Hep B Blog

Category Archives: Living with Hepatitis B

HBV Journal Review – April 2014

ChrisKHBF 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:

  • Despite Antiviral Treatment, Liver Cancer Risk Persists
  • Vitamin D Appears to Help Prevent Liver Cancer
  • Dandelions May Be the Next Best Herbal Treatment for Hepatitis B
  • Kidney Problems Are Prevalent with Hepatitis B Even Before Treatment Starts
  • HBV Genotype H Appears to Cause Immediate Chronic Infection in Adults
  • HBV Genotype E Has the Worst Response to Pegylated Interferon
  • Cancer-Causing YMDD Mutations Found Frequently in HBV Genotype C
  • High Iron Levels Found in Patients with Liver Failure
  • Vietnamese-Americans at High Risk of Undiagnosed Hepatitis B and C
  • Entecavir Performance Is Mediocre in Lamivudine-Resistant Patients
  • A Simple Platelet Count Test Could Be Best Indicator of Fibrosis

HBV Journal Review
April 1, 2014
Volume 11, no 4
by Christine M. Kukka

Despite Antiviral Treatment, Liver Cancer Risk Persists
Researchers have hoped that treating hepatitis B patients with antivirals would reduce both their viral loads and their liver cancer risk. However, a new study that followed 1,378 treated and 1,014 untreated patients over five years found antivirals did not reduce liver cancer rates as hoped.

The study tracked new liver cancer cases among patients infected with the hepatitis B virus (HBV) (average age 47, 65% male) who had been treated primarily with entecavir (Baraclude) for their high viral loads and liver damage. They compared that group’s liver cancer occurrence to those of patients whose “inactive” HBV infection did not require treatment.

Among the treated group, 70 patients (6.2%) developed liver cancer during the study period compared to only 11 (1.1%) in the untreated group. Notwithstanding  the ability of antivirals to reduce viral load, a life-long history of HBV infection and liver damage appeared to increase cancer risk, despite the reduction in viral load later in life.

What is especially disappointing is that liver cancer developed even in treated patients who had no history of cirrhosis (severe liver scarring) which increases cancer risk. Among the antiviral-treated patients:

  • • 20 of 223 HBeAg-negative patients who had cirrhosis at the start of treatment developed liver cancer.
  • • 15 of 316 HBeAg-negative patients who had no cirrhosis also developed liver cancer.
  • • Among the treated patients who developed liver cancer, 30 were positive for the hepatitis B “e” antigen (HBeAg) and 30 were HBeAg-negative.

How well the antiviral worked in patients also determined who remained cancer-free. Of the 246 patients who failed to achieve low or undetectable viral loads as a result of treatment, 36 (18.8%) patients developed liver cancer over the five-year study.

The risk of cancer was increased overall by male gender, underlying cirrhosis and older age in the treated group. Curiously, having high viral loads (HBV DNA) at the start of treatment did not appear to increase liver cancer risk.

The key message for doctors is that liver cancer risk remains despite a dramatic reduction in viral load, researchers noted. “…Patients on (antiviral) treatment that effectively suppressed viral replication are still at higher risk of liver cancer compared with patients with inactive stage chronic hepatitis B,” they concluded in the study published in the March issue of the journal Gut.

Persistent liver damage before the start of antiviral treatment, evidenced by elevated alanine aminotransferase (ALT) levels, may predispose patients to liver cancer, they also noted.

“The inactive group may have more intact immune response to HBV and therefore may also have entered the inactive stage early in life, with a shorter period of high viral replication and active hepatitis,” they wrote.

Source: www.ncbi.nlm.nih.gov/pubmed/24615378

Vitamin D Appears to Help Prevent Liver Cancer
Recent studies show a diet rich in vitamin D can improve liver health in patients with hepatitis B. A new study from Emory University in Atlanta finds that people with high vitamin D levels have lower rates of liver cancer.

The researchers examined vitamin D levels and liver cancer risk among 520,000 participants in the European Prospective Investigation into Cancer and Nutrition between 1992 and 2010.

Continue reading this review and additional HBV related reviews for March

Viral Hepatitis Action Alert!

red-phoneRepresentatives Mike Honda, Hank Johnson, and Judy Chu are asking all House Representatives to sign an important letter supporting increased funding for viral hepatitis programs in the Fiscal Year 2015 appropriations bill (see text of letter below)

Please take a few minutes before March 25th to call your House Representative’s office in Washington, DC and ask/him to sign this letter.

You can reach your Representative through the Congressional Switchboard at (202) 224-3121. Ask to be connected to your Representative. Once you are connected to the office, ask to speak to the staff person who handles health care issues. Whether you speak to that person live or leave a voicemail, tell them (1) your name, (2) where you live and that you are a constituent, (3) that you would like the Representative to sign the “Dear Colleague” letter from Representatives Honda, Johnson, and Chu supporting increased funding for viral hepatitis and (4) a brief message why this issue is important to you. Tell them they can sign the letter by contacting Kelly Honda in Representative Honda’s office, Scott Goldstein in Representative Johnson’s office, or Linda Shim in Representative Chu’s office. The deadline for Representatives to sign is March 25th.

