Hep B Blog

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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? Acute or Chronic? Learning the Hep B Basics

Image courtesy of dream designs at FreeDigitalPhotos.net
Image courtesy of dream designs at FreeDigitalPhotos.net

If you’ve just been diagnosed with hepatitis B after a routine blood test or following a blood donation, you may be feeling overwhelmed with information about this complicated infection and references to acute or chronic hepatitis B.

Here is an explanation of these two terms and what happens when you’re first infected with the hepatitis B virus (HBV). Hepatitis B is transmitted through blood and body fluids. It can be spread during unprotected sex, unsafe medical procedures, exposure to blood that enters your body through a cut,  or by sharing personal items such as body jewelry or toothbrushes. Most commonly it is spread during childbirth when the mother is infected.

What is a chronic infection? When we’re infected as newborns or young children, our immature immune systems don’t notice or fight the virus and it travels to our liver and begins reproducing. With no opposition from our immune systems, a hepatitis B infection can continue for years. When a hepatitis B infection lasts longer than six months, it is considered a chronic or long-term infection. Most people with chronic hepatitis B were infected at birth or during early childhood. Immunization with the hepatitis B vaccine and hepatitis B immune globulin (HBIG), if available, within 12 to 24 hours of birth can break this mother-to-child infection cycle, but the birth vaccine dose and often HBIG is not always available around the world.

What is an acute infection? When we’re infected with HBV as healthy adults, about 90 percent of us are able to get rid of the infection within six months. It can take up to six months for our immune systems to generate antibodies and eradicate the infection in our liver. This short-term infection is called acute hepatitis B.

To determine if you have an acute or chronic infection, you must be tested for hepatitis B over a six-month period. The specific test that indicates if you are infected is the hepatitis B surface antigen (HBsAg) test. This antigen covers the surface of the virus and usually there are lots of HBsAg in your blood when you’re infected. If you test positive for HBsAg for longer than six months, it means you have a chronic hepatitis B infection.

But, if you no longer test positive (or “reactive”) for HBsAg after six months and you develop hepatitis B surface antibodies (HBsAb), then you have cleared hepatitis B after an “acute” infection. There are some additional blood tests that your doctor may order to get a better understanding of your infection, but not everyone has access to these tests. Some tests are rather expensive and they may still need to be repeated over time in order to confirm the diagnosis. Please be patient. The good news is that hepatitis B is not typically an emergency.

Here is more good news. If you are a healthy adult and are newly or acutely infected, know that your chances are good that the hepatitis B infection will go away on its own. It is rare that you require medication to get rid of the virus, your immune system does that for you.  A person with a new hepatitis B infection may not have any symptoms, or they may not be very notable. For example, you might feel more tired. About 70 percent of people newly-infected with hepatitis B never experience symptoms.

But, some people experience severe symptoms like jaundice (yellowing skin or eyes), severe nausea or vomiting, or a bloated stomach (unrelated to your weight), and they need to see a doctor immediately. If you have a new or acute infection, even these drastic symptoms may not necessarily mean that you need any form of treatment, but you will need to be monitored with additional tests to make sure your liver is safe.

If you can’t confirm you were infected as a child, you will need to wait the six months to find out if you cleared your infection. Please be patient and do not panic, but remember you do need to take precautions during this time to make sure you don’t spread the infection to others. Practice safe sex (use a condom), and don’t share personal items that may have trace amounts of blood on them.

Also, you can suggest that your family members get screened for hepatitis B and vaccinated if needed. If you were infected at birth, there is a chance that your siblings may also be infected. Sexual partners and close household members should also be tested. There may be a nine-week period right after infection when they may not test positive for HBsAg even if they have been infected.

Celebrate Asian-Pacific American Heritage Month, And Get Tested for Hepatitis B

Image courtesy of hin255 at FreeDigitalPhotos.net
Image courtesy of hin255 at FreeDigitalPhotos.net

May is Asian-Pacific American Heritage Month – a celebration of Asians and Pacific Islanders in the United States. The month of May was selected in 1978 to mark the first major Japanese immigration to the United States (May 7, 1843), and the completion of the transcontinental railroad (May 10, 1869), built primarily by Chinese immigrants.

Like all immigrants, Asians and Pacific Islanders brought with them unique cultures, languages, and lingering health problems from their homeland, including hepatitis B.

This blood-borne infection, unknowingly passed from mother-to-child, is an infection without a cure that would impact Asian immigrants and their children for decades until a vaccine was developed.

Today, administration of the first dose of the hepatitis B vaccine along with a dose of HBIG within 12 hours of birth severs this viral legacy and protects newborns from inheriting this infection. But that is not the end of the story. There are still many Asian-Americans who remain infected, and many Asian immigrants arriving today live with hepatitis B.

