Hep B Blog

Joan Block, Hepatitis B Foundation Co-founder, Honored for Advocacy Work

A wonderful article (reprinted below) and short video was published last weekend in Phillyburbs.com recognizing the work of Joan Block, the Executive Director and co-founder of the Hepatitis B Foundation. In commemoration of World Hepatitis Day, Joan and Dr. Anna Lok were honored by the Viral Hepatitis Action Coalition of the Centers for Disease Control Foundation, for advocacy work resulting in the protection of medical students from HBV discrimination, and ultimately having HBV recognized as a disability protected under the Americans with Disabilities Act (ADA). This amazing accomplishment is just one of the many successes Joan and the HBF have had over the last 23 years as a result of her tireless efforts and dedication to the mission to help improve the lives of those affected by hepatitis B.

Please visit Phillyburbs.com to access to view the short video where Joan talks about the Foundation’s beginnings and how the HBF has grown from a grass roots effort to the leading national nonprofit for hepatitis B. Joan Block and the HBF truly are the “voice of hepatitis B”.

Read more about the story and the mission of the Hepatitis B Foundation and be sure to visit the HBF website to learn more about hepatitis B and the work of the Foundation.

For more than two decades, the Hepatitis B Foundation has fought to find a cure for the liver disease and advocate for those who have it.

What started as a grass-roots effort of four passionate people has grown into one of the leading nonprofit research and disease advocacy organizations in the United States.

“We are the voice for hepatitis B in the United States,” said co-founder and executive director Joan Block. “There’s still a lot of work to do, but we’ve accomplished a lot in the past 23 years.”

Earlier this year, the foundation’s mission got a boost when the U.S. Department of Justice said hepatitis B patients are protected under federal disability law in a case brought by the foundation against a New Jersey medical school on behalf of two students who were denied admission because they had the disease.

The case earned Block and Dr. Anna Lok, director of clinical hepatology at the University of Michigan Health System, recognition from the Centers for Disease Control Foundation, which honored both women on World Hepatitis Day July 25.

“That award is really being given to the foundation,” said Block, who lives in Doylestown Township. “It’s not me; it’s the work of the foundation. Without the foundation, I honestly don’t know if hepatitis B would even have much on the radar screen. There are very few voices, and we are probably the primary voice at the national level.”

Hepatitis B is an infectious liver disease that can be spread by sexual contact, sharing infected needles or at birth from mother to child, according to the Centers for Disease Control and Prevention. Chronic infection can lead to liver failure and cancer.

Block, her husband, Timothy Block — a researcher and academic who more often serves as the public face of the foundation — and New Hope philanthropists Jan and Paul Witte founded the Hepatitis B Foundation 23 years ago to draw more attention to and develop a cure for the disease, which affects up to 1.4 million Americans.

The couples initially started out to help a local family dealing with the disease. But what they found was little interest from the public health sector in researching a cure. The hepatitis B vaccine has led to dramatically lower rates of infection, and the prevailing, yet incorrect, belief at the time was that the disease infected mainly gay men and intravenous drug users.

“The more we dug, the more we realized there was nothing out there,” Joan Block said. “It was really grass roots, just the four of us in (the Wittes’) kitchen. We had the grand mission of raising a lot of money to start a research effort. That’s really what we needed. But it was hard to raise money when people didn’t know what hepatitis B was.”

Over the years, she said, the foundation has received numerous phone calls from people who believed they were being discriminated against because they have the disease. Some of them were medical professionals.

In 2011, four students contacted the foundation over six months, all claiming they were denied admission to or kicked out of medical and dental schools after discovering they had hepatitis B. All four were Asian Americans who were infected at birth. About half of infected patients in the U.S. are of Asian descent.

“It seemed like an avalanche,” said Block, a registered nurse who taught at Abington’s nursing school.

The foundation and Lok lobbied the CDC to update hepatitis B guidelines for medical professionals and students last changed in 1991. Since that last update, there have been no reports of hepatitis B transmission from medical or dental students, according to the CDC.

The Hepatitis B Foundation also filed a lawsuit on behalf of two students denied admission to the University of Medicine and Dentistry of New Jersey. The school settled with the Department of Justice.

In an added step, the departments of justice, health and human services and education sent a joint letter to the nation’s medical and dental schools about hepatitis B, encouraging them to adopt the CDC guidelines and informing them that people with hepatitis B are protected under the Americans with Disabilities Act.

But the foundation’s advocacy work is far from over. The organization is now lobbying on behalf of servicemen and women who are fighting discharge from the military on the grounds that they’re infected with the disease.

And the foundation’s executive director continues to push for a cure.

“We still want that cure,” Joan Block said. “We’re not satisfied that it’s preventable and controllable. We still have an urgent mission. That has not changed.”