Text of “Dear Colleague” letter from Representatives Honda, Johnson, and Chu:

Support Funding for Viral Hepatitis

March XX, 2014

The Honorable Jack Kingston
Chairman
Subcommittee on Labor, Health and Human Services
United States House
Washington, D.C., 20515

The Honorable Rosa DeLauro
Ranking Member
Subcommittee on Labor, Health and Human Services
United States House
Washington, D.C., 20515

Dear Chairman Kingston and Ranking Member DeLauro:

As you begin deliberations on the Fiscal Year 2015 Labor, Health and Human Services, Education, and Related Agencies Appropriations bill, we would like to respectfully request that you allocate $47.8 million for the Division of Viral Hepatitis (DVH) at the Centers for Disease Control and Prevention (CDC), an increase of $16.4 million over the FY2014 level.

The CDC’s 2010 professional judgment (PJ) budget recommended $90.8 million each year from FY2011-FY2013, $170.3 million annually from FY2014-FY2017, and $306.3 million annually from FY2018-FY2020 for DVH in order to comprehensively address the viral hepatitis epidemic. While past increases have been helpful, these have only been small steps toward building a more comprehensive response to viral hepatitis. Our recommendation of $47.8 million is in line with the needs determined by the PJ and the goals of the Viral Hepatitis Action Plan, but pales in comparison to the CDC’s PJ.

The need to enhance and expand these prevention efforts is growing more urgent. Viral hepatitis is the leading cause of liver cancer – one of the most lethal, expensive and fastest growing cancers in America. More than 5.3 million people in the U.S. are living with hepatitis B (HBV) and/or hepatitis C (HCV) and 65-75% of them are undiagnosed. Without an adequate, comprehensive surveillance system, these estimates are only the tip of the iceberg. Viral hepatitis kills 15,000 people each year and is the leading non-AIDS cause of death in people living with HIV – nearly 25 percent of HIV-positive persons are also infected with HCV and nearly 10 percent with HBV.

The epidemic is particularly alarming because of the rising rates of new infections and high rates of chronic infection among disproportionately impacted racial and ethnic populations, and presents a dramatic public health inequity. For example, HCV is twice as prevalent among African Americans as among Caucasians. Asian Americans comprise more than half of the known hepatitis B population in the United States and, consequently, maintain the highest rate of liver cancer among all ethnic groups. Additionally, African American and Latino patients are less likely to be tested for HCV in the presence of a known risk factor, less likely to be referred to treatment for subspecialty care and treatment, and less likely to receive antiviral treatment. Recent alarming epidemiologic reports indicate a rise in HCV infection among young people throughout the country. Some jurisdictions have noted that the number of people ages 15 to 29 being diagnosed with HCV infection now exceeds the number of people diagnosed in all other age groups combined.

Further, the baby boomer population (those born 1945-1965) currently accounts for two out of every three cases of chronic HCV. As these Americans continue to age, they are likely to develop complications from HCV and require costly medical interventions that can be avoided if they are tested earlier and provided with treatment options. It is estimated that this epidemic will increase costs to private insurers and public systems of health such as Medicare and Medicaid from $30 billion in 2009 to over $85 billion in 2024, and also account for additional billions lost due to decreased productivity from the millions of workers suffering from chronic HBV and HCV.Over the last two years, CDC and the U.S. Preventive Services Task Force (USPSTF) have begun to align their recommendations for hepatitis screening, recommending one-time testing of baby boomers and screening vulnerable groups for HCV.

We appreciate the Committee’s support for viral hepatitis prevention, in particular the increased support to prioritize the identification of HBV and HCV-positive individuals who are unaware of their status. We strongly encourage you to sustain your commitment this year. We have the tools to prevent the major causes of viral hepatitis and liver cancer – a hepatitis B vaccine and effective treatments that reduce disease progression, new diagnostics for HCV and treatments that increase cure rates over 90%, and even more medical advances in the research pipeline. Making this relatively modest investment in the prevention and detection of viral hepatitis represents a key component in addressing a vital public health inequity and will get more Americans into care, strengthen our public health infrastructure and combat the devastating and expensive complications caused by viral hepatitis.

