Hep B Blog

Talk with Dr. Block: An Expert’s Insight into a Hepatitis B Cure- Part 1

 

 

This November, the Hepatitis B Foundation attended The Liver Meeting – an annual conference hosted by the American Association for the Study of Liver Disease (AASLD). Inspired by the enlightening presentations and conversations at the conference, hepatitis B expert Timothy Block, Ph.D, co-founder and President of the Hepatitis B Foundation, took a moment to talk to us about the complexities of the hepatitis B virus and the status of a hepatitis B cure!  

This is part one of a two-part series.

  Why is finding a cure for chronic hepatitis B so challenging?    

       

That’s the big question. A cure is only complicated until we  are able to figure it out. Once we understand it, it will be simple! Hepatitis B is curable, but finding a cure for it is complex for two reasons. The first is that it is not a simple matter of virology. The virus establishes itself in a stable nest inside of the liver – called the covalently closed circular DNA (cccDNA) – and successfully invades the immune system. To do this, the virus enters a healthy cell and plants itself inside of the cell’s DNA – a component of the cell that allows it to function properly and produce more healthy cells. This makes it difficult – but not impossible – to create a treatment that will attack the hepatitis B virus while not damaging the rest of the healthy cell.

Another reason that finding a cure is so difficult is because of the body’s immune response. Typically, your body can recognize a virus as a potentially harmful invader, or something that is not supposed to be within your body. This triggers something called an “immune response”, which is when your body sends fighter cells to destroy the virus. With hepatitis B, the proper immune response often does not occur. Your body does not completely recognize the virus as a threat. Instead of eliminating the virus as it is supposed to, your body responds by creating an inflammatory reaction in the liver, which is called hepatitis. The incomplete attack on the virus allows it to replicate inside of healthy cells and kill them. Together, the cccDNA and the body’s incomplete immune response create a challenge for scientists and researchers.

    What will a hepatitis B cure look like?

As a patient advocate, I believe that the term “cure” should be reserved for when a person is no longer at risk for illness or death due to the infection. Having said that, I also realize the need for more practical definitions. You don’t know how effective a drug is until it’s been used for a long time, so it is important to use a definition that can encompass a wide range of possibilities.

A functional, practical cure would ideally be a drug that a person can take for a short amount of time. Once they have completed their prescribed dosage, they will stop taking the medication and still have the same benefits of the drug without having to take it. It would be great to eliminate the viral markers of the disease, such as the hepatitis B surface antigen (HbsAg), along with the reversal of liver disease and the return of normal liver function. 

 

 What is the Hepatitis B Foundation’s contribution to the cure?

 

When we started the Hepatitis B Foundation in 1991, there was very little interest in hepatitis B. Our goal was to help people with chronic hepatitis B and the diseases with which it was associated, like liver cancer and cirrhosis. We wanted to help people by finding a cure and by linking them to care. The Hepatitis B Foundation aims to help find a cure in two ways: through our own research institute – the Baruch S. Blumberg Institute – or by providing assistance to other researchers who are working towards a cure. Through the ups and downs of governmental and pharmaceutical interest, the Hepatitis B Foundation has remained committed and focused on solely addressing hepatitis B.

We created the Pennsylvania Biotechnology Center, which became a home for other hepatitis B companies, and we kept the interest strong. The Pennsylvania Biotechnology Center has now grown into a place for hepatitis B education and collaboration for professionals and students alike. We host regular seminars that provide updates on current research in the field and provide a welcoming environment for other hepatitis B experts to share their knowledge through presentations, guest lectures, and interactive discussions.

Nowadays, we have entered a clinical renaissance; people have a renewed interest in hepatitis B. Our job is to keep the attention focused on the infection and the people who are affected by it. We remain committed, resolved and steady. The Hepatitis B Foundation is the organization that is there for the patients.

Disclaimer: The information provided in this article is based upon recent research and updates in the field. Please note that timelines and specific information regarding hepatitis B drugs are estimations and are subject to change as new research emerges.

Holidays with Hepatitis B: How to Tell Your Family

Image courtesy of Unsplash

As the holidays approach, families are planning parties and dinners and preparing to spend time with their loved ones. In such a merry atmosphere, the idea of discussing hepatitis B – whether its a recent diagnosis or the first time that you are ready to disclose your status – may be intimidating. However, it doesn’t have to be! In honor of  National Family Health History Day – which falls on Thanksgiving – we put together some tips to help you start the conversation.

