Hep B Blog

Category Archives: About Hepatitis B

Caregivers and Hepatitis B

November is National Family Caregivers Month. This month we celebrate and recognize the caregivers who take care of and support their family members 24/7. People living with hepatitis B or advanced liver disease might need a caregiver. Oftentimes, family members step in and fulfill this role. Being a caregiver is a tough, but noble job. Caregivers to someone living with hepatitis B might have to manage medications, doctors’ appointments, and oversee their overall health. This blog will highlight the challenges associated with caregiving and provide supportive resources.

Hepatitis B disproportionately affects Asian, Pacific Islander, and African populations. In fact, around 59% of those U.S. residents with chronic hepatitis B in the U.S. in 2018 emigrated from Asia, 19% from the Americas and 15% from Africa. It can be hard for people living with chronic hepatitis B to receive culturally appropriate care in the U.S., where English is the primary language. Caregivers of individuals living with hepatitis B might have to provide these translation services at doctors’ appointments, which can be difficult to juggle for caregivers who also work and/or take care of families – and some may find it difficult to discuss sensitive health information on behalf of their loved ones.

Taking time to be with a family member at the doctors’ office can sometimes be difficult, especially if the caregiver is working a full-time job. Often companies can be understanding of family obligations, but sometimes caregivers’ occupations do not allow them to be at appointments, making them take time off, which can become a financial burden.

Additionally, a study in China1 “suggested that the annual direct cost for patients with chronic hepatitis B infection, compensated cirrhosis, decompensated cirrhosis or primary liver cancer were $4,552, $7,400.28, $6,936 and $10,63, respectively, which were catastrophic expenditures for the households of the patients”. This financial burden can take a considerable toll on a caregiver’s mental health. Caregivers often worry about the health of their family members living with hepatitis B, but and can have financial concerns regarding the cost of managing a chronic illness, and potentially lost wages.

It is normal for caregivers to experience burnout. Providing around-the-clock care can be difficult. Below are some resources for caregivers experiencing burnout.

Resources for Caregivers

  1. Join – Join a support group. Hep B Community is a global peer-led, volunteer-driven forum to support those living with and affected by hepatitis B. They are dedicated to connecting people affected by hepatitis B with each other and with verified experts in the field, who provide trustworthy and accurate advice.
  2. Listen – In our newest B Heppy podcast episode, Caregiving and Hepatitis B, we chat with Kim, who was a caregiver for her father living with hepatitis B. She talks about her caregiving experience and gives advice to other caregivers of people living with hepatitis B. You can listen to the episode here.
  3. Take Time – It is important for caregivers to take time for themselves. You need to stay healthy yourself to be an effective caregiver for your family member living with hepatitis B. This can mean taking walks, meditating, setting boundaries, and practicing stress management.
  4. Read – Does someone in your close circle have hepatitis B? Check out the CDC and Hep B United Know Hepatitis B campaign’s fact sheet, When Someone in the Family has Hepatitis B”. This fact sheet has basic information about hepatitis B and the importance of testing and vaccinating family members. The fact sheet is available in 13 Asian and African languages as well as three English versions focused on Asian American, Native Hawaiian, and Pacific Islander, and African immigrants –  Download the fact sheet here.

 

Reference

  1. Ren, Hong & Yu, Yan & Hu, Jia-Yu & Shi, Yang & Lu, Yihan & Meng, Wei. (2014). Caregiver burden and its determinants among family members of patients with chronic viral hepatitis in Shanghai, China: A community-based survey. BMC infectious diseases. 14. 82. 10.1186/1471-2334-14-82.

 

 

Author: Evangeline Wang

Contact Information: info@hepb.org

The Importance of Liver Surveillance

October is Liver Cancer Awareness Month! This blog will discuss the importance of liver surveillance if you are living with hepatitis B.