Sincerely,

XXX

The World’s Second Deadliest Cancer Is …Preventable

bandages

Liver cancer is the world’s second leading cause of cancer deaths, according to the latest World Cancer Report 2014 released by the International Agency for Research on Cancer (IARC), which is the specialized cancer agency of the World Health Organization (WHO). About 800,000 deaths per year are related to liver cancer. Continue reading "The World’s Second Deadliest Cancer Is …Preventable"

HBV Journal Review – March 2014

ChrisKHBF 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:

  • Tenofovir More Potent Than Entecavir in Patients with High Viral Loads
  • Antiviral Treatment After Liver Cancer Surgery Improves Survival Dramatically
  • The New “Normal” ALT Levels Are Better at Diagnosing Active Infections
  • Culturally-Adept Program Boosts HBV Screening Among Asian-Americans
  • Experts Explore Ways to Treat and Monitor HBeAg-Negative Patients
  • CDC Experts Estimates 6.5 New Hepatitis B Infections for Every One Reported
  • Sperm Washing Successfully Prevents Infection Transmittal During Conception
  • Tenofovir Effective in Patients with Drug Resistance, But Less So with Adefovir-Resistance
  • Hepatitis B Vaccination Still Protects Even When Antibodies Decline

Continue reading "HBV Journal Review – March 2014"

HBV Journal Review – February 2014

ChrisKHBF 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:

  • Tests for Antigens and Drug-Resistant Virus Emerge as Valuable Diagnostic Tools
  • Experts Issue a Report Card on Side Effects from Antivirals
  • Experts Weigh in on Why They Prefer Either Antivirals or Interferon
  • Doctors Explain Which Medical Guidelines They Follow, Or Ignore
  • Truvada Effective in Lowering Viral Load in Young Adults with High Viral Load
  • Hepatitis B Causes Most Liver Cancer Deaths in China
  • Smoking Shortens Survival after Liver Cancer Surgery

 HBV Journal Review

February 1, 2014
Vol 11, no 2
by Christine M. Kukka

Tests for Antigens and Drug-Resistant Virus Emerge as Valuable Diagnostic Tools

Measuring the amount of hepatitis B surface antigen (HBsAg) in your bloodstream or conducting quick tests for drug-resistant hepatitis B virus (HBV) may soon be part of your office visit in the brave new molecular world of hepatitis B treatment.

Doctors increasingly are measuring HBsAg levels to determine if treatment is needed or if current medications are working. HBsAg tests—along with measuring alanine aminotransferase (ALT) for signs of liver damage and HBV DNA for viral load—may become essential tools to assess hepatitis B progression or remission.

HBsAg is the protein that makes up the outer covering of HBV. When a patient has a high viral load (and is positive for the hepatitis B “e” antigen—HBeAg), there are often large quantities of HBsAg circulating in the blood stream. When viral replication slows and HBeAg disappears, there can be lower quantities of HBsAg.

But experts are learning that high HBsAg levels can increase cancer risk, even in HBeAg-negative patients, according to a study published in the journal Annales de Biologie Clinique. (1) As a result, there is heightened attention on HBsAg as a key indicator of a patient’s health. For example:

  • In HBeAg-negative patients, HBsAg levels less than 1,000 international units per milliliter (IU/mL) along with low viral load (HBV DNA) under 2,000 IU/mL indicate the patient is an “inactive” patient.
  • When patients are treated with pegylated interferon, doctors can tell if the treatment is working if there is a decline in HBsAg levels within 12 weeks. This early indicator can save money if the drug isn’t working and help to avoid uncomfortable side effects. Doctors recommend patients with genotypes B and C should stop interferon at week 12 if their HBsAg levels remain at 20,000 UI/mL or higher.

Another team of French researchers, also exploring the implications of HBsAg in an article published in the February 2014 issue of the journal Liver International, suggest that as HBsAg levels decline, so does the risk of liver cancer.

They also suggest that during antiviral treatment, a rapid decline in HBsAg may indicate which patients will eventually clear HBsAg. A 100-fold decline or more of HBsAg over six months of treatment, “… could be a marker of a sustained response after treatment cessation,” they wrote.(2)

In another diagnostic breakthrough, researchers writing in the December journal of Clinical Molecular Hepatology promoted the value of a HepB Typer-Entecavir kit that can precisely detect HBV that have viral mutations that can “resist” the antiviral drug entecavir (Baraclude). This diagnostic tool allows doctors to select the most effective antiviral for each individual patient based on the molecular makeup of their HBV.(3)

1. Source: www.ncbi.nlm.nih.gov/pubmed/24235324  
2. Source: www.ncbi.nlm.nih.gov/pubmed/24373085  
3. Source: www.ncbi.nlm.nih.gov/pubmed/24459645

Experts Issue a Report Card on Side Effects from Antivirals
Hong Kong researchers evaluated the side effects of commonly-used antivirals in the December 2013 issue of the Journal of Gastroenterology and Hepatology. Antivirals disrupt the genetic make-up of HBV, making it difficult for the virus to replicate. While generally safe, patients must take antiviral pills daily over several years and side effects include damage to the mitochondria of the body’s cells (called mitochondria toxicity.)

