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Diagnosed with Hepatitis B? Preventing Transmission to Others. Learning the HBV Basics Transmission – Part III

How can you prevent future transmission? Now that you are aware of your infection, it’s easier than you think.  In a perfect world, everyone would be vaccinated against HBV and be protected, but of course this is sometimes not the case. Always encourage HBV vaccination when possible now that you understand the importance of this safe and effective 3-shot series. However, the vaccine does take time to complete, so in the interim, some general precautions will keep you and everyone you know safe.

Always maintain a barrier between blood and infected body fluids and any open cuts, mucous membranes (eyes, nose or mouth), or orifices of someone else. Keep cuts, bug bites – anything that bleeds or oozes – covered with a bandage. Also, remember to carry a spare bandage.  These are some simple prevention methods.

Do not consider unprotected sex unless you are sure your partner has had all 3 shots of the HBV vaccine series. And remember to consider the risks of other infectious diseases that are transmitted sexually if you are not in a monogamous relationship.  Multiple sex partners and non-monogamous relationships expose you to the potential of more health risks and even the possibility of a co-infection.  Co-infections are when someone has more than one serious chronic condition (like HBV and HCV , HBV and HIV or HBV and HDV).  Co-infections are complicated health conditions that you want to avoid. Therefore, practice safe sex by using a latex or polyurethane condom if you have multiple partners.

General precautions include carefully handling of your own blood, tending to your own blood spills when possible, and properly disposing of feminine hygiene products. Properly dispose of blood stained materials in tightly closed plastic bags. If someone else must tend to your bleeding wound or clean up your blood spill, be sure they wear gloves, or maintain a barrier, and wash their hands thoroughly with soap and water.  Many germs and virus (like HBV) can be effectively killed when cleaned using a diluted bleach solution of 1 part bleach to 9 parts water.  Ideally this solution should be made when needed as the shelf life is limited.  Everyone should use these basic precautions – with or without a known HBV infection.  Make this part of your daily life.

And what about your personal items?  Well it’s best if they are kept personal and out of common areas unless everyone is vaccinated. This includes things like razors, nail clippers, files, toothbrushes and other personal items where microscopic droplets of blood are possible.  This is good practice for everyone in the house. After all, you may not be the only one with an infection. Simple changes in daily habits keep everyone safe.

If those at risk in your life are not already vaccinated or have not recovered from a past infection, then they need to start the series immediately. This includes sexual partners and close house hold contacts and  family members. The HBV vaccine is a safe and effective 3-shot series.  Timing may be of concern or a sense of urgency, so just get it started. The regular schedule is completed within six months. Tack on an extra month and ask their doctor to test surface antibody (anti-HBs) titers 1-2 months following the last shot of the series to ensure that adequate immunity has been generated by the vaccine.  This is not standard routine but will help insure those at higher risk that they are protected. In the interim, remember to practice safe sex with your partner using latex or polyurethane condoms.

The timing of the antibody titre should be 4-8 weeks following the last shot of the series. If titers are above 10 then there is protection for life.  If someone has been previously vaccinated a titer test may show that their titers have waned and dipped below the desired reading. There is no reason to panic, as a booster shot can be administered and then a repeated titer test one month later will ensure adequate immunity. Once you know you have generated adequate titers, there is no need for concern of transmission.

When recovering from an acute infection, if your follow up blood test results read: HBsAg negative, HBcAb positive and HBsAb positive then you have resolved your HBV infection and are no longer infectious to others and you are no longer at risk for infection by the HBV virus again.

However if your follow up blood tests show that you are chronically infected or your infection status is not clear, you will want to take the precautionary steps to prevent transmitting your HBV infection to others. You will also need to talk to your doctor to be sure you have the appropriate blood work to determine your HBV status and whether or not you are chronically infected.

Please be sure to talk to your doctor if you are unsure, and don’t forget to get copies of those labs. Check out  transmission part I and part II if you are looking for a little more transmission information.

Diagnosed with Hepatitis B? Preventing Transmission to Others Learning the HBV Basics, Transmission Part II

Part I discussed how hepatitis B is transmitted and may have helped you determine how you were infected with HBV.   In Part II we will discuss the people closest to you who may be susceptible to your infection.

Anyone exposed to HBV is susceptible. This is true if you have not already been vaccinated, or are not taking precautions. HBV does not discriminate. However, those most susceptible to infection are your sexual partners, close household contacts or family members. Why are the these people more susceptible?  Remember that HBV is transmitted through blood and infected body fluids, so sexual partners will be at risk. Unfortunately even close contacts without sexual intimacy may also be at risk. These include family members or roommates that might borrow your razor, the nail clippers on the downstairs counter, or your favorite pair of pierced earrings. Such personal items may have trace amounts of blood on them.  Hepatitis B can live outside the body for a week. It just makes sense that the odds of an exposure will happen with someone you live with just due to the increased potential for daily exposure in simple grooming routines or household activities where blood could be exchanged. The good news is that HBV is preventable.