Hepatitis B as a Major Risk Factor for Liver Cancer

Although liver cancer is the sixth most common cancer in the world, it is the second most common cause of cancer deaths. Many people do not realize that chronic hepatitis B is the primary global risk factor for developing liver cancer. Certain viruses, including hepatitis B, can cause hepatitis, which translates to “inflammation of liver.” The virus attacks the liver and weakens its ability to perform important tasks like filtering toxins from your blood and maintaining the level of sugar in your blood. Chronic (long-term) infection with hepatitis B or hepatitis C viruses can lead to liver cancer. Worldwide, hepatitis B is very widespread, making it a priority when it comes to the prevention of liver cancer. Approximately 292 million people around the world are living with hepatitis B.

Why Should I be Screened?

 Early detection of liver cancer can save lives! Regular screening for liver cancer and early detection are the most effective ways to improve treatment success and survival rates. Early detection of liver cancer results in more treatment options, which greatly improves the chances of survival after initial diagnosis. For patients in whom liver cancer is detected at an early stage and before symptoms occur – while the tumor is small and can be surgically removed – the 5-year survival rate can sometimes be more than 50%. This is why regular liver cancer screening is so important.

If you have cirrhosis or other known risk factors for liver cancer, make sure your health care provider screens you for liver cancer during your medical visits. Finding the cancer early may increase the chance of successful treatment. Your health care provider may refer you to a hepatologist, a doctor who specializes in liver diseases. Hepatologists have the most experience in managing chronic hepatitis B and C infections, including regular screening for liver cancer.

How Often Should I be Screened?

Liver cancer screening can be done as part of your regular visit to the health care provider who manages your hepatitis B. The American Association for the Study of Liver Diseases (AASLD) recommends that liver cancer screening include ultrasound of the liver every 6 months. If you are living with hepatitis B and are not getting screened every 6 months for liver cancer, you should ask your healthcare provider to start!

Listen and Learn!

The Hepatitis B Foundation’s podcast B Heppy has an episode out: Liver Cancer and Hepatitis B. In this episode, they chat with Dr. Kenneth Rothstein of University of Pennsylvania about the relationship between liver cancer and hepatitis B. He gives insight into herbal medicines, treatment options, liver surveillance, and important questions patients should ask their healthcare provider. Listen for more: https://bheppy.buzzsprout.com

 

 

Author: Evangeline Wang

Contact Information: info@hepb.org

October is Liver Cancer Awareness Month!

October marks the start of Liver Cancer Awareness Month! This month let’s celebrate your liver for all it does for your body!


Action Alert: Urge ACIP to Recommend Universal Hepatitis B Vaccination for Adults in the US

universal hepatitis B recommendation for adults is critical in addressing the consistently low adult hepatitis B vaccination rates and eliminating viral hepatitis in the United States. Tell the CDC’s Advisory Committee on Immunization Practices (ACIP) that universal adult hepatitis is essential to preventing liver cancer.  Take action here.


What Does Your Liver Do?

The liver is such an important organ – it’s like the engine of your body. It does hundreds of vital things to make sure everything runs smoothly:

  • Stores vitamins, sugar, and iron to help give your body energy
  • Controls the production and removal of cholesterol
  • Clears your blood of waste products, drugs, and other poisonous substances
  • Makes clotting factors to stop excessive bleeding after cuts or injuries
  • Produces immune factors and removes bacteria from the bloodstream to combat infection
  • Releases a substance called “bile” to help digest food and absorb important nutrients

The Link Between Liver Cancer and Hepatitis B  

The most common type of liver cancer is “primary liver cancer” or hepatocellular carcinoma (HCC). Worldwide, the most common risk factor for primary liver cancer is chronic infection with the hepatitis B virus. Chronic viral hepatitis infections (hepatitis B and hepatitis C) cause about 80% of all liver cancers. Obesity, heavy alcohol use, fatty liver disease (NAFLD or NASH), and some metabolic disorders also increase the risk for primary liver cancer. People chronically infected with hepatitis B are more likely to develop liver cancer than uninfected people because the virus directly and repeatedly attacks the liver. These attacks over time can lead to increased liver damage, cirrhosis (scarring of the liver), and ultimately, liver cancer. People who have chronic hepatitis B can reduce their risk of liver cancer through regular medical monitoring, taking antiviral treatment if necessary, and making healthy lifestyle changes.

The best way to prevent liver cancer is to prevent hepatitis B infection! This is why hepatitis B vaccination is so important. When someone gets vaccinated to protect them from getting hepatitis B, they are also preventing liver cancer!

