People generally think liver cancer is non-treatable and non-curable. But that perception needs to change. Diagnosis and treatment of liver cancer have improved so much in the past 20 years that it can be cured if caught early and managed by an experienced health care team.Liver Cancer Connect’s “Fighting the Doom and Gloom” series explains how the right treatment plan and teamwork offer the best chances for a cure. Continue reading "Fighting the Doom and Gloom: It Takes a Team"→
The hepatitis B virus (HBV) can be transmitted two ways: 1) through direct contact with blood and 2) infected body fluids. Some risks for direct blood contact are obvious, such as touching an open wound to another open wound or cleaning up someone’s blood without any protective gear. However, other methods of blood transmission are harder to catch. Common activities like sharing razors, earrings, or toothbrushes are simple, innocent actions, yet they all have the potential for blood exchange.
Medical and dental procedures are aspects of our lives that we might not think twice about. While beneficial to our health, they also carry the risk of exposure to another person’s blood. Surgeries, shots, and dental activities all use sharp objects that pierce the skin and draw blood. If the tools are not properly sterilized, or cleaned, before they are used on a new patient, the blood that was on the equipment can be transferred to the next patient.
How do I know if medical tools are sterile?Ask! It is your right to know if the equipment that will touch your body has been thoroughly cleaned. In a dentist office, the assistant might unwrap a package of tools in front of you; this typically means that the tools are either new or have been properly cleansed. In a medical setting, needles and surgical equipment might come in packaging as well. If you still are not certain, feel free to ask what the standard cleaning procedures are for the tools being used. The staff will be happy that you are taking your health into your hands!
Why is it important to have sterile tools?Hepatitis B earned the nickname “silent infection” because there are often no symptoms. Those who have been infected may not take the necessary precautions simply because they do not know that they should. They may not even know they are infected! In many cases, medical and dental professionals are unaware when a patient has hepatitis B. Therefore, it is important to make sure that all equipment that is being reused has been sterilized. Although there are no global sterilization standards, many countries and medical facilities around the world – like hospitals, dental offices, and doctor offices – have disinfection guidelines and practices for their equipment.
Tips to Protect Yourself:
Be your own advocate: Ask the dental hygienist, nurse, doctor, acupuncturist or person in charge of your procedure if the tools have been sterilized.
Know where you go: Try to visit medical or dental facilities that you trust and that provide clean, safe environments for any procedures involving blood or body fluids.
Get vaccinated:Hepatitis B is a vaccine preventable disease. After receiving all three doses, most people are protected for life! Check your immunization records to make sure that you have been vaccinated or ask your doctor or local clinic about the vaccine.
Share with caution: Sharing or eating food prepared by someone with hepatitis B is safe, but any activities that may involve direct contact with blood carry a risk. A good guideline is to keep all personal hygiene items personal.
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.
If you have been diagnosed with chronic hepatitis B, our Physicians Directory* can help you locate a liver specialist near you. TheWorld Hepatitis Alliancecan also help you find health care services and hepatitis B education in your country.
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.
I thought hepatitis B was sexually transmitted? I just tested positive, but my partner tested negative, we’ve been together for years, what gives?
This question is a common one. Hepatitis B is indeed easily transmitted sexually, so why do some people — who were not vaccinated — never get hepatitis B from their sexual partners?
It comes down to variables, such as the type of sexual activity you engage in, the viral load (HBV DNA) of the infected partner, and who is on the receiving end of infectious body fluids, especially blood that contains the most virus, and semen.
Having one partner infected, and other not, can add more stress to an already traumatic hepatitis B diagnosis. “It was very confusing and made me question how was it possible I was the only one infected,” said a woman who tested positive while her husband tested negative. “I thought it was possibly a mistake, maybe I was a biological anomaly, which of course I was not.”
Let’s look at the factors that affect who gets infected and who doesn’t when two people have sex.
Viral load: Semen, vaginal fluids and blood all contain the hepatitis B virus (HBV), and the higher the viral load, the more infectious one’s blood and body fluids are. However, having an undetectable viral load doesn’t mean you won’t infect someone during unsafe sex. Even if a man has an undetectable viral load, studies show his semen still contains some HBV and can spread infection, though the risk is lower.
So, the rule here is if a man tests positive for the hepatitis B surface antigen (HBsAg), he must consider himself infectious.