It is important to know that unvaccinated babies and young children are more susceptible to HBV. This is because they have undeveloped, immature immune systems. In fact 90% of babies and up to 50% of young children infected with HBV will have life-long infection. That is why hepatitis B vaccination is so important for babies and young children.

So what should you do? You need to do the right thing. You need to talk to sexual partners and close contacts and family members now that you know you are infected. You don’t need to tell everyone; just those that you believe are at risk. Tell them to ask their doctor to run a hepatitis B panel.

The hepatitis B panel is one blood test with 3 parts: HBsAg – surface antigen;  HBcAb – core antibody; and HBsAb – surface antibody.  When read in combination, this one test can tell your close contacts if they are currently infected, have resolved a previous infection, and whether or not they have immunity to the hepatitis B virus. Typically the blood test results are straight forward, but sometimes they can be tricky. Ask those tested to discuss their results with their doctor, and to keep a copy of the blood tests results for review.

One important factor for those that may have been exposed is the timing. There is up to a 9 week window period between an exposure to HBV and when the hepatitis B virus shows up in the blood resulting in a positive test result.  If you tell your partner and they insist on immediate testing, they need to understand that they will need to be re-tested 9 weeks later to ensure whether or not they have been infected. AND, it is essential to practice safe sex and follow general precautions until everyone is sure of their status –both the known and potentially infected.

Remember you may still be in a waiting period trying to determine if you are acutely or chronically infected. Very possibly you have not had symptoms with your HBV. Nearly 70% of those with newly infected with HBV have no notable symptoms. It’s also very likely you are unsure when you were infected.  And of course it’s possible you are chronically infected and have had HBV for quite some time. It’s stressful and little confusing not knowing the details of your infection, but you need to move forward doing the right thing and talking to those at risk and taking care of yourself.

Take a look at Part I and Part III for further discussion of HBV transmission.

Newly Diagnosed with Hepatitis B? How Did I Get this? Learning the HBV Basics, Transmission – Part I

If you have just been diagnosed with hepatitis B virus (HBV) then you need to understand how HBV is transmitted. This is the case whether you are acutely or chronically infected.  You must understand you are infectious at this time and can transmit the virus to others.

How is hepatitis B transmitted? Hepatitis B is transmitted through blood and infected body fluids. This can happen through direct blood-to-blood contact, unprotected sex, unsterile needles and unsterile medical or dental equipment, and from an infected mother to her baby.  For kids, pediatric experts report that the fluid that oozes from cuts and open sores is also highly infectious. HBV can also be transmitted inadvertently by the sharing of personal items such as razors, toothbrushes, nail clippers, and other personal items that may have trace amounts of blood on them.

HBV is not transmitted casually by sneezing or coughing, shaking hands or sharing or preparing a meal. In fact it is not contracted during most of life’s daily activities. Hugging or even kissing won’t cause infection unless there are bleeding gums or open sores during the exchange. It’s really all about trace amounts of infected blood, though the virus is in other bodily fluids in lower concentrations.  For example, it’s not about the saliva on the toothbrush that is a big concern, but rather the potential for trace amounts of blood that could be exchanged with a shared toothbrush.

How did I get this? If you have been diagnosed with hepatitis B virus you are likely racking your brain trying to figure out how you could have gotten HBV. Some can immediately track their likely exposure to a recent event, or perhaps a time period in their life where they were more likely to have been exposed. They may fit into an at-risk category for hepatitis B due to lifestyle choices, country of origin, frequent travel and exposure in endemic areas of the world, high risk employment, or unsafe blood or medical or dental procedures without adequate infection control. (Sadly, this is common in many parts of our world, but accidents can happen anywhere).

Since HBV is a silent infection there can be years before it is detected.  Many individuals born in endemic parts of the globe find out later in life that they are hepatitis B positive, even though they have likely had HBV since birth or early-childhood. Children are especially vulnerable to chronic HBV. 90% of babies and up to 50% of young children infected with HBV will remain chronic, and most will have no symptoms.  Often it remains undetected until it is caught in routine blood work or later in life when there may be liver disease progression. In Asia, vertical transmission from mother to child is very common; whereas in Africa, horizontal transmission at a young age is often the culprit.