How Would I Know if I Have Liver Cancer?

If you have chronic hepatitis B, make sure you are getting routine surveillance for liver cancer every 6 months with your healthcare provider. This surveillance, which includes a combination of blood tests and liver imaging (ultrasound) is so important because early detection of liver cancer greatly improves the chances of survival with treatment. For patients in whom liver cancer is detected at an early stage and before symptoms occur – while the tumor is small and can be removed – the 5-year survival is greatly improved.  Learn more about who should be screened for liver cancer here.

Unfortunately, liver cancer is on the rise in the United States. The 2020 Annual Report to the Nation on the Status of Cancer found that the incidence of primary liver cancer in the United States increased by 2.5% overall and by 3.7% amongst women – the largest increase in incidence of any cancer between 2012-2016. Liver cancer was also stated as the second most common cause of death for Asian American and Pacific Islander males, who are disproportionately impacted by HBV, and the fifth most common cause of cancer deaths for men overall.

Making sure that people are protected from getting hepatitis B is so important in the U.S. – and establishing universal vaccination recommendations is essential to reducing liver cancer incidence and mortality. 

The Role of Universal Screening Guidelines for Hepatitis B

In the U.S., current childhood immunization recommendations by the Advisory Committee on Immunization Practices (ACIP) were established in the 1990s, and have significantly helped reduce rates of hepatitis B transmission over the past two decades, as more and more children have been vaccinated against hepatitis B. Individuals born prior to these recommendations, however, may be vulnerable to HBV, and span three generations: Baby Boomers, Generation X, and Millennials. Together, these groups account for approximately 63% of the U.S. population. Within this vulnerable population, the recent rise in incidence of hepatitis B cases has increased the most within 30- 49 year olds, attributed to the opioid epidemic. Of the 2.4 million Americans estimated to be living with hepatitis B, approximately 75% remain undiagnosed and may display no symptoms. This increases the risk of transmission to unvaccinated household members or sexual partners who are unaware that precautions should be taken to prevent transmission. Lack of awareness and low vaccination rates in this community leave millions of Baby Boomers, Generation X, and Millenials vulnerable to HBV.

Take Action: Sign the Petition to Support a Recommendation for  Hepatitis B Vaccination for All Adults!

The CDC’s Advisory Committee on Immunization Practices (ACIP) is currently reviewing evidence to determine if they should recommend universal adult hepatitis B vaccination. If the committee votes in favor of the proposal, this would mean that all adults in the United States would officially be recommended to receive the hepatitis B vaccine by the federal government. 

universal adult hepatitis B recommendation is critical in addressing the consistently low adult hepatitis B vaccination rates and eliminating viral hepatitis in the United States. Please add your name to support universal adult hepatitis B vaccination by Friday, October 15th here. For questions or more information, please reach out to Michaela.Jackson@hepb.org. 

 Other Resources

  1. Listen and LearnListen to B Heppy’s newest podcast episode “Liver Cancer and Hepatitis B”! We chat with Dr. Rothstein from the University of Pennsylvania about the relationship between hepatitis B and liver cancer. He offers provider insight and recommendations to individuals listening.
  2. Check Out Liver Cancer Connect – This program was created to provide individuals and families with the information and support they need when facing the challenge of primary liver cancer.
  3. Seek Community SupportHep B Community a global peer-led, volunteer-driven forum to support those living with and affected by hep B. They are dedicated to connecting people affected by hepatitis B with each other and verified experts in the field, who provide trustworthy and accurate advice.
  4. Learn More From Experts – Dr. Robert Gish talks about treatment options for liver cancer. How does the stage of cancer affect treatment? Why are screening and surveillance so important? What are the available treatments and what are the therapies in development? Find out by listening to the webinar.

Your Sexual Health and Hepatitis B!

September is Sexual Health Month! This month we focus on the intersection of hepatitis B and sexual health.

Hepatitis B is the most common serious liver infection in the world with 300 million people chronically infected. It is caused by the hepatitis B virus that attacks and injures the liver. Hepatitis B can be spread through sexual contact. It is usually spread when blood, semen, or other body fluids from a person infected with the hepatitis B virus enter the body of someone who is not infected. In fact, hepatitis B is easily spread through sexual contact as it is 50x-100x more infectious than HIV.