An estimated one in 12 Asian-Americans currently has hepatitis B, and two in three don’t know they are infected. Their infection rate is more than 20 times higher than that of the total U.S. population. Hepatitis B is the greatest health disparity between Asian-Americans and the general U.S. population. Approximately 1 million Asian-Americans are living with chronic hepatitis B infection – that’s about half of all cases in the United States. Continue reading "Celebrate Asian-Pacific American Heritage Month, And Get Tested for Hepatitis B"

It’s Hepatitis Awareness Month: Five Reasons We Don’t Get Tested, and How to Overcome Them

Members of Drexel University's Asian Pacific American Medical Student Association participate in a hepatitis B screening program at a Chinese Christian church in Philadelphia.
Members of Drexel University’s Asian Pacific American Medical Student Association participate in a hepatitis B screening program at a Chinese Christian church in Philadelphia.

May is Hepatitis Awareness month. Why do we need an annual reminder about hepatitis B? Because 65 percent of the estimated 2.2 million people in the U.S. living with hepatitis B don’t know they’re infected.

Studies show when people know their hepatitis B status, they’re more likely to get monitored regularly, get treatment, and take steps to avoid passing on the disease to partners and their children.

So why are so many Americans unaware of their hepatitis B infection? Here are five roadblocks that stop us from getting tested for hepatitis B, and what how we can do to overcome them.

We feel fine, so we assume we’re not infected. Hepatitis B rarely causes symptoms. There are very few sensory nerves around the liver, so when a viral hepatitis infection strikes, we rarely feel its effects. As a result, most of us – especially if we were infected as children or newborns – never experience any symptoms for decades. So remember, “feeling OK” is no excuse to avoid testing. Continue reading "It’s Hepatitis Awareness Month: Five Reasons We Don’t Get Tested, and How to Overcome Them"

How Was I Infected with Hepatitis B? Making the Journey from Anger to Acceptance

Image courtesy of stockimages at FreeDigitalPhotos.net
Image courtesy of stockimages at FreeDigitalPhotos.net

By Christine Kukka

“How did I get infected? Who could have infected me?” These questions are common when we are first diagnosed with hepatitis B.

Dumbfounded by the news, we struggle to understand when this infection could have occurred and who could have infected us with a virus that now threatens our health and well-being.

This diagnosis not only affects our health, it can weaken the trust we’ve placed in family members, friends and lovers. It threatens to dismantle basic beliefs we’ve held about fairness and honesty, and the assumption that if we treated people well that we would be treated fairly in return. Infections know no moral codes and ignore all the unspoken deals we have made with the universe. Continue reading "How Was I Infected with Hepatitis B? Making the Journey from Anger to Acceptance"

Taking Antivirals Long-Term for Hepatitis B? Should You Worry About Bone Loss?

Image courtesy of Sira Anamwong at FreeDigitalPhotos.net.
Image courtesy of Sira Anamwong at FreeDigitalPhotos.net.

By Christine Kukka

To prevent liver damage and cirrhosis and reduce the risk of liver cancer–especially in older patients who’ve had hepatitis B for decades–doctors often prescribe long-term antiviral treatment. But some antivirals cause minor bone loss, which poses a problem for older patients with osteoporosis.

According to experts, the risk of bone loss from long-term antiviral treatment is low, and in fact some antivirals do not cause any bone loss at all. But if you are starting antivirals at an older age, or if you have been on antivirals long-term, experts recommend you monitor your potassium and vitamin D levels and regularly test for bone loss in the hip area so you know if you are experiencing bone loss and need a calcium or vitamin D supplement. Continue reading "Taking Antivirals Long-Term for Hepatitis B? Should You Worry About Bone Loss?"

Diagnosed With Chronic Hepatitis B? What Does Your HBV DNA Test Tell You?

Image courtesy of Praisaeng, at FreeDigitalPhotos.net.
Image courtesy of Praisaeng, at FreeDigitalPhotos.net.

If you have been diagnosed with chronic hepatitis B, your doctor has probably run several blood tests that show if the infection is harming your liver and identify what stage of infection you are in. Doctors consider all of these results when deciding if you need treatment and how often you should be monitored.

In this blog, we’ll examine how one of the tests — the HBV DNA or viral load test –can give you a snapshot into your hepatitis B infection and your health. The HBV DNA test  is performed on a blood sample using a Polymerase Chain Reaction (PCR) technique that rapidly generates HBV DNA fragments so they can be measured. Today, viral load is usually measured using international units per milliliter (IU/mL). However, in the past it was measured in copies per milliliter (copies/mL), and in some regions and labs, it is still used.

If you ever need to convert copies into international units, there are about 5.6 copies in one international unit, so 5,000 copies/mL equals about 893 IU/mL. Remember to keep copies of your lab information on file so you can track your status. An Excel spreadsheet works great.