Although not casually transmitted, there are inadvertent opportunities for exposure to hepatitis B. If you are from an area where HBV is very common, then the odds of exposure, transmission, and infection will be higher. If you do, or have participated in high-risk activities at some point in your life, you are also at greater risk. People are often quick to point out that they have never injected drugs or participated in more obvious high-risk activities, but let’s face it – multiple sex partners? Certainly sexual experimentation in college or early adulthood is not that unique. Things happen, people change, or sometimes they don’t. This isn’t a time for judging, it’s a reflection of what happened yesterday or 20 years ago that may have exposed you to HBV and resulted in infection.  That being said, unless it happened just recently and you can definitively identify your exposure, I would advise that you let it go and move forward. I spent a number of years wondering about the details of my daughter’s infection, but ultimately, it really doesn’t matter.

Time to move forward.

The next step – preventing transmission to others, Part II

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, so blood tests can be run 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 blood 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.

A Capitol Celebration: US Leaders in Hepatitis B Celebrate World Hepatitis Day

Hep B United (HBU), a coalition established by the Hepatitis B Foundation (HBF) and the Association of Asian Pacific Community Health Organizations (AAPCHO), held its fifth annual Hep B United Summit from July 26th to 28th in Washington D.C. The summit was held to promote screening and prevention strategies and advocate for a cure to further HBU’s mission to eliminate hepatitis B in the United States.

The summit is the largest gathering of hepatitis B leaders from around the country including public health agencies, national non-profit organizations, community coalitions, and individuals and family members affected by hep B. Catherine Freeland, MPH, Public Health Manager of HBF, said, “The summit is like a family reunion.” It’s an opportunity for HBU members to convene, share best strategies, and celebrate their wins over the past five years. The partnerships within HBU ensures that best practices and resources are shared as well. “Once we have a cure, we are committed to making sure chronically infected Americans get it,” Chari Cohen, DrPH, MPH, co-chair of HBU mentioned during the summit. Over the past year, HBU screened 22,556, educated 52,194, and reached over 6 million people with in-language hepatitis B messaging! That’s a win for sure!

As a part of the summit, HBU partners visited Capitol Hill to discuss with federal legislators the need to support hepatitis B and liver cancer research, education, screening, and treatment programs. A Congressional reception was also held to highlight the “#justB: Real People Sharing their Stories of Hepatitis B” storytelling campaign, which increases awareness of hepatitis B through personal stories. There were also meeting sessions focusing on capacity building, sustaining local hepatitis B coalitions, and best ways to utilize resources like the “Know Hepatitis B” campaign from the CDC and Hep B United and the #justB campaign. The Hep B United Summit is a way to celebrate World Hepatitis Day, which is on July 28th every year. Partners celebrated and raised awareness for World Hepatitis Day around Capitol Hill with a scavenger hunt!

At the Summit, HBU and its CDC partners presented five community leaders with the 2017 Hep B Champion Awards in recognition of their outstanding commitment to eliminating hepatitis B and liver cancer in their communities:

 Cathy Phan, the Health Initiatives Project Manager at HOPE Clinic in Houston, Texas, is recognized for her dedication to reducing health disparities, advocating for access to health care and health equity for underserved populations. Cathy brings unique perspectives, best practices and creative, innovative ideas from the local community clinics to the national level.

Vivian Huang, MD, MPH, the Director of Adult Immunization and Emergency Preparedness for the New York City Department of Health and Mental Hygiene and the medical director for the NYC Department of Health Immunization Clinic is recognized for her commitment to reducing the burden of vaccine-preventable diseases locally and globally including hepatitis B and liver cancer. Dr. Huang is a strong, tireless advocate for hepatitis B prevention, education, and treatment and health equity through health department engagement.

Hong Liu, PhD, the Executive Director of the Midwest Asian Health Association in Chicago, Illinois, is recognized for her innovative approaches to educating the public on hepatitis B and her willingness to share her best practices and experiences with others working in the field. This year, Dr. Liu’s leadership has led her organization to educating over 1,337 individuals in Chicago’s Chinatown district and screening close to 300 individuals for hepatitis B.

Dan-Tam Phan-Hoang, MSc., is program manager of HBI-Minnesota, a Minneapolis, Minnesota-based non-profit that she helped start in 2015. Dan-Tam is recognized for her leadership in Minneapolis, building strong collaborations with community leaders, healthcare providers, funders, and government agencies to address hepatitis B throughout the state and successfully establishing a hepatitis B outreach and prevention program for high-risk communities in the Twin Cities.