The role of gender: In heterosexual relationships, uninfected women are at higher risk of getting infected by a male partner infected with hepatitis B, than the reverse. Women are on the receiving end of semen, which greatly increases their risk of becoming infected unless a condom is used.
When a woman is infected with hepatitis B, an uninfected man is at risk through direct contact with her vaginal secretions, but that contact is lower-risk than a woman’s direct exposure to infectious semen during intercourse.
However, an infected woman who is menstruating is more likely to spread hepatitis B because blood can contain higher levels of HBV than vaginal secretions. That is why gloves and dental dams are recommended to provide a barrier against exposure.
The type of sexual activity: Certain sexual activities are far more efficient 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 very high risk of transmission because of tears in the skin that can occur during penetration, which improves transmission of HBV.
Fingering carries a lesser risk, unless the infected woman is menstruating or a person has bruises or cuts on their hands that allow entry of hepatitis B virus in semen or vaginal fluids, then gloves are recommended.
The “uninfected” partner could already have been infected and cleared hepatitis B: When a person is first diagnosed with hepatitis B, doctors often test his or her partner for only the hepatitis B surface antigen (HBsAg), which indicates a current hepatitis B infection. If they are negative for HBsAg, they are immediately vaccinated.
If the partner isn’t also tested for the hepatitis B surface antibody (anti-HBs or HBsAb), then no one knows if the individual was already protected, either due to recovery from a past hepatitis B infection, or because they had already been vaccinated.
Hepatitis B is not called the “silent” infection for nothing — many people who get hepatitis B never have any symptoms and never realize they were infected. As a result, a wife, husband, partner or lover who tested negative for HBsAg, may actually have been infected in the past and cleared the infection and now has protective hepatitis B surface antibodies to forever safeguard them from infection. If they’re immediately vaccinated and retested after the three-dose vaccination, they will test positive for surface antibodies, without ever knowing that their antibodies resulted from a past infection, not immunization.
Bottom line, if one of you have been diagnosed and the other is not infected, it is unusual but not uncommon. Get tested and immediately vaccinated if the uninfected partner tests negative for the hepatitis B surface antibody.
Take a quiz to find out how much you know about hepatitis B transmission: click here.
Disclaimer: The information provided in this video is not intended to serve as medical advice or endorsement of any product. The Hepatitis B Foundation strongly recommends each person discuss this information and their questions with a qualified health care provider.
Although there are highly effective treatments available to manage hepatitis B, there are few available treatments for hepatitis D, and none are U.S. Food and Drug Administration (FDA) approved. Hepatitis D is the most severe form of viral hepatitis, and coinfection can accelerate liver damage and cause cirrhosis or liver cancer in as little as 5 years for some patients. Currently there is no approved drug for acute or chronic hepatitis B/D coinfection, but in trials pegylated interferon alpha has shown to be somewhat effective. By stimulating the body’s immune system, around 25-30% of patients are able to suppress their hepatitis D viral load with weekly injections over 48 weeks. Emerging research is showing higher rates of effectiveness with prolonged interferon treatment beyond one year, but it can be difficult for patients to continue due to the physical and mental toll of interferon on the body. Antiviral medications that are proven effective against hepatitis B are sometimes prescribed along with interferon therapy for patients with a high hepatitis B viral load, but these have no effect on hepatitis D. It is urgent that more treatment options be developed for the millions of hepatitis B/D patients that are eagerly awaiting them.
The good news is that with renewed scientific interest, research and funding, eight new drugs are currently in development that offer hope for more treatment options in the coming years. Two drugs have even been granted special designations by the FDA and one by European Medicines Agency (EMA), paving the way for increased resources and funding for development. Due to recent advancements, the future looks hopeful, and within a few years it is likely there will be more treatment options available. Below is a chart that provides more information on these new drugs and their current clinical trial status.
Pegylated Interferon Lambda
Pegylated-interferon-lambda (PEG-IFN-λ) is a well-characterized, late-stage, first in class, type III interferon that stimulates cell-mediated immune responses that are critical for the development of host protection during viral infections. This drug has now been granted “Orphan Drug Designation” by the FDA, fast-tracking the development process.