 

  • Start Small – Facing your entire family at once can be frightening in any situation. Consider pulling one or two family members that you trust aside and speak with them first. They might offer advice on how to tell the rest of the family.
  • Come PreparedAlthough chronic hepatitis B is the world’s most common risk factor for liver cancer, there is a universal lack of education and awareness about the infection. Use our fact sheets to help your loved ones understand what hepatitis B is, how it impacts your liver, and what it means to live with it.  For more fact sheets and to view them in different languages, click here. Be sure to let your family know that hepatitis B is spread by direct blood contact, not through casual interactions. They cannot be infected by sharing the same utensils as you, eating food prepared by you, or casual touches such as hugging.
  • Be EncouragingMost people who are diagnosed with hepatitis B live long, healthy lives! Let your family know that you are monitoring the infection and taking the necessary precautions to prevent liver damage. Your family will be happy to know that you are in control of your health!
  • Let them know how to helpAlthough you may be able to
    Image courtesy of Canva

    manage hepatitis B by yourself, creating a support network is always a good idea! Do you have any active family members?  Exercise is great for the liver, so ask them to come along next time you go for a bike ride or hit the gym! Maybe you know someone who is great at cooking. Try cooking some healthy meals together!

  • Give them timeHearing about a medical diagnosis can be difficult for everyone involved and may also be a sensitive topic for some. Don’t let this discourage you! Try showing them a few of our #justB campaign videos, which feature real people who have been impacted by hepatitis B. Some stories, like Alan’s, discuss how people often do not realize that hepatitis B and liver cancer are related. Other stories, like Alice’s, showcase the importance of being honest with your loved ones and explain how to turn a diagnosis into an educational opportunity. Viewing  #justB stories might help your family members feel more comfortable talking about the infection and encourage them to learn their own hepatitis B status.

National Family Health History Day

Image courtesy of Canva

In 2004, the Surgeon General declared Thanksgiving Day to be National Family Health History Day. It’s meant as a time for families to discuss health issues that appear to run in the family. While hepatitis B cannot be passed from generation to generation like genetic diseases, it is commonly spread within families due to how the virus is transmitted. The most common mode of transmission is from mother-to-child during childbirth, often because the mother was unaware that she was infected and that certain precautions needed to be taken to prevent transmission to the baby. As hepatitis B rarely has any symptoms, many people do not discover that they are infected until a family member is diagnosed or they develop liver damage.  Approaching the topic and starting the conversation can help to break this cycle of transmission within families.

The good news is that hepatitis B is preventable and, if detected early, liver damage can be prevented! Offer to help your loved ones make an appointment with their doctor or to accompany them when they go to get tested or vaccinated; they’ll appreciate the extra support!  

Also, consider making some time this Thanksgiving to fill out My Family Health Portrait – a free tool that maps out your family’s history of health conditions and identifies what you may be at risk for.

The topic of health is important all year round; you don’t have to wait for the holiday season to bring it up! Start the conversation today and help your family find the information they need to protect themselves and stay healthy!

 

Know the Risk: Transmission Through Tattoos & Piercings

Tattoos and piercings are a popular mode of self-expression. Oftentimes, they hold cultural and societal significance. Rarely are they thought about in relation to public health. In the United States, there are no federal regulations for tattoos or piercings apart from age restrictions. This means that tattoo and piercing parlors may have different sanitation and sterilization standards in accordance with how strictly a state chooses to manage the industry. For example, Nevada does not regulate tattoo or piercing shops, but New Jersey requires each shop to meet certain equipment sterilization and sanitation standards. Many people also decide to forgo a professional setting and receive body art from their friends, which can be especially dangerous. This lack of universal regulations and sanitation laws increases the risk of spreading bloodborne infections like hepatitis B.  

Image Courtesy of Unsplash

How Tattoos and Piercings Work: A tattoo is created by sharp needles repeatedly piercing the skin to embed ink into your body. While this ensures a permanent image, it also exposes your blood directly to the needle and anything that might remain on the needle from its previous usage. As hepatitis B is spread by direct blood contact, getting a tattoo poses a risk of infection if the equipment is not single use has not been properly sanitized, preferably using an autoclave. A fresh tattoo is an open wound, so it is important to properly bandage the area and keep it away from shared items that could potentially have blood on it, such as razors.