The National Task Force on Hepatitis B for AAPI, is a national organization that brings together scientists, health professionals, non-profit organizations, and concerned citizens in a concerted effort to eliminate the transmission of hepatitis B and to decrease health disparities among those chronically infected. The Task Force is recognized for increasing physicians’ awareness about hepatitis B and launching a new health care provider program, bringing together public health and health care professionals in regional meetings around the country. The Health Education for Liver Providers (H.E.L.P.) Training Program is designed to provide health care providers and their medical team core medical knowledge of hepatitis B and hepatitis C.

Read the summit press release here.

More pictures of the summit can be found on HBU’s Facebook album, Storify, and e-newsletter.

To read about the Hep B United 2016 Summit from last year, click here.

Join the Conversation at the Hep B United Summit; Watch Summit Sessions On Facebook Live!

Summit Image FB Insta (1)The annual Hep B United Summit, organized by the Hepatitis B Foundation, convenes in Washington D.C. from Thursday, July 27 through Friday, July 28. National and local coalition partners, experts, stakeholders, and federal partners will meet to discuss how to increase hepatitis B testing and vaccination and improve access to care and treatment for individuals living with hepatitis B.

You can watch many of these important sessions on Facebook Live. You can also follow the conversation at the Summit on Twitter with #Hepbunite!

Facebook Live is live video streaming available to all Pages and profiles on Facebook. Check out the agenda below and go to the HepBUnited Facebook Page to view the live broadcast. The session will be made available following the broadcast for those who are not able to join us live.

Here are the details on the sessions that will be broadcast on Facebook Live:

Day 1 – Thursday July 27:

8:30 – 10:00 AM:  Welcome and Introductions
Tim Block, PhD, President & Co-founder, Hepatitis B Foundation and Baruch S. Blumberg Institute, Chari Cohen DrPH, MPH, Co-Chair, Hep B United and Director of Public Health, Hepatitis B Foundation, Jeff Caballero, MPH, Co-Chair, Hep B United and Executive Director, AAPCHO

10:00 – 10:30 AM:  Time to Eliminate Hepatitis B
Dr. John Ward, Director, CDC Division of Viral Hepatitis 

10:30 -11:15 AM:  #justB Storytelling Campaign Panel: Real People Sharing their Stories of Hepatitis B
Rhea Racho, MPP, Public Health Program and Policy Coordinator, Hepatitis B Foundation and storytellers

11:15 – 12:00 PM: Know Hepatitis B Campaign Updates
Cynthia Jorgenson, DrPH, Team Lead and Sherry Chen, MPH, Health Scientist, Division of Viral Hepatitis, Centers for Disease Control and Prevention

12:00 – 12:30 PM:  Increasing Community Awareness and Education
Moderator: Catherine Freeland, MPH, Hepatitis B Foundation and Sherry Chen, CDC

3:00 PM – 4:15 PM:  Breakout Session: Increasing Awareness through Media Engagement
Facilitators: Jessie MacDonald, Vice President, Weber Shandwick and Lisa Thong, Account Supervisor, IW Group

4:15 PM – 5:00 PM:  State of Hep B United
National Advisory Committee
–  Strengthening Coalition Partnerships: Sharing Resources and
–  Overcoming Challenges
Kate Moraras, MPH, Director, Hep B United and Sr. Program Director, Hepatitis B Foundation and Catherine Freeland, MPH, Public Health Program Manager, Hepatitis B Foundation

 Day 2 – Friday July 28

11:30 AM:   Hepatitis B CME Provider Education Program
Amy Trang, PhD, Administrator, National Task Force on Hepatitis B
Focus on Asian Pacific Islander Americans

12:45 PM – 1:45 PM:  HBU Mini-Grantee Presentations
Moderator: Catherine Freeland, MPH, Public Health Program Manager, Hepatitis B Foundation

Not able to join the sessions with Facebook Live? Follow the conversation on Twitter using the #Hepbunite hashtag. Follow the events, Retweet and engage with event attendees and help us raise hepatitis B awareness in the U.S. and around the globe.

World Hepatitis Day is July 28th, and this Summit is a terrific opportunity to share with the world what we’re doing to help those living with hepatitis B in our communities. Other popular hashtags for World Hepatitis Day, and to raise hepatitis B awareness, include: #NOhep, #KnowHepB, #WorldHepatitisDay, #WorldHepDay, #WHD2017, #hepatitis, #hepatitisB, #HBV, #hepB, #justB. Connect with, follow and engage with fellow partners on twitter to keep the hep B conversation going during the Hep B United Summit and World Hepatitis Day events, and beyond.