This drug is an “entry inhibitor” that prevents the virus from entering into hepatocytes (liver cells) and has shown activity against the hepatitis B virus. It may also stop the development of a hepatitis D infection. A recent study showed promise for Myrcludex B when combined with PEG-INF in reducing hepatitis D viral levels. It has been granted PRIME Eligibility by the European Medicines Agency, a status that promotes support in development of drugs that serve an unmet medical need.
Currently used to lower cholesterol in the blood, Ezetimibe is being studied for effectiveness against hepatitis D. Ezetimibe possesses pharmacophore features to stop NTCP, the receptor required for hepatitis B and hepatitis D hepatocyte entry.
This drug works by targeting the protein assembly process, preventing the production of new virus particles. In a current clinical trial, Lonafarnib combined with Ritonavir has shown promise in reducing hepatitis D viral levels, and the FDA has granted it fast-track status since this class of drugs have been developed for the treatment of cancers and have been shown to be safe.
This compound is known as a “Nucleic acid-based Amphipathic Polymer” (NAP) which prevents the release of hepatitis B surface antigen (HBsAg) from infected liver cells and is being evaluated for hepatitis D virus in combination with pegylated interferon (PEG IFN).
GI-18000 Tarmogen is being studied for its effectiveness in causing a T cell immune response against cells infected with Hepatitis D and thereby improving outcomes. The strategy is to identify molecular targets that distinguish diseased cells from normal cells and activate the immune system to selectively target and eliminate only the diseased cells.
This approach is being used for both the hepatitis B and hepatitis D virus to “silence” the viral RNA with compounds that interfere with and cause the destruction of the viral genome (e.g. stop replication of the virus).
As clinical trials progress, sites may open across the world that are enrolling hepatitis D patients. Keep checking here for an up-to-date list of all current clinical trials.
Click here for more information about the phases of the clinical trial process.
May is Hepatitis Awareness Month and Saturday, May 19this National Hepatitis Testing Day in the United States. This day is an opportunity to increase awareness and testing for both hepatitis B and C. It is also a reminder for health care providers and the public of the importance of testing for viral hepatitis.
Why is hepatitis B testing necessary? Hepatitis B is largely asymptomatic, which means that symptoms don’t always occur or are not obvious. Some people will not know that they have hepatitis B until it is too late, or they may learn of their infection from a blood donation screening or lab work. There are groups of people who have a greater risk of hepatitis B compared to others, so it doesn’t hurt to be sure. here are some places around the world that have an extremely high hepatitis B prevalence (where many people are infected). It is important that people who are at high risk for a hepatitis B infection see a doctor to get tested, to find out if they have a hepatitis B infection. People living with chronic hepatitis B should be monitored regularly and appropriately screened for liver cancer. So, if you find you do have hepatitis B, talk to your doctor about what to do next.
Remember, hepatitis B does not discriminate. Don’t wait for symptoms. B sure. B tested. If you do not have hepatitis B, then give yourself lifelong protection with the hepatitis B vaccine. The hepatitis B vaccine is safe and effective. Children or adults can get the 3-shot vaccine series, and there isa newly approved two-dose adult vaccine to protect us against hepatitis B! However, the vaccine doesn’t work if you are already infected.
Don’t forget to check out these free, confidential hepatitis screenings this weekend! Check out Hep B United’s resource to find local events in your area. You can also visit the CDC’s website for more ideas on how to increase awareness on National Hepatitis Testing Day, and every day!
Little Hep B Hero, which is available in English, Simplified Chinese and Vietnamese, gives children and their families a delightful glimpse into a young girl’s visit to her neighbor and friend, Rosa. As Rosa and the young girl prepare food and lemonade together, Rosa tells her about living with chronic hepatitis B. Rosa explains what the liver does, what hepatitis B is, how the virus is transmitted, how she maintains a healthy lifestyle with chronic hepatitis B, and shares tips on preventing hepatitis B transmission. Little Hep B Hero also provides cute and easy to understand visuals of the little girl as a superhero while Rosa explains this information.
The book does an excellent job of explaining liver functions and what the hepatitis B virus does to the liver! The analogy of using a sieve to demonstrate how the liver filters toxins in the body was creative. The book also does a great job of indirectly tackling some myths associated with hepatitis B. For example, people are often hesitant to share meals with those living with chronic hepatitis B. Little Hep B Hero lets its audience know that you cannot get hepatitis B through food preparation or sharing a meal, so Rosa cooks a meal for her neighbors.
Little Hep