Can I Kiss My Partner?

Yes! Spreading hepatitis B through kissing is highly unlikely, however, deep kissing that involves the exchange of large amounts of saliva might result in infection if there are cuts or abrasions in the mouth of the infected person, especially if they have a high viral load.

Does Type of Sexual Activity Matter?

Certain sexual activities are riskier at spreading hepatitis B than others. Oral sex appears to have a lower rate of hepatitis B transmission than vaginal sex. Anal sex carries a high risk of transmission because tears in the skin that can occur during penetration improves the transmission of hepatitis B.

Who Should be Vaccinated for Hepatitis B?

The great news is that there is a safe and effective vaccine for hepatitis B and is recommended for sexually active adults. Once vaccinated, a person should be protected from developing a hepatitis B infection even if they are exposed through sexual contact! Adults who especially should get the vaccine include:

  • People with multiple sexual partners
  • Anyone who has been diagnosed with a sexually transmitted disease
  • Men who have sexual encounters with other men
  • Sexual partners or close household contacts of someone living with hepatitis B

For adults, the vaccine is usually given as a series of 3 shots over a period of 6 months. In the U.S., there is also a 2-dose vaccine available that is given over 1 month. Whichever brand of vaccine you take, the entire series of shots is needed for long-term protection. If you are unaware of your hepatitis B status, ask your healthcare provider to get tested! More information on the simple hepatitis B testing can be found here!

Additional Prevention Methods

Practicing safe sex is also a great way to prevent the transmission of hepatitis B. If someone is living with hepatitis B and you don’t know your partner’s hepatitis B vaccine status, be sure to have sex with a condom to prevent the transmission of hepatitis B during intercourse. Sometimes during sex, people like to use personal lubricants. When using condoms it is important to remember to only use silicone or water-based lubricant. Oil-based lubricants increase the chance of ripping or tearing the condom.

 

Author: Evangeline Wang

Contact Information: info@hepb.org

Happy NAIRHHA Day!

Today is NAIRHHA Day! Every September 9th, the Hepatitis B Foundation brings awareness to National African Immigrant and Refugee HIV/AIDS and Hepatitis Awareness Day. Founded by advocates in Massachusetts, Washington D.C., and New York, NAIRHHA Day has been observed annually on September 9th by healthcare professionals, awareness campaigns, and other organizations since 2014. The Multicultural AIDS Coalition (MAC), Hepatitis B Foundation and the Coalition Against Hepatitis for People of African Origin (CHIPO) are working to establish NAIRHHA day as their own federally designated awareness day.

Hepatitis B and HIV in African Immigrant Communities

 People of African origin are disproportionately affected by hepatitis B infection. Worldwide an estimated 292 million people are infected with chronic hepatitis B. Over 60 million people in Africa have hepatitis B which annually accounts for an estimated 68,870 deaths.1

In fact, in some African communities in the United States, between 5%-15% of people have chronic HBV infection. Unfortunately, due to the silent nature of the disease, lack of disease awareness, and limited health care access, most African community members who have hepatitis B DO NOT KNOW that they are infected. This puts them at much greater risk for premature death from cirrhosis or liver cancer.

There is a high burden of HIV/HBV co-infection in African countries because both diseases share similar transmission routes such as mother-to-child, unsafe medical and injection practices, and unscreened blood transfusions.2 Chronic HIV/HBV infection is reported in up to 36% of people who are HIV positive, with the highest prevalence reported in west Africa and southern Africa. The co-infection of HIV and HBV is especially dangerous because it accelerates liver disease such as fibrosis and cirrhosis. In fact, liver-related mortality is twice as high among people with an HIV/ HBV co-infection.2

 With approximately 54,000 people with HBV who immigrate to the United States annually it is important to bring awareness to hepatitis B in African Immigrant communities on this day!

Get Involved

Viral hepatitis and HIV heavily impact African immigrant communities in the U.S. Let’s raise awareness and advocate for resources and funding to support elimination efforts & healthier communities.