Check out: @AAPCHOtweets, @AAHC_HOPEclinic, @AAHI_Info, @AAPInews, @apcaaz, @APIAHF, @ASIAOHIO, @CBWCHC, @cdchep, @cpacs, @HBIDC, @HepBFoundation, @HepBpolicy, @HepBProject, @HepBUnited, @HepBUnitedPhila, @HepFreeHawaii, @HHS_ViralHep, @MinorityHealth, @njhepb, @NVHR1, @nycHepB, @NYU_CSAAH, @sfhepbfree, @supportichs @wahainitiative @jlccrum

Missing from the list? Contact the foundation at info@hepb.org to be added.

Don’t forget to join the World Hepatitis Alliance  Thunderclap and register your World Hepatitis Day events  prior to World Hepatitis Day. Be sure to participate in the #ShowYourFace campaign.  and tell the world how you’re standing up against viral hepatitis.

Still have questions? Email us at info@hepb.org and we’ll help you get started!

Visit the Hep B United and Hepatitis B Foundation websites for more information about hepatitis B and related programs.

Learn Which Cancer, Arthritis or Asthma Drugs Can Reactivate Hepatitis B – Even If You’ve Cleared the Infection

Courtesy of Pixabay.
Courtesy of Pixabay.

By Christine Kukka

Drugs that suppress your immune system in order to treat cancers, rheumatoid arthritis, psoriasis, COPD and asthma can cause a life-threatening reactivation of your hepatitis B.

This dangerous viral rebound can occur if you are currently infected or even if you cleared the infection and now test negative for the hepatitis B surface antigen (HBsAg) and positive for the surface antibody (HBsAb).

These drugs weaken the immune system, which allows your infection to rebound with a vengeance, spiking your viral load and causing life-threatening liver damage within weeks of starting chemotherapy or high-dose steroids.

What’s behind this reactivation risk? Think herpes or chicken pox (shingles). You might get rid of the infections and the ugly blisters, but small amounts of virus remain and as we age and our immune systems weaken, they can reappear.

The hepatitis B virus (HBV) behaves similarly. When we lose HBsAg and/or develop surface antibodies, there are still small amounts of HBV lurking in our bodies. When we’re healthy, our immune systems effectively contain these trace amounts of virus, but old age, another serious medical condition or immune-suppressing drugs allow hepatitis B to reactivate.

Today, medical guidelines require doctors to test everyone they plan to treat with any immune-suppressing drugs for the hepatitis B core antibody (HBcAb) so they know who has been infected with hepatitis B. If a patient tests positive, doctors must run more tests to determine what risk the new drug will pose. When a patient is at risk of reactivation, doctors will simultaneously treat them with antivirals (either tenofovir or entecavir) and continue antiviral treatment for six more months after the immune-suppressing therapy ends to prevent reactivation.

U.S. CDC.
U.S. CDC.

This mandatory testing is important because some people don’t know they should tell their doctors about their past infection, and many don’t know they’re infected. Here is what happened to one person who contacted the Hepatitis B Foundation after her doctor failed to test her for hepatitis B:

“I recently had my first dose of chemotherapy and I did not mention (to) my oncologist that I was a carrier of hepatitis B, (because) I knew that it was not active. Then, after a week of chemo, I was really sick and got a high temperature. Then, my blood test came back (indicating) that my hepatitis B was reactivated. My liver doctor gave me medicine (an antiviral) to take to deactivate the virus.”

Her oncologist immediately stopped chemotherapy and monitored her HBV DNA (viral load) and liver enzymes (ALT/SGPT) to make sure the antiviral lowered her viral load before restarting chemotherapy. This example shows why it’s important to tell all doctors, including specialists, about a current or resolved hepatitis B infection. No one wants to be battling cancer and a reactivated hepatitis B infection at the same time.

According to experts, about 4.3 percent of people who have cleared hepatitis B will experience a reactivation when treated with immune-suppressing drugs.

Which drugs reactivate hepatitis B? Below is a summary of drugs that can reactivate your hepatitis B and require monitoring and preventive use of antivirals to reduce reactivation risk, according to American Gastroenterological Association (AGA) guidelines:

High-risk Drugs:

More than 10 percent of people with current or resolved hepatitis B infections will experience a dangerous reactivation if treated with:

  • Rituximab for non-Hodgkins lymphoma, or
  • Ofatumumab for chronic lymphocytic leukemia

Anyone with a current infection (HBsAg positive) treated with the following is also at high risk of reactivation:

  • Anthracycline derivatives (such as doxorubicin, epirubicin) used to treat cancers, including breast or bladder cancer, Kaposi’s sarcoma, lymphoma or acute lymphocytic leukemia, or,
  • Moderate-doses of prednisone/corticosteroids (10 to 20 mg daily) or high doses (more than 20 mg daily or equivalent) for four or more weeks. This steroid is used to treat inflammatory diseases including asthma, COPD, rheumatic disorders, ulcerative colitis, Crohn’s disease, MS, tuberculosis, shingles side effects, lupus, poison oak and tuberculosis among others.

