17. Are there other counseling recommendations for someone with chronic hepatitis B?
In terms of counseling, we do a lot of things
that Dr. Sam So has emphasized as well, although we didn’t really
emphasize vaccination. One of my research interests that I’ve
published quite a bit is that if you have underlying chronic hepatitis
B or chronic hepatitis C or some other liver disease, and you get
acute hepatitis A, it will be a more severe liver illness if
you already have pre-existing liver disease. Therefore, the CDC now
recommends hepatitis A vaccine for all people with any chronic liver
disease, alcoholic liver disease, hepatitis B, hepatitis C. Now many of the Asian community that are my
age, that were born in China, already have hepatitis A antibodies,
about 90%-95% are already immune. So, it’s worth checking an A
antibody. Hepatitis A is a very silent infection, occurs often in
childhood in Asian countries and most Asians who are adults are
already immune and don’t need the vaccine, but younger people are
often not immune and need to be vaccinated. Alcohol- now this is just common sense, no
one has studied the lower threshold. The best data is from the
hepatitis C literature and we know that people who drink daily and
heavily have an accelerated progression of their hepatitis C it’s
probably the same for hepatitis B. People need to be counseled about
infectivity, and there it’s DNA and e-antigen. 50% of sexual partners
will be infected with hepatitis B. This is also not widely known- hepatitis B
is far more infectious by sexual contact than HIV and more than
hepatitis C. Now if you have a low DNA, then there’s a low risk of
sexual spread, but you can still spread hepatitis B. All household contacts should be tested and
all newborns should be vaccinated.
16. What are the AASLD Practice Guidelines for treatment of chronic hepatitis B?
18. Should someone with chronic hepatitis B be screened for liver cancer?