Action Items:

  1. There are African community organizations all over the U.S., from Boston to Seattle. Connect with one in your area to learn more about & contribute to the health of these vibrant communities. Start by visiting https://www.hepb.org/research-and-programs/chipo/member-organizations/
  2. Data drives policy change & it can be difficult to find data about African immigrant communities because it is often not separated from data about African American communities. Advocate for this data to be separated by contacting your local Department of Health today!
  3. Education & awareness matter! Many elected officials do not know about these issues, but they should! Contact your state & federal reps today to ask what they’re doing to address viral hepatitis & HIV in African immigrant communities. Visit https://www.usa.gov/elected-officials
  4. Change needs resources! Help grow the capacity of African organizations in your area by contributing your time, money, or other resources to eliminating viral hepatitis & HIV in African immigrant communities. Find an org in your state or city & ask how you can plug into their work!
  5. Funding is critical for progress to occur & advocacy is needed to make sure African immigrant communities receive enough money to combat viral hepatitis & HIV. Contact your federal, state, & local elected officials & local department of health to ask what they’re doing to support this. Start with members of @NASTAD found at https://www.nastad.org/membership-directory
  6. Good health & healthcare can’t happen without communication. Learn more about the need for language access programs to include African dialects at https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=1&lvlid=6.
  7. Federal recognition means greater awareness, education, & resources. Continue to support the establishment of NAIRHHA Day as a federally recognized awareness day by contacting @HHS’s sitehiv.gov to advocate for this!
  8. Spread the word! A big part of NAIRHHA Day is raising awareness & you can help with that! Share this toolkit far and wide on social media & also check out some great resources on hepatitis in African immigrant communities at https://www.hepb.org/research-and-programs/chipo/resources/resources-for-educators/

 

 

  1. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
  2. Spearman, C. W., Afihene, M., Ally, R., Apica, B., Awuku, Y., Cunha, L., Dusheiko, G., Gogela, N., Kassianides, C., Kew, M., Lam, P., Lesi, O., Lohouès-Kouacou, M. J., Mbaye, P. S., Musabeyezu, E., Musau, B., Ojo, O., Rwegasha, J., Scholz, B., Shewaye, A. B., … Gastroenterology and Hepatology Association of sub-Saharan Africa (GHASSA) (2017). Hepatitis B in sub-Saharan Africa: strategies to achieve the 2030 elimination targets. The lancet. Gastroenterology & hepatology, 2(12), 900–909. https://doi.org/10.1016/S2468-1253(17)30295-9

August is National Immunization Awareness Month!

As August wraps up National Immunization Awareness Month (NIAM). This month we raise awareness to highlight the importance of vaccination. In the era of COVID-19, we are shown how effective and protective vaccines are. During NIAM, we encourage you to talk to your doctor, nurse, or healthcare professional to ensure you and your family are protected against serious diseases by getting caught up on routine vaccination, especially the hepatitis B vaccination!

What is Hepatitis B

Hepatitis B is the most common serious liver infection in the world. It is caused by the hepatitis B virus that attacks and injures the liver. Two billion people (or 1 in 3) have been infected and about 300 million people are living with a chronic hepatitis B infection. Each year around 820,000 people die from liver disease caused by hepatitis B despite the fact that it is preventable and treatable. In the United States, 2.4 million people are chronically infected with hepatitis B!

The hepatitis B virus (HBV) is transmitted through blood and infected bodily fluids. It can be passed to others through direct contact with blood, unprotected sex, unsterilized or contaminated needles, and from an infected woman to her newborn during pregnancy or childbirth.

Hepatitis B is a “silent epidemic” because most people do not have symptoms when they are newly infected or chronically infected. Thus, they can unknowingly spread the virus to others and continue the silent spread of hepatitis B. For people who are chronically infected but don’t have any symptoms, their liver is still being silently damaged which can develop into serious liver disease such as cirrhosis or liver cancer.

Preventing Hepatitis B  

It takes only 2 to 3 shots to protect yourself and your loved ones against hepatitis B for a lifetime.