The sensitivity of HBV DNA tests may vary with each lab so it’s a good idea to always use the same lab for your test. Labs usually measure down to about 300 IU/mL. Below that threshold, the viral load is considered “undetectable” – something all of us with chronic hepatitis B wants to hear.

How HBV DNA results are presented mathematically on your lab report can be confusing. Because the amount of virus in the blood may be very high – in the millions or billions – the result may be displayed as an exponent or a log, rather than a whole number. If this is confusing to you, please take a look at this explanation on the math.

What does viral load say about what stage of hepatitis B you are in? Your viral load also varies over time, depending on your age and “stage” of infection.

Children and adults in the “immune tolerant” stage can have viral loads in the millions or even billions. It sounds scary, but it’s not unusual. Your viral load can remain very high for decades until your immune system begins attacking the infection. Most children and young adults who test positive for the hepatitis B “e” antigen (HBeAg) generally have high viral loads, generally doctors don’t treat patients in this stage. Once their immune systems get rid of HBeAg and generate “e” antibodies (HBeAb), their viral loads begin to decline.

Adults with undetectable or low viral loads and no signs of liver damage are in an “inactive” stage. Adults with normal ALT (SGPT) levels, which indicate no current liver damage, and undetectable or viral loads less than 2,000 IU/mL generally do not require treatment.

People in the “active” stage with elevated viral loads and signs of liver damage need treatment. Many people in their 40s, 50s or 60s, develop HBeAg-negative hepatitis B. Though individuals may have lost HBeAg, the virus has mutated over time and is able to keep replicating, putting these older patients at risk of liver damage. Doctors recommend antiviral treatment if these patients’ viral load exceeds 2,000 IU/ML and their ALT levels are elevated.

Why is it important to measure HBV DNA during treatment? When daily antiviral pills (either tenofovir or entecavir) are prescribed, doctors measure your HBV DNA to see if the drug is working to reduce your viral load. Antivirals work by meddling with the viral DNA so the virus cannot reproduce effectively. Doctors measure your viral load to make sure the antiviral is working.

Why is measuring viral load important if you’re pregnant? Today, all pregnant women are screened for hepatitis B, and experts also want their viral loads to be measured. When pregnant women have high viral loads—exceeding 200,000 IU/mL—medical guidelines recommend antiviral therapy during their third trimester of pregnancy to reduce their risk of infecting their newborns. Babies born to HBV-infected women can become infected even if they are immunized at birth and treated with HBIG (hepatitis B antibodies) if their mothers have high viral loads.

It is important to remember that a viral load test provides you with important information, but it must be considered in relation to your other HBV and liver function tests results to determine if treatment is needed at all, or if you are responding favorably to current treatment. Although an undetectable or low viral load is good news, it does not necessarily guarantee that you have not, or will not experience liver damage. Hepatitis B is a tricky virus. Talk to your liver specialist about all of your test results.

Can People with HBeAg-Negative Hepatitis B Ever Stop Taking Antivirals?

Image courtesy of rakratchada torsap, at FreeDigitalPhotos.net.
Image courtesy of rakratchada torsap, at FreeDigitalPhotos.net.

Medical guidelines suggest that individuals with HBeAg-negative hepatitis B with signs of liver damage face an “indefinite” or even lifetime commitment to taking daily antiviral pills.

In this week’s blog, we explore when—if ever—individuals with hard-to-treat HBeAg-negative hepatitis B can ever stop taking antivirals.

First of all, what is HBeAg-negative hepatitis B? Many people infected with hepatitis B at birth and who remain infected into their 40s, 50s or 60s, develop HBeAg-negative hepatitis B. Researchers believe that over time the virus mutates to evade the immune system. Though individuals may have lost the hepatitis B “e” antigen (HBeAg) and developed the “e” antibody, this mutated virus develops the ability to keep replicating despite the loss of HBeAg. And this mutated virus is capable of putting people at higher risk of liver damage.

Generally, doctors recommend treatment to HBeAg-negative patients when their viral load exceeds 2,000 IU/ML and their ALT liver enzyme levels, which rise when liver cells are damaged, are even moderately elevated. (Normal ALT levels are less than 30 for men and 19 for women.)

The most common antiviral treatments are either entecavir (Baraclude) or tenofovir (Viread). These two are considered the most powerful at quickly reducing viral load (HBV DNA) and have a very low risk of causing drug resistance, which is critical considering the long-term treatment required by HBeAg-negative patients.

But can individuals with HBeAg-negative hepatitis B ever stop treatment? Antivirals are expensive, without insurance tenofovir costs about $1,000 a month and generic entecavir costs about $407 in the U.S. Additionally, long-term antiviral treatment can cause bone loss.