Moderate-risk Drugs:

 Anyone with a resolved or current infection treated with the following drugs is at moderate risk of reactivation:

  • Tumor necrosis factor alpha inhibitors, such as etanercept, adalimumab, certolizumab, infliximab, for arthritis, inflammatory bowel disease, psoriasis and asthma;
  • Other cytokine or integrin inhibitors (such as abatacept, ustekinumab, natalizumab, vedolizumab), or
  • Tyrosine kinase inhibitors (such as imatinib, nilotinib)

 Also with a current infection treated is at moderate risk if treated with:

  • Low-dose (less than 10 mg prednisone daily or equivalent) corticosteroids for four or more weeks.

Also, anyone with a resolved infection treated with:

  • Moderate-dose (10—20 mg prednisone daily or equivalent) or high-dose (more than 20 mg prednisone daily or equivalent), or
  • Corticosteroids daily for four or more weeks, or anyone treated with anthracycline derivatives (eg, doxorubicin, epirubicin).

Low-risk Drugs:

Drugs that reactivate hepatitis B in fewer than 1 percent of patients include:

Current or previously-infected people treated with:

  • Traditional immunosuppressive drugs such as azathioprine, 6-mercaptopurine or methotrexate, or
  • Intra-articular corticosteroids
  • Any dose of oral corticosteroids daily for a week or less.

Previously-infected patients treated with:

  • Low-dose (less than 10 mg prednisone or equivalent) corticosteroids for four weeks or longer.

To see the entire list of immune-suppressing drugs, read the AGA guidelines.

Hepatitis B reactivation following successful hepatitis C treatment: New antivirals (such as Harvoni), used to cure hepatitis C do not suppress the immune system, but they leave coinfected people at risk of HBV reactivation once the dominant hepatitis C virus disappears. Coinfected patients need to be monitored carefully and treated with antivirals if their HBV rebounds.

You Have Hepatitis B, Will Liver-Detox Diets or Supplements Help? Experts Weigh In

Courtesy of Pixabay.
Courtesy of Pixabay.

By Christine Kukka

Manufacturers and health “gurus” around the world market liver detox diets and supplements that promise to remove toxins, reduce inflammation, strengthen the immune system and help you lose weight. But do they help people with chronic hepatitis B?

A team of Australian researchers examined these claims and concluded, “At present, there is no compelling evidence to support the use of detox diets for weight management or toxin elimination.

“Considering the financial costs to consumers, unsubstantiated claims and potential health risks of detox products, they should be discouraged by health professionals and subject to independent regulatory review and monitoring,” the authors wrote in their report published in the Journal of Human Nutrition and Dietetics.

Let’s look at some of the diets and products the researchers evaluated.

  • The Cleanser/Lemon Detox Diet that requires 10 days of drinking only lemon juice, water, cayenne pepper and tree syrup, along with sea salt water and a mild laxative herbal tea.

    Courtesy of Pixabay.
    Courtesy of Pixabay.
  • The Liver Cleansing Diet featuring vegetarian, high-fiber, low-fat, dairy-free, minimally processed food for eight weeks, along with “liver tonics and Epsom salts.”
  • Martha’s Vineyard Detox Diet: A 21-day regimen features vegetable juice and soup, herbal tea and special powders, tablets, cocktails and digestive enzymes.
  • Dr Oz’s 48-hour Weekend Cleanse: A two-day program featuring quinoa, vegetables, fruit juices and smoothies, vegetable broth and dandelion root tea, and;
  • The Hubbard purification rundown: This requires increasing doses of niacin with a range of A, D, C, E and B vitamins, a variety of minerals and a blend of polyunsaturated oils and mandates that adherents spend five hours in a hot sauna daily.

According to researchers, none of these plans have been evaluated scientifically, which includes using a control group that receives a placebo instead of the treatment. The L. Ron Hubbard plan, promoted by the Church of Scientology, received some scientific evaluation after the purification protocol was applied to 14 rescue workers who were exposed to high levels of chemicals after the 9/11 collapse of the World Trade Center.

The program used niacin supplements, sweating in a sauna and physical exercise to get rid of toxins stored in body fat — which is where nearly all toxins end up – not in liver cells.