The hepatitis B vaccine is a safe and effective vaccine that is recommended for all infants at birth and for children up to 18 years. The hepatitis B vaccine is also recommended for adults living with diabetes and those at high risk for infection due to their jobs, lifestyle, living situations, or country of birth. Since everyone is at some risk, all adults should seriously consider getting the hepatitis B vaccine for lifetime protection against a preventable chronic liver disease.

The hepatitis B vaccine is also known as the first “anti-cancer” vaccine because it prevents hepatitis B, the leading cause of liver cancer worldwide.

You cannot get hepatitis B from the vaccine. All hepatitis B vaccines that have been used since 1986 are made synthetically – meaning the hepatitis B vaccines do not contain any blood products. Learn more.

Vaccine Schedule

How to Get Vaccinated

If you are unsure of your hepatitis B vaccination status, ask your healthcare provider for a simple blood test!

If you have not been vaccinated – ask your healthcare provider for the simple and effective vaccine! They are generally available at your doctor’s office, local pharmacy, or local health clinic. If you are United States-based the Center for Disease Control maintains a database of locations that offer the hepatitis B vaccine. You can search for locations within the U.S!

Author: Evangeline Wang

Contact Information: info@hepb.org

Why You Should Get the Hepatitis B Vaccine

During the Covid-19 pandemic, there has been much controversy over vaccines. Although there has always been an anti-vaccine movement, it has grown during the pandemic. However, despite all of that, it is highly recommended that people who are at risk get the hepatitis B vaccine. Almost 300 million people worldwide have chronic hepatitis B and almost 800,000 people die every year due to hepatitis B complications. In fact, hepatitis B is the greatest risk factor for developing liver cancer (HCC). The hepatitis B vaccine is simple and effective. It requires either 2 or 3 shots over a few months. It is one of the most-administered vaccines worldwide, and one of the safest, with few side effects!

There are many groups that may need the vaccine. These include but are not limited to: 

  • All infants, beginning at birth
  • All children aged <19 years who have not been vaccinated previously
  • Susceptible sexual partners of hepatitis B-positive persons
  • Sexually active persons who are not in a long-term, mutually monogamous relationship (e.g., >one sex partner during the previous six months)
  • Persons seeking evaluation or treatment for a sexually transmitted disease
  • Men who have sex with men
  • Injection drug users
  • Susceptible household contacts of hepatitis B-positive persons
  • Healthcare and public safety workers at risk for exposure to blood
  • Persons with end-stage renal disease, including pre-dialysis, hemodialysis, peritoneal dialysis, and home dialysis patients
  • Residents and staff of facilities for developmentally disabled persons
  • Travelers to and families adopting from countries where hepatitis B is common (e.g. Asia, Africa, South America, Pacific Islands, Eastern Europe, and the Middle East)
  • Persons with chronic liver disease, other than hepatitis B (e.g. cirrhosis, fatty liver disease, etc.)
  • Persons with hepatitis C infection
  • Persons with HIV infection
  • Adults with diabetes aged 19 through 59 years (clinicians can decide whether or not to vaccinate their diabetic patients ≥60 years)

Now, this is a large list of people who might need the vaccine, but how hard is it to receive one? It is one of the easiest vaccines to get. Most hospitals carry the vaccine, and in the UK, hospitals are required to give the vaccine to at-risk groups. In the United States, the Affordable Care Act should cover preventive services; so the hepatitis B vaccine should be mostly available free of cost.

The Hepatitis B Foundation recommends everyone who is at risk or may in the future be at risk receive the vaccine. It is a smooth and seamless process that can prevent HBV, liver cancer, and let you live a long and healthy life. If you are not vaccinated for hepatitis B, ask your doctor or primary care provider for the vaccination! 

If you are unsure of your hepatitis B status, ask your doctor or primary care provider to become tested! The hepatitis B test is super simple – it only requires one blood sample. Your doctor should order the “hepatitis B panel” which includes different tests. Read more hepatitis B testing here!