Diagnosed With Chronic Hepatitis B? What Phase – HBeAg-Positive Chronic Hepatitis / Immune Reactive / Immune Clearance?

In the last chronic hepatitis B stages blog, we looked at the HBeAg-Positive Chronic Infection (also known as immune tolerant).

At some point the immune system recognizes the hepatitis B virus and the chronically infected person will enter a phase referred to as the  HBeAg–positive chronic hepatitis- (also  known as immune reactive/immune clearance). During this phase blood work will show that you are HBeAg positive, with lower levels of HBV DNA when compared to the HBeAg-positive chronic infection/immune tolerant stage, and increased ALT (SGPT) levels. (Remember, it is not at all unusual for kids to have viral loads in the millions or even billions.) During this “clearance” phase the immune system is actively attacking infected liver cells. This is both good and bad. On the good side, if the immune system is able to “beat” the virus, the person will go through HBeAg seroconversion and lose the HBeAg antigen. This means that HBeAg will go from positive to negative and the HBeAb antibody, or anti-HBe will go from negative to positive.  This results in significant decrease in the hepatitis B virus level, often to an undetectable level, and normalization of ALT/AST liver enzymes and other liver function blood test results. Successful HBe serconversion moves you into the HBeAg-negative chronic infection/inactive carrier phase.

When the immune system activates and starts attacking infected liver cells, it not only kills the virus, but also the host liver-cells. You may not feel any of this, but your ALT (SGPT) and AST (SGOT) lab values will be elevated. These enzymes are released when there is inflammation caused by liver cells that are injured or killed.  Your doctor may see a mild, moderate or high levels of ALT elevation reflecting inflammation in the liver. Ultimately the problem is how much inflammation and liver damage occurs during the process of HBeAg seroconversion. Your doctor will need to carefully monitor liver enzymes, liver function and use non-invasive calculations and diagnostic imaging to get a clearer picture of what is happening with your liver.

It is possible a person will quickly and spontaneously move into and out of the HBeAg-positive chronic hepatitis/immune reactive phase, and with a limited amount of inflammation and liver damage. However, some people may cycle up and down for years with intermittent flares, which are evidenced by ALT elevations which may be as high as 10 times above the upper limits of normal (normal is 35 IU/mL for men and 25 IU/mL for women) when in the immune reactive phase.  While the immune system attacks infected liver cells, viral replication will decrease and ALT levels will elevate as infected liver cells die in the battle.  If successful, the immune system response will result in HBe seroconversion –  losing HBeAg, gaining the HBe antibody, and a decline of the viral load  (HBV DNA) to very low or undetectable levels, and the normalization of ALT/AST and other liver enzyme levels.

Unfortunately, that might not be enough, and the immune system may not be able to put up a big enough fight permitting HBe seroconversion to a less active or HBeAg negative chronic infection /inactive carrier phase. Evidence of this is ALT levels that go back down, and viral replication that goes back up. (Note the above diagram.) This cycling up and down over time will be reflected in lab work if a liver specialist monitors you regularly over time. If you are not having your ALT levels regularly monitored (every few months), then you may miss these cycles of intermittent elevations or flares over time. It is during these elevations that liver damage occurs, and you will likely be completely unaware, unless you have lab work done while liver enzymes are elevated, or you wait until there are symptoms and significant liver damage.

It is during the immune clearance phase when treatment is sometimes recommended. It is true that a chronically infected person will eventually serconvert HBe spontaneously – without treatment, but most liver specialists choose to treat in order to prevent years of ALT elevations and flares and subsequent damage to the liver.

If you appear to be in the HBeAg-Positive Chronic Hepatitis / Immune Reactive phase, be sure to ask your doctor about treatment with first line antivirals such as tenofovir (TAF or TDF) and entecavir.  Don’t be afraid to ask questions about your hep B infection and the health of your liver. Treatment with antivirals greatly reduce liver disease progression and can be lifesaving.


Kudos to HBF’s Blog Voted as a “Sexual Health Top 10, Must Read Blog”

The team at Health Express has voted HBF’s blog as one of the “Must Read Blogs of 2013 – Sexual Health Top 10!”  HealthExpress.co.uk is an online clinic that provides support, advice and treatment for common medical conditions that patients do not always feel comfortable talking about. You can take a look at their recommended Top 10 blogs and learn more about them at healthexpress.co.uk.

The accolades from the HealthExpress team are a great opportunity to review transmission of the hepatitis B virus. HBV is transmitted through infected blood and body fluids. This includes direct blood-to-blood contact, unprotected sex, unsterile needles, and from an infected woman to her newborn baby at birth.  Sharing sharp, personal items that may have trace amounts of blood on them such a razors, toothbrushes, nail clippers and body jewelry including earrings, can also spread the virus.  Remember that the HBV virus may live up to a week on a surface resulting in possible transmission through direct blood-to-blood contact. This is why close, household contacts or family members are at greater risk of infection if one or more members are living with HBV. Don’t forget to be sure your tattoo or piercing experience is safe and that the parlor carefully follows infection control practices. Hepatitis B is also 50-100 times more infectious than the HIV virus.

