
  • Staff and clients of institutions for the developmentally disabled
  • Individuals with tattoos and body piercings performed in a parlor that does not strictly adhere to infection control practices – it may be up to you to ensure proper infection control practices are followed.
  • People living with diabetes are at risk if diabetes-care equipment such as syringes or insulin pens are inadvertently shared.

The good news is that hepatitis B is a vaccine preventable disease. There is a safe and effective, 3-shot HBV vaccine series that can protect you and your loved ones from possible infection with HBV.  The earlier you are vaccinated, the better. In the US, a birth dose of the vaccine is recommended for all infants, since these little ones are most vulnerable to hepatitis. (90% of infected infants will live with HBV for life). HBV vaccination doesn’t give you a free-pass from other infectious diseases such as HCV or HIV, both without vaccines, so strict infection control practices should still be followed. However, HBV is a tenacious virus that survives outside the body for a week and is 50-100 times more infectious than HIV  3-5 times more infectious than HCV.  Plus the HBV vaccine is actually an anti-cancer vaccine, so why not get vaccinated?

Hepatitis B isn’t casually transmitted, but in the right scenario, it is effectively transmitted. You may think that situation may never come about for you, or for your loved ones –especially your little ones who are so vulnerable to HBV. Some people travel to exotic lands with unsafe blood supplies and abysmal infection control practices, and sometimes they get sick, or require emergency dental or medical services, so they may be put at risk. Most people have an occasional lapse in judgment – sometimes it’s a one-time thing, sometimes it lasts for years, but the net-net is that it’s unusual to find someone who has not engaged in some sort of high-risk activity, whether intentionally or unintentionally. If you are properly vaccinated to protect against hepatitis B, you can cross that concern off-of-your-list.

B sure. Get screened. if you do not have HBV, get vaccinated and be hepatitis B free. If you discover you have HBV, talk to your doctor and have him refer you to a liver specialist who can better evaluate your hepatitis B status and your liver health.

The Hepatitis B Foundation Mourns the Loss of Dr. R. Palmer Beasley

Dr. Palmer Beasley (center), with his wife Dr. Lu-Yu Hwang at his side, received the HBF's Distinguished Scientific Award from Dr. Timothy Block (left) and Nobel Laureate Dr. Baruch Blumberg, HBF co-founder (far right) in 2010.

The Hepatitis B Foundation mourns the loss of a great hepatitis B champion. Dr. R. Palmer Beasley. The Hepatitis B Foundation was proud to have honored Dr. Beasley with the Distinguished Scientist Award 2010, at HBF’s annual Crystal Ball. Dr. Beasley’s groundbreaking research discoveries in Taiwan included identifying mother-to-infant hepatitis B transmission, and the fatal link between hepatitis B and hepatocellular carcinoma (primary liver cancer). Additionally, Dr. Beasley’s initiation of a national hepatitis B immunization program has protected a generation of people in Taiwan against hepatitis B and liver cancer.

Dr. Timothy Block, President and Co-Founder of the Hepatitis B Foundation wrote: “Our cause has lost another great one with the passing of Palmer Beasley. He was passionate and visionary in working to advance hepatitis B awareness and research. His work with the HBV vaccine, particularly in Taiwan, is considered definitive and as having set the stage for saving millions of people. The HBF recognized him as our honoree in 2010, and for that, I am glad.”

The Washington Post obituary of Dr. Beasley, dated August 5th, presented a wonderful review of some of Dr. Beasley’s many accomplishments and touches on his unique personality. Please see the reprint below –

Adventurous, meticulous and intensely curious about the world and its people, Dr. R. Palmer Beasley, epidemiologist and infectious-disease expert, used those skills to discover the link between the hepatitis B virus and liver cancer — proof that a virus could cause a human cancer, and a finding that ultimately led to vaccinations that saved hundreds of thousands of lives.

Dr. Beasley, a former University of Washington faculty member and dean of the University of Texas School of Public Health, died Aug. 25 at his home in Houston. He was 76. His death, from pancreatic cancer, was confirmed by his wife Lu-Yu Hwang.

Measles, plague, HIV — they all intrigued Dr. Beasley, who had decided as a student at Harvard Medical School that he wanted to be an epidemiologist, studying infectious diseases. In the early 1970s, as a fellow at what later became the University of Washington School of Public Health, he jumped at the chance to go to Taiwan to research rubella (German measles). There, he became determined to delve into the mysteries of hepatitis B, which he considered the least understood unconquered virus of the time.

“He took an approach like Albert Schweitzer,” said Herbert DuPont, director of the Center for Infectious Diseases at the University of Texas. “He lived in the field, he worked with patients, with the people. He didn’t go back to Seattle and sit in an office at the University of Washington and contact people in Taiwan.”

J. Thomas Grayston, then Dr. Beasley’s supervisor at the University of Washington, recalls a bit of friction in that regard. “We talked to him about coming back, and he wasn’t going to do that,” he said.

Dr. Beasley arranged independent funding for his research project, married a co-researcher and settled down in Taiwan, where he would spend the next 14 years. But he kept his affiliation with the University of Washington, which lasted nearly two decades.

With exacting attention to detail, Dr. Beasley and his colleagues designed long-term studies that would follow more than 22,000 Taiwanese government workers for decades, in the process proving that the hepatitis B virus is a main cause of liver cancer — at the time a controversial theory — and that childbirth can transmit the virus from a mother to her baby, who becomes a carrier and much more likely to develop liver cancer.

Dr. Beasley found that a shot of immune globulin at birth protected babies; later, his work helped push the World Health Organization to include the hepatitis B vaccine in routine vaccination programs.

For his work, Dr. Beasley was awarded the King Faisal International Prize in Medicine, the Charles S. Mott Prize, the Maxwell Finland Award for Scientific Achievement and the 2010 Distinguished Scientist Award by the Hepatitis B Foundation.

“There are at least a million people alive today who otherwise would not be here if not for Dr. Beasley’s pioneering research in hepatitis B,” Nobel laureate Baruch Blumberg said at the award ceremony, according to the foundation.

Robert Palmer Beasley was born in Glendale, Calif. He received a degree in philosophy from Dartmouth College in 1958, a medical degree from Harvard University in 1962 and a master’s degree in preventive medicine from the University of Washington in 1969.

Early in his career, he worked as an epidemic investigator for what is now the Centers for Disease Control and Prevention in Atlanta from 1963 to 1965, including an assignment to find a sample of plague in Bolivia.

Riding in trucks and on burros, he and his colleague James Gale tracked down plague in a tiny village on the east side of the Andes, said Gale, now an emeritus professor of epidemiology at the University of Washington. Because the disease had killed nearly all those in the village, they had to exhume a body, cut off a finger and get it back to the capital city, where the material containing the plague was injected into a guinea pig, which promptly died.

Assured that the pathogen was still viable, the two doctors packed it up in dry ice for shipment to a secure lab in Maryland.

From 1987 to 2005, Dr. Beasley was dean of the University of Texas School of Public Health.

His first marriage, to Sonia Garon, ended in divorce. Survivors include his wife of 32 years, Dr. Lu-Yu Hwang of Houston, an epidemiologist who collaborated with him on his research; two children from his first marriage, Monica Payson of Seattle and Fletcher Beasley of Los Angeles; a daughter from his second marriage, Bernice Hwang Beasley of Seattle; a brother; and two grandchildren.