“The firemen’s scores on several memory tests reportedly improved after the intervention but the sample size was small and no control group was included,” researchers noted. The Church of Scientology used a similar program and employed a small control group, but the length of the treatment varied widely (ranging from 11 to 89 days). “Rather dubiously, the average increase in IQ in the experimental group was reported to be 6.7 points, despite the average intervention length being only 31 days,” researchers noted.

As with herbal supplements sold around the world, there is also no regulation of the detox diet industry.

“At present, the European Union has refused to authorize the detoxification claims of a dozen nutritional substances (including green coffee, grapefruit and taurine), although there are hundreds of other ‘detox’ products that do not yet appear on the Health and Nutrition Claims Register,” researchers wrote.

More alarming, it appears these companies are now using new marketing terms, such as “reinvention” and “revamp,” instead of detox and cleansing, which makes it difficult for government agencies to regulate these products.

“In some cases, the components of detox products may not match their labels, which is a potentially dangerous situation,” researchers noted. “In Spain, a 50-year-old man died from manganese poisoning after consuming Epsom salts as part of a liver cleansing diet.”

So why are these diets and supplements so popular?

“The seductive power of detox diets presumably lies in their promise of purification and redemption, which are ideals that are deep-rooted in human psychology,” researchers observed. “These diets … are highly reminiscent of the religious fasts that have been popular throughout human history. Unfortunately, equating food with sin, guilt and contamination is likely to set up an unhealthy relationship with nutrition. There is no doubt that sustained healthy habits are of greater long-term value than the quick fixes offered by commercial detox diets.”

Celebrate Father’s Day By Protecting Your and Your Family’s Health — Get Tested for Hepatitis B

William and his family.
William and his family. Click here to watch his story.

By Christine Kukka

After our daughter was diagnosed with chronic hepatitis B 20 years ago, my doctor explained that every household member, including my husband, had to be tested for the liver infection that’s transmitted by direct contact with blood and body fluids. ASAP.

The good news was my daughter was healthy and had no signs of liver damage, but my husband and I were shaken to the core by her diagnosis. Weighed down by worry and ignorance, I feared we might all be infected and faced a death sentence.

I drove out to my husband’s work and we went for a walk. I explained what the doctor had said and explained he had to get tested. It was one of those moments when fear and denial play out over the course of a conversation. Like everyone, he was afraid to get tested. He felt fine, at first he didn’t want to know whether he was infected. For a few moments, he thought ignorance might be less painful than finding out he had hepatitis B.

And, as in most families, this disclosure wasn’t easy. He had children from his first marriage who were with us every weekend and they had to be tested too. He would have to share this information with his former wife. This disclosure was going to upend two households. After a few minutes of waffling and processing, he did what courageous fathers do. He got tested and made sure his children were tested too.

Poster-GetTested_SuperDad-2-235x300The news was all good. His children had been immunized and were fine, he was not infected and was immediately immunized. Today, we are all doing fine, including our daughter.

Every father’s day, I think about that moment, when my husband refused to  retreat into denial, and put his family’s health ahead of his initial impulse to hide from a frightening and messy situation. It is what being a good father is all about, and it takes courage.

For another story about hepatitis B and fatherhood, please view the Storyteller video featuring William’s Story: #justB Dad by clicking here.  

Excited by the impending birth of his first child, William decided to plan for his family’s financial future. He was shocked to learn through a required health insurance blood test that he had hepatitis B. He spent sleepless nights wondering how he contracted the virus and whether it was a death sentence. After wading through dense layers of information online, he went in for more tests and was reassured by a caring provider that with monitoring, dietary changes and an active lifestyle, he would live a long life.

He realized that knowing where hepatitis B came from isn’t as important as focusing on staying healthy.

The CDC offers short video clips that feature a conversation between a daughter and her parents, with the daughter explaining why Asian-Americans should be tested for hepatitis B in English, Cantonese, Mandarin, Vietnamese and Korean. A high percentage of Asian and African immigrants have hepatitis B, but most don’t know they are infected. To view these clips, visit: http://www.cdc.gov/knowhepatitisb/materials.htm

The Medical Community Wakes Up to a Dangerous Threat to People with Hepatitis B – Coinfection with Hepatitis D