 

Sources –https://www.goodrx.com/hepatitis-a-and-hepatitis-b-vaccine/what-is

Author: Simeon Paek, Intern

Contact Information: info@hepb.org

Liver Cancer Among Men

June is Men’s Health Month. This month we bring awareness to preventable health problems and encourage early detection and treatment of disease among men and boys. In 2020, The World Health Organization found that liver cancer is the third leading cause of cancer deaths with 830,000 deaths.1 Liver cancer occurs more often in men than in women with it being the 5th most commonly occurring cancer in men and the 9th most commonly occurring cancer in women.2

There are two main types of liver cancers, hepatocellular carcinoma (HCC) which accounts for about 75% of liver cancer cases, and intrahepatic cholangiocarcinoma which accounts for 12-15% of cases. Liver cancer especially impacts Asian countries like Mongolia, Vietnam, Laos, Cambodia, Thailand, and China. Hepatitis B is the leading cause of HCC globally. Of the 300 million individuals living with a chronic hepatitis B diagnosis, about 25% will develop HCC.3

Risk Factors

HCC affects men with an incidence 2x-4x higher than women due to differences in behavioral risk factors and biological factors.3 Research has found men were less likely to undergo HCC screening and more likely to smoke.  Additionally, studies have shown alcohol is a major risk factor for HCC. In the United States, HCC associated with alcohol is higher among men than in women at 27.8% and 15.4% respectively.3

Biologically, there is evidence estrogen (a female hormone) decreases IL-6 mediated hepatic inflammation and viral production.3 Studies have demonstrated IL-6 may promote virus survival and/or exacerbation of the disease.4 In the context of hepatitis B, men are at an increased risk for HCC as they do not produce estrogen which would help decrease the risk of IL-6, in turn, promoting viral survival.

Prevention

The great news is that HCC can be prevented by preventing hepatitis B. There is a safe and effective vaccine that can be completed in either 2 or 3 doses over a span of 3 months. Ask your healthcare provider for the hepatitis B vaccine series.

If you are unsure of your hepatitis B status, you can get tested! Ask your healthcare provider for the “Hepatitis B Panel” – it should include 3 parts. The panel is super simple and only requires one sample of blood.  If you are of Asian descent and male, it is especially important for you to get tested as liver cancer disproportionately impacts individuals from Asian countries and men.

If you have chronic hepatitis B, make sure your doctor screens you regularly for liver cancer. Typically done with a combination of blood tests and imaging, liver cancer screening can help detect HCC early when it is still curable.

As we wrap up June and Men’s Health Month, you are encouraged to get vaccinated and tested for hepatitis B. Take control of your health, and don’t wait!

References

  1. https://www.who.int/news-room/fact-sheets/detail/cancer
  2. https://www.wcrf.org/dietandcancer/liver-cancer-statistics/
  3. Wu EM, Wong LL, Hernandez BY, et al. Gender differences in hepatocellular cancer: disparities in nonalcoholic fatty liver disease/steatohepatitis and liver transplantation. Hepatoma Res. 2018;4:66. doi:10.20517/2394-5079.2018.87
  4. Velazquez-Salinas L, Verdugo-Rodriguez A, Rodriguez LL, Borca MV. The Role of Interleukin 6 During Viral Infections. Front Microbiol. 2019;10:1057. Published 2019 May 10. doi:10.3389/fmicb.2019.01057

 

Author: Evangeline Wang

Contact Information: info@hepb.org

 

World Refugee Day!

June 20th is World Refugee Day! This day “celebrates the strength and courage of people who have been forced to flee their home country to escape conflict or persecution. World Refugee Day is an occasion to build empathy and understanding for their plight and to recognize their resilience in rebuilding their lives.”1

In 2020, the United Nations Refugee Agency estimates that 80 million people were forcibly displaced. A majority of refugees originate from Syria, Venezuela, Afghanistan, South Sudan, and Myanmar and are mostly resettling in countries like Turkey, Colombia, Pakistan, Uganda, and Germany.1

As individuals who are experiencing forcible displacement begin to resettle, it is important to encourage hepatitis B testing and vaccination, even though hepatitis B might be the last thing on their minds. It is important to keep health, and especially hepatitis B in mind because hepatitis B disproportionately affects people from the World Health Organization’s (WHO) African, Western Pacific, and Asian regions.