Late last year, hepatitis B experts with the American Association for the Study of Liver Disease (AASLD) tackled this question and reviewed recent studies that followed HBeAg-negative hepatitis B patients who stopped antivirals. They found that even when these patients enjoyed two years of undetectable viral load and normal ALT levels during treatment, when they stopped only half of them were able to maintain a low viral low (below 2,000 IU/mL) and normal ALT levels.

The risk of dangerous “flares” after stopping treatment, “requires careful weighing of potential for harm and benefit,” the experts wrote. This is important because many HBeAg-negative patients are older and more vulnerable to liver damage and cancer.

In their new recommendations, AASLD experts make clear their findings are “conditional” and the quality of evidence found in the studies they reviewed is “low.” However, this is what they tentatively recommend:

  • Stopping treatment, “may be considered in persons who have (lost) the hepatitis B surface antigen (HBsAg). However, there is currently insufficient evidence to definitively guide treatment decisions for such persons.”
  • And, anyone who stops antiviral therapy should be monitored every three months for at least one year to see if their viral load rebounds or if they have signs of liver damage, including ALT flares.

Given the knowledge-gap about the long-term health consequences of HBeAg-negative hepatitis B, more research with longer durations of monitoring are needed, experts recommended. “Alternative treatment strategies for patients on long-term antiviral therapy, such as adding or switching to (pegylated interferon), warrant further study,” they concluded.

 

I’ve Lost the Hepatitis B “e” Antigen (HBeAg), So When Can I Stop Treatment?

Image courtesy of Naypong at FreeDigitalPhotos.net
Image courtesy of Naypong at FreeDigitalPhotos.net

Eighteen years ago, doctors started treating hepatitis B patients with antivirals and today liver specialists have a wealth of knowledge about how these drugs stop the virus from replicating and reduce viral load. But one thing they’re still not certain about is when patients can safely stop taking their daily antiviral pill.

In this week’s blog, we’ll explore when experts think it’s safe for patients, who have lost the hepatitis B “e” antigen (HBeAg) during antiviral treatment, to stop . Next week, we’ll look at when it’s safe for patients who were already HBeAg-negative when they began antiviral treatment to stop.

Today, doctors prescribe one of two antivirals—either entecavir (Baraclude) or tenofovir (Viread). Among the antivirals developed since 1998, these two are considered the most powerful in quickly reducing viral load (HBV DNA) and they carry the lowest risk of drug resistance. Doctors usually prescribe antivirals when our viral load is elevated and we have sign of liver damage–indicated by elevated liver enzymes (ALT or SGPT).

Antivirals quickly knock down viral load, which in turn is believed to lower our risk of liver damage and cancer. But antivirals work for only as long as we take them. When we stop, the virus usually reactivates although this is very rarely fatal or results in a liver transplant. Studies show that at least 78 percent of people who stop antivirals have an increase in viral load, 44 percent have a rise in ALT levels indicating liver damage, and among those who lose HBeAg during treatment, at least 9 percent experienced a return of HBeAg.

But what about individuals who take antivirals for long periods and enjoyed years of undetectable viral load, no signs of liver damage, loss of HBeAg, and development of the “e” antibody? Can they stop? After all, antivirals are expensive. Without insurance, a month’s supply of tenofovir costs about $1,000 and generic entecavir costs about $407 in the U.S., not to mention possible side effects such as bone loss or reduced kidney function with tenofovir..

Late last year, hepatitis B experts from the American Association for the Study of Liver Disease (AASLD) tackled this question and reviewed recent studies that followed patients who stopped antivirals after losing HBeAg. They found no clear answers and made clear their recommendations were “conditional” because the quality of evidence found in the studies was “low.” But here is what they recommend for patients who lost HBeAg during antiviral treatment and now have normal ALT levels:

  • Experts “suggest” that adults who don’t have cirrhosis (severe liver scarring) who lost HBeAg and developed “e” antibodies may stop treatment after a minimum of 12 months of normal ALT levels and undetectable viral load.
  • However, they recommend a longer “consolidation” treatment period might be better to reduce patients’ risk of relapse and a return of HBeAg after treatment stops. They suggested that an alternative approach would be to stay on antivirals until patients lose the hepatitis B surface antigen (HBsAg).

Decisions about how long to stay on antivirals require careful consideration of health risks and benefits, they wrote, including risks of relapse, liver damage, and liver cancer. Other considerations include the cost of treatment, the risk of developing drug resistance if people stop antivirals intermittently, and other side effects.

Anyone who stops taking antivirals, they advise, should be monitored frequently – at least every three months — for at least one year for liver damage and resurgence of viral load. Anyone with cirrhosis should continue treatment indefinitely because of their high risk of liver cancer.

For now, the message appears to error on the side of caution and continue on antivirals until you have cleared HBsAg for a prolonged period of time. Clearly this decision is one you must discuss carefully with your doctor.

In next week’s blog, we examine how long people who were HBeAg-negative when they started antivirals should remain on treatment.