hep DBy Christine Kukka

In the U.S. and around the world, the medical community is finally acknowledging a hidden threat to people with hepatitis B – a virulent liver coinfection that requires the presence of the hepatitis B surface antigen (HBsAg) to survive.
Hepatitis D (Delta), which causes the most severe liver infection known to humans, infects between 15 to 20 million people worldwide and an estimated 20,000 people living with chronic hepatitis B in the U.S.
For years, health officials assumed hepatitis D did not threaten Americans and occurred primarily in Central Asia and Sub-Saharan Africa. However, recent U.S. Centers for Disease Control and Prevention (CDC) studies found 4 to 5 percent of Americans with chronic hepatitis B are also infected with hepatitis D.
As a result of these findings, researchers including Hepatitis B Foundation‘s Medical Director Dr. Robert Gish, are now pushing medical organizations to establish hepatitis D testing and monitoring guidelines so doctors will start testing patients for this dangerous liver disease.
Recently, the foundation sponsored a webinar, attended by dozens of healthcare providers, patients and officials from around the world, in which Dr. Gish outlined whom should be tested for hepatitis D, and how it should be treated. A new webinar that examines hepatitis D prevalence in the U.S. is scheduled for 3 p.m. (EST), Wednesday, June 28. To register for the webinar click here.
How do people get infected with hepatitis D? Infection occurs when people are exposed to blood and body fluids from someone with an active hepatitis D infection. Basically, they get both hepatitis B and D in one exposure. This is called an acute coinfection. Some healthy adults are able to clear both infections, but they often experience serious liver damage during the clearance or recovery phase.

Another way to become infected is if someone infected with chronic hepatitis B is exposed to someone with hepatitis D. This is called a superinfection, and in 90 percent of cases, people with chronic hepatitis B will also develop chronic hepatitis D.

Who is at risk of hepatitis D? Anyone with chronic hepatitis B who themselves or their family comes from Sub-Saharan Africa, China, Russia, Middle East, Mongolia, Romania, Georgia, Turkey, Pakistan and the Amazonian River Basin should be tested. Hepatitis D rates in some of these countries can reach up to 30 percent in people infected with chronic hepatitis B.

Banner CurveWhat medical conditions suggest hepatitis D? Anyone with chronic hepatitis B who is not responding to antiviral treatment, or who has signs of liver damage even though they have a low viral load (HBV DNA below 2,000 IU/mL) should be tested. Fatty liver disease (caused by obesity) and liver damage from alcohol or environmental toxins should be ruled out before testing for hepatitis D.
Often, people with hepatitis D have low viral loads (even if they are hepatitis B “e” antigen HBeAg-positive), but they have signs of liver damage, including elevated liver enzyme (ALT/SGPT) levels.

Do hepatitis B antivirals work against hepatitis D? No. The hepatitis D virus (HDV) is structurally different from the hepatitis B virus (HBV) and does not respond to tenofovir and entecavir used to treat hepatitis B. Hepatitis B antivirals will lower HBV DNA, but they don’t reduce HBsAg, which HDV need to thrive and reproduce.

How is hepatitis D treated? The only proven hepatitis D treatment is pegylated interferon. Interferon cures hepatitis D 15 to 25 percent of the time after one year of treatment. Once interferon clears hepatitis D, doctors treat patients who continue to be infected with HBV with antivirals. There are dozens of research companies now looking into hepatitis D treatment, and if researchers can find a cure for hepatitis B that eradicates HBsAg, it will also be effective against hepatitis D.

How should people with hepatitis D be monitored? According to Dr. Gish, doctors should:

  • Monitor patients’ ALT/SGPT and liver function at least every six months
  • Perform an ultrasound of the liver and conduct a liver cancer biomarker panel (including AFP, AFPL3% and DCP) every six months;
  • And, perform viral load (HBV DNA) and HDV RNA testing every six months.

How is hepatitis D prevented? The hepatitis B vaccine prevents hepatitis D infection, as does use of safe sex and safe injection practices. According to Dr. Gish, all hepatitis B-positive pregnant women should be tested for hepatitis D if they or their families are from a country with high rates of hepatitis D, or if they have signs of liver damage — even if they do not come from a region with high hepatitis D rates.

If a pregnant woman is infected with either hepatitis B and/or hepatitis D, immunizing her newborn with the first dose of the hepatitis B vaccine within 12 hours of birth and giving the baby a dose of HBIG (hepatitis B antibodies) will prevent both infections.

Bottom line, if you are infected with chronic hepatitis B, you should be tested for hepatitis D if:

  • You or your family comes from a region with high rates of hepatitis D; and/or
  • You have a low viral load, but you continue to have signs of liver damage, indicated by elevated ALT/SGPT or an ultrasound exam of your liver, if your doctor has ruled out fatty liver, NASH or alcohol-related liver damage.

Talk to your doctor about getting tested. Click here for a hepatitis D fact sheet to give to your doctor and click here for a patient-oriented fact sheet. An affordable hepatitis D test has recently become available in the U.S. For more information, click here.

  • Find answers to frequently-asked-questions about hepatitis D here.
  • To watch the webinar featuring Dr. Gish discussing the hidden, hepatitis D epidemic, click here.