Hepatitis B is also a sexually transmitted disease and is spread through infected semen, vaginal fluids and any blood that may be exchanged as part of a sexual practice – most often through sexual intercourse. In the United States, sexual transmission is the most common mode of HBV transmission and is responsible for 2/3 of acute HBV infections. A common question is “what about oral sex?” In general, oral sex would be considered less risky, but any kind of intimate sharing that may result in the exchange of bodily fluids will present some degree of risk.

So how can you prevent hepatitis B transmission between sexual partners? Fortunately there is a safe and effective hepatitis B vaccine to protect against the spread of HBV.  Get screened for HBV and vaccinate to protect – especially if you or your partner has more than one sexual partner, or if one or more partners is at greater risk.  When in doubt, get screened. Keep in mind that HBV is referred to as a “silent infection” since it may take decades for symptoms to occur. People with chronic HBV may be completely unaware of their infection and inadvertently spread HBV to their partner(s) if precautions are not taken.

Other precautions include practicing safe sex by using a latex or polyurethane condom. A lambskin condom will not prevent the spread of hepatitis B or other viral STDs. Looking for condom details?

A general comment to those with multiple sex partners– We are very fortunate to have a vaccine to protect against the hepatitis B virus. However, practicing safe sex with an effective condom is always advised to prevent the transmission of other infectious diseases that are not vaccine preventable, such as HCV and HIV, along with condom use to prevent the spread of other sexually transmitted diseases. Use common sense. No one wants a sexually transmitted disease, and if you have HBV, you really don’t want a coinfection. It can really complicate your life.

HBV Journal Review – August 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:

*First Clinical Trial Using “RNA Interference” for Hepatitis B Begins
*Why Do Some People Clear HBsAg After Years of Chronic Infection?
*Longer Antiviral Treatment Urged after Seroconversion to Prevent Relapse
*Federal Officials Dramatically Undercount Liver Disease Deaths in the U.S.
*More Women Than Men Retain Protection Against Hepatitis B After
*Immunization Hepatitis B Cirrhosis Declines in China, But Alcohol-related
*Cirrhosis Rises Hepatitis E Vaccine Development Shows Promise
*Tenofovir Most Effective Antiviral Treatment in HIV-HBV Coinfected Patients
*Study Confirms Coffee Protects the Liver in European Populations
*Hepatitis C Is Also a Risk for Southeast Asians, Including Women
*In Small Trial, Chinese Herbal Medicine Reduces ALT Levels

HBV Journal Review
August 1, 2013
Volume 10, Issue 8
by Christine M. Kukka

First Clinical Trial Using “RNA Interference” for Hepatitis B Begins

A ground-breaking approach to hepatitis B treatment, which manipulates RNA messengers to halt viral replication, has begun its first human clinical trial. If successful, this approach would be a paradigm shift in treatment, possibly re- placing interferon and antivirals.

In animal trials, reported in the May 2013 journal Molecular Therapy, RNA interference (RNAi) treatment reduced hepatitis B surface antigen (HBsAg) levels to undetectable within 24 hours in mice and the antigen remained undetectable for nearly a month.

RNAi treatment works by destroying or “silencing” the molecular messengers that carry im- portant genetic information to the hepatitis B virus (HBV) antigen/ protein factories. Without the critical information that messenger RNA molecules carry, these antigen factories shut down and HBV reproduction de- clines dramatically.

Early RNAi research found that RNA silencing worked extremely well in the liver, but the challenge has been to create a formula and delivery system to target hepatitis B antigens in liver cells without affecting other important cells.

Arrowhead Research Corp. found that when the small RNA interrupters are linked to cholesterol, they target liver cells extremely well, and the addition of special polymers helps the gene silencing process. Arrowhead designed an intravenous formula, called ARC-520, that is utilized in its Phase 1 trial.

The hope is that when the viral load is dramatically reduced, the body’s immune system can gain the upper hand and eradicate the infection on its own.

In addition to its mouse trial, a similar trial involving an HBV infected chimp with an extremely high viral load also led to rapid reduction in HBV DNA and a 90% reduction in another hepatitis B antigen—the hepatitis B “e” antigen (HBeAg).

The clinical trial of ARC-520 (which uses a Dynamic Polyconju- gate delivery platform and includes two distinct RNA silencing agents that should shut down hepatitis B anti- gen reproduction) in humans is taking place in Melbourne, Australia. It is a randomized, double-blind, placebo- controlled trial. Each group of six healthy volunteers will receive either a placebo intra- venous injection or a single dose of ARC- 520…
Continue reading about this and additional studies…