Continue reading this and additional studies for Februrary

HBV Journal Review – January 2014

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: Continue reading "HBV Journal Review – January 2014"

HBV Journal Review – December 2013

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: Continue reading "HBV Journal Review – December 2013"

Entecavir + Tenofovir Works Well for Hepatitis B Patients with Prior Treatment Failure

Published on Monday, 11 November 2013
Written by Liz Highleyman
HIVandHepatitis.com

A dual regimen of entecavir (Baraclude) plus tenofovir (Viread) for 48 weeks led to virological response and was generally well-tolerated as second-line therapy for chronic hepatitis B patients who had failed previous nucleoside/nucleotide treatment, according to a poster presentation at the 64th AASLD Liver Meeting last week in Washington, DC. Continue reading "Entecavir + Tenofovir Works Well for Hepatitis B Patients with Prior Treatment Failure"

Hepatitis B Mutation Seen in Only Men, Increased Risk of Liver Cancer

High Level of Sexual Harassment in Men Linked to Purging: Study

Are you depressed? (Photo : Reuters)

Posted in Science World Report, October 17, 2013

A recent study looks at a form of hepatitis B that is only found in men and may explain higher rates for certain types of cancer.

According to a team of researchers from Seoul National University in Korea, they identified a mutation from the hepatitis B virus that seems to appear only in men and may explain why HBV-infected males are roughly five times more likely than HBV-infected women to develop certain types of liver cancer. Continue reading "Hepatitis B Mutation Seen in Only Men, Increased Risk of Liver Cancer"

HBV Journal Review – October 2013

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:

  • Study Finds Only 21% of Hepatitis B Patients Are Treated Correctly
  • Combination of Chinese Herbs Plus Antiviral Entecavir Proves Effective
  • Caesarians Reduce Infection of Newborns When Mothers Have High Viral Loads
  • Combined Antiviral and Interferon Treatment Effective in Those Under Age 30
  • New Tenofovir Formula May Lead to Less Bone Loss and Kidney Problems
  • HBV Mutation Found Only in Men May Explain Their Higher Rates of Liver Damage
  • Sumo Wrestlers Found to Transmit HBV Infection
  • Taiwan’s Hepatitis B Immunization of Infants Reduces Hepatitis B by 90%
  • Tenofovir Reverses Severe, Decompensated Cirrhosis

HBV Journal Review
October 1, 2013
Volume 10, Issue 10
by Christine M. Kukka 

Study Finds Only 21% of Hepatitis B Patients Are Treated Correctly

A new study, examining how well San Francisco primary care providers care for their patients infected with the hepatitis B virus (HBV), finds most fail to screen them for liver cancer or regularly evaluate their viral load or hepatitis B “e” antigen (HBeAg) status, though medical guidelines require annual or semi-annual testing.

The study, published in the September 2013 issue of the journal Digestive Diseases and Sciences, surveyed doctors who provide care through a safety net program to many uninsured patients. They were asked how well they thought they followed current medical guidelines, and then patient medical records were analyzed to assess the true quality of care.

Of the 148 doctors surveyed, 79% claimed to follow medical guidelines and monitor patients’ liver health every 6 six 12 months. However, patient medical records covering the last 12 months showed substandard care.

  • • Only 75% of patients had their alanine aminotransferase (ALT) levels, which shows liver damage, tested in the past year.
  • • Only 51% had their viral load (HBV DNA) tested.
  • • Only 51% had been screened for liver cancer (either with an alpha fetoprotein test or some type of liver imaging). This test should be performed annually, and doctors are at risk of medical malpractice if they do not screen patients for cancer.
  • • HBeAg tests were performed in only 29% of patients.
  • • Only 32% of the hepatitis B patients had been immunized against hepatitis A, another guideline requirement, to protect them from another liver infection.

Bottom line, researchers found that only 21% of patients had been monitored properly in compliance with current hepatitis B guidelines. Forty-three percent of doctors were not familiar with medical guidelines for hepatitis B management and only 73% answered all questions about hepatitis B correctly.

There was also a racial bias regarding which HBV-infected patients were screened for hepatitis C and HIV. Doctors tended to test African-American and Latino patients for hepatitis C (48% and 44% respectively) at a higher rate than they tested whites and Asian-American patients (34% and 31%.)

The study suggests that fear of malpractice—more than knowledge of current practice guidelines—may drive doctors to perform the required liver cancer screenings each year. Also, the researchers suggest that hepatitis B public education initiatives, spearheaded by the San Francisco Hepatitis B Free Campaign, may have contributed to better monitoring of Asian-Americans because it raised awareness among the public and their providers.

“These findings highlight the importance of targeted provider education to improve overall care,” for hepatitis B, the researchers from the University of California, San Francisco, suggest.

Continue reading about this and additional HBV related studies