In South Sudan, hepatitis B accounts for 80% of the viral hepatitis cases. Moreover, Myanmar has a moderate to high burden, with 6.5% of the general population being infected with hepatitis B. It is imperative that testing and vaccination is encouraged in countries like South Sudan and Myanmar and in countries where people are resettling to not only prevent the spread of hepatitis B but also allow people living with hepatitis B who might not know it to live a long and healthy life. Additionally, it is important to note that the continuation of care for people experiencing forcible displacement is halted when resettling in different countries. This interruption can be damaging to individuals’ health, especially those living with hepatitis B as medication must be taken daily, and seeing a liver specialist should happen every 6 months.

However, some people who are in the process of resettling might be hesitant to get tested for hepatitis B. This can be due to a myriad of reasons like the cost of healthcare if they do test positive, access to quality healthcare, fear of stigma, and other cultural/language barriers.

So how can organizations encourage people experiencing displacement to get tested for hepatitis B? This answer is frankly too complicated and complex for a simple blog post, but here are a few suggestions for organizations.

  1. Utilize community health workers. Community health workers who are fluent in refugee languages and cultures can educate community members about preventative health measures. People might be more receptive to the information if someone familiar with the community is the educator.
  2. Reduce barriers to healthcare. Transportation sometimes is a barrier for individuals experiencing resettlement. Offering transportation to and from healthcare clinics can greatly increase access to quality healthcare. Furthermore, when the individual arrives at their healthcare facility, they must have an interpreter if they do not speak the local language or go to a provider who speaks their native language.
  3. Use culturally sensitive educational materials. Using materials in languages other than English is so important to effectively communicate health information about hepatitis B! The Centers for Disease Control and Prevention (CDC), has their Know Hepatitis B Campaign where you can access FREE multi-lingual hepatitis B educational materials.

Reference:

  1. https://www.unhcr.org/en-us/world-refugee-day.html

Happy Pride Month – HIV/HBV Co-Infection

 

June is Pride Month in the United States! This month we celebrate the LGBTQ+ community in honor of the 1969 Stonewall Uprising in Manhattan. This blog post will discuss HIV/HBV coinfection in LGBTQ+ individuals and how to prevent both viruses.

HIV/HBV Co-Infection

Human Immunodeficiency Virus or HIV disproportionately affects LGBTQ+ individuals, mostly gay and bisexual men. In the United States, approximately 69% of the 37,968 new HIV cases were among gay and bisexual men in 2018. HIV can also impact lesbian women, although the infection rate among this community is lower. There is also very limited current data out about lesbian and bisexual women and the burden of HIV. However, HIV can be transmitted between women who have sex with women through sex toys and injection drug use. The CDC reports 1 million people have identified as transgender in the United States, and 2% of those individuals are affected by HIV.

Approximately 5-20% of the HIV-infected population worldwide is also living with hepatitis B. These rates vary among different regions and at-risk populations based on modes of transmission. This figure may approach 20% in Southeast Asia, and 5% in North America and Western Europe. In the U.S., Western Europe, and Australia, the prevalence of chronic hepatitis B was reported to be 5%-14% among HIV-positive individuals.

Since both HIV and the hepatitis B virus share similar transmission routes, it is not surprising that there is a high frequency of coinfection. Sexual activity and/or injection drug use are the most common routes of transmission of the hepatitis B virus among those also infected with HIV.

Prevention

You can easily prevent hepatitis B with a safe and effective vaccine. The vaccine comes in either 2 or 3 doses, given over a span of 6 months. Learn more about the vaccine dose schedule here!

If you are not vaccinated for hepatitis B, ask your doctor or primary care provider for the vaccination! Check out this list of LGBTQ+ friendly providers.

If you are unsure of your hepatitis B status, ask your doctor or primary care provider to become tested! The hepatitis B test is super simple – it only requires one blood sample. Your doctor should order the “hepatitis B panel” which includes different tests. Read more hepatitis B testing here!

You can lower your risk of acquiring HIV by using PrEP (pre-exposure prophylaxis). PrEP is a daily medication you can take to prevent HIV. Just make sure you are tested for hepatitis B before starting PrEP. Read more about PrEP here!

 

Author: Evangeline Wang

Contact Information: info@hepb.org