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Closing a Healthcare Gap: Medicare Finally Covers Hepatitis B Testing in At-risk Seniors

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

By Christine Kukka

Medicare insurance pays for seniors to get vaccinated against hepatitis B, but it doesn’t cover testing to find out if they’re infected and need life-saving treatment. The federal government is now poised to close this glaring healthcare gap that prevents at-risk seniors from getting screened for hepatitis B.

Last week, the Centers for Medicaid and Medicare Services proposed to cover hepatitis B testing in seniors age 65 and older who may be at risk of the liver infection.

Currently, the majority of the estimated 2 million Americans with chronic hepatitis B are over age 50, and the longer they are infected, the higher their risk of liver damage and cancer. This preventive screening saves lives and is cost-effective, because treatment with antivirals quickly and effectively reduce liver damage.

Until the Hepatitis B Foundation, Hep B United, the Association of Asian Pacific Community Health Organizations and the National Viral Hepatitis Roundtable asked the federal government to cover screening,  seniors who wanted to be tested for hepatitis B had to pay for the test themselves. Because hepatitis B is a “silent” infection, causing few symptoms until cirrhosis or cancer develop, nearly two-thirds of Americans living with hepatitis B have never been tested, identified or referred to life-saving treatment.

The highest rate of liver cancer in this country is in Vietnamese-American men, many of whom were never tested for hepatitis B. By the time they are diagnosed, it is often too late. Here’s two more examples of the high cost of this healthcare gap:

  • The Charles B. Wang Community Health Center in New York City serves a large Asian-American population. When the clinic screened all of its patients for hepatitis B, it found 7.8 percent of patients age 65 and older were chronically infected and 45 percent had been infected in the past.
  • Another New York City study of African immigrants, which included all ages, found 9.6 percent of them were chronically infected.

Today, the most vulnerable Americans are infected at a rate 10-times the national average, yet until now the government didn’t cover the cost of screening them. Medicare did cover testing if there were signs of liver damage from other medical tests, but in the case of late-stage hepatitis B infections, a diagnosis often comes too late for treatment.

Screening seniors for hepatitis B has a life-saving ripple effect across generations. When hepatitis B is diagnosed in a grandparent, there is an opportunity to educate, test and vaccinate their children and grandchildren who are also at risk.

Under the new guidelines, which also apply to disabled people covered by Medicare Part B, Medicare will reimburse primary care providers when they screen people at risk of hepatitis B, including:

  • People born in regions with high hepatitis B rates, including Asia, Africa, the Middle East, the Caribbean, Eastern Europe, and some areas of South and Central America.
  • Second-generation residents who were not vaccinated at birth and whose parents come from high-risk regions, such as sub-Saharan Africa and central and Southeast Asia
  • HIV-positive persons, injecting drug users, men who have sex with men, and
  • Family and household members of people with chronic hepatitis B.

This expanded coverage will go far to screen seniors, but gaps remain.

Under the proposed guidelines, only primary care providers can order testing, but many specialists including oncologists, rheumatologists and gastroenterologists see patients at risk for hepatitis B. The expanded coverage should include them and also pharmacists.

Additionally, both providers and the public need to know more about hepatitis B. Today, the majority of people infected with hepatitis B don’t know they’re infected. Patients often don’t share their true stories of activities that may put them at risk of hepatitis B, especially if it includes sexual abuse or injecting drug use, and doctors often don’t have the time or the skills to elicit this vital information. Along with expanded coverage should come public education to provide a common language for these difficult conversations.

Lastly, while providers are screening more Asian-Americans for hepatitis B, many of those at-risk remain undiagnosed, including first- and second-generation African immigrants.

This expanded Medicare coverage is long over-due, but we have a long way to go.

To read the proposed, expanded coverage for hepatitis B testing,  please click here.

To submit a comment about the proposed coverage, click here .


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?"

Want to Avoid Liver Cancer? There Are Things You Can Control

Image courtesy of FreeDigitalPhotos.net
Image courtesy of FreeDigitalPhotos.net

We who live with hepatitis B know that avoiding alcohol and cigarettes go a long way toward reducing our risk of liver cancer. But there are new threats emerging. Researchers are finding that obesity, diabetes and developing fatty liver from unhealthy food and a sedentary lifestyle can be just as dangerous to our livers.

In a recent study, published in the Journal of Hepatology, researchers found:

  • If you have chronic hepatitis and are obese with a fatty liver, your liver cancer risk increases 1.5 to 4.5 times
  • And, if you have hepatitis B and diabetes, your liver cancer risk climbs two- to three-fold.

This is a sobering realization that our lifestyle and our weight matter a lot when it comes to how long we will live. We may like to think we won’t develop liver cancer because our viral load is low or our liver tests don’t show any damage, but sitting all day and over-eating are just as dangerous. Continue reading "Want to Avoid Liver Cancer? There Are Things You Can Control"

Your Doctor Not Screening You for Liver Cancer? Time for a Talk

Image courtesy of FreeDigitalPhotos.net
Image courtesy of FreeDigitalPhotos.net

The longer we have hepatitis B, the higher our risk of developing liver cancer. With every decade of life, our liver cancer risk increases 2.7-times, according to a report on Viral Hepatitis in the Elderly published in the American Journal of Gastroenterology.

But current medical guidelines don’t spell out exactly when liver cancer testing should begin in many hepatitis B patients who don’t have liver damage (cirrhosis) or a family history of liver cancer, and are not of Asian or African descent.

Age is clearly an important factor when it comes to liver cancer, “… but current guidelines only provide age-specific recommendations for (liver cancer) surveillance in hepatitis B carriers of Asian ethnicity (men over age 40 and women over age 50),” a team of University of Miami and Veterans Affairs researchers wrote in the journal article. Continue reading "Your Doctor Not Screening You for Liver Cancer? Time for a Talk"

Growing Older with Hepatitis B: Prevention and Precautions Still Matter

Image courtesy of Ambro at FreeDigitalPhotos.net
Image courtesy of Ambro at FreeDigitalPhotos.net

Most people living with chronic hepatitis B today are over age 50, and like their younger counterparts, they need to prevent spreading hepatitis B to their sexual partners, housemates, and neighbors in assisted living facilities.

You’re never too old for safe sex: You may not have to worry about pregnancy any more, but you still need to protect yourself and your partner against sexually transmitted diseases such as hepatitis B. Using a condom (and keeping a barrier between you and potentially infectious body fluids) is essential because many seniors have not been immunized against hepatitis B.

The widespread marketing of erectile dysfunction drugs allows for sex by older men, and thinning and dryness of vaginal tissue in older women may raise their risk of infection during intercourse. Continue reading "Growing Older with Hepatitis B: Prevention and Precautions Still Matter"