When you get a body part pierced, an artist typically uses a piercing gun with a very sharp needle that pokes a hole into the desired area and earrings or body jewelry are placed into the hole to make sure that the body tissue does not close. Earrings or body jewelry pose another possible risk of direct blood contact if they have been previously worn by another individual, so it is always best to use a new pair of earrings when getting pierced. In general, it is best to avoid sharing earrings and body jewelry. It is important to remember that hepatitis B often has no symptoms, so most people who are infected do not know that they have it. Safety precautions should be taken for everyone receiving a tattoo or piercing to prevent accidental transmission of the infection.

Do Your Research: Making a permanent decision can be difficult and the risk of contracting an infection can complicate matters; it is not something that you want to rush into it. Completing background research can narrow down your choices and help you feel more confident in your ultimate decision. Look at reviews of the shops and see what customers have said. If you see a review about a rash or an infection, it could be a sign that the establishment is not meeting basic safety standards. If you are in America, you can also check the state laws for body art and ask to see a parlor’s compliance certificates if they are not displayed. Don’t be afraid to ask questions! Ask to see the autoclave and ensure equipment bags are opened in front of you.

Image Courtesy of Unsplash

Although it may be tempting to have a friend or family member complete your body art in the comfort of a familiar setting, it also poses a higher risk for exposure to infections like hepatitis B. It is likely that such a setting does not have the proper tools, sterilization equipment, or training to clean the needles as they should be cleaned. Completing the hepatitis B vaccine series is strongly recommended for everyone, but especially to those who participate in activities with higher chances of blood exposure, such as getting body art in unregulated areas. After completing the vaccine series, most people are protected from hepatitis B for life, but other infections – like hepatitis C or HIV – still pose a risk.

If you need help identifying safe establishments, the Association for Professional Piercers is an international non-profit organization that allows you to search for shops in your area that meet certain health standards and answers any questions you may have about piercing. The Alliance for Professional Tattooists, Inc. is another international non-profit that can also help you find safe shops. Both have been approved by the Centers for Disease Control and Prevention (CDC). For more information from the CDC about hepatitis B or other bloodborne infections, click here.

What to look for in a Tattoo or Piercing Parlor:

  • Gloves – The artist should be wearing disposable gloves to keep the risk of contamination and blood exposure as low as possible. In addition, they should change their gloves each time they leave their work area or switch to a new client.
  • Disinfectant – Does the artist wipe down their work area when they are done with a client? Make sure that any area that they have set a tool on has been properly cleaned as well. The hepatitis B virus can survive on a surface for up to a week, so it is extremely important that any surface a tool comes into contact with has been sanitized.
  • Clean Equipment – Many tattoos and piercing shops have reusable needles and piercing guns. These objects are sharp and draw the clients’ blood, so they should always be thoroughly cleaned before being used again. If you notice that an artist works on one client and does not disinfect or change their tool before accepting a new client, there is an extremely high risk for blood exchange. Be sure to ask about the autoclave.
  • Certifications – Oftentimes, shops will have their certifications displayed on the wall. This shows that they have either been properly trained or are required to meet certain standards by law. Depending on the certification, this could mean that the shop is well-educated in preventing and knows how to properly sterilize their tools.

If you think you have been exposed to hepatitis B, it is important to get tested. Visit your doctor or local health clinic to get screened. To a find a place near you where you can get tested in the U.S., visit www.hepbunited.org.

If you have been diagnosed with chronic hepatitis B, our Physicians Directory*  can help you locate a liver specialist near you. The World Hepatitis Alliance can also help you find health care services and hepatitis B education in your country.

*Disclaimer

The Hepatitis B Foundation Liver Specialist Directory is intended for use by the public to assist in locating a liver specialist within a specific state or country. All data is self-reported and is not intended for use by organizations requiring credentialing verification. The HBF does not warrant the accuracy, completeness, timeliness, or appropriateness for a particular purpose of the information contained in the Liver Specialist Directory. The HBF does not endorse the individuals listed in the service, nor does HBF verify medical qualifications, licenses, practice areas or suitability of those listed. In no event shall the HBF be liable to you or anyone else for any decision made or action taken by you based upon the information provided in the service.

Note: This is not a physician referral service. The HBF cannot provide referrals to specific physicians nor advice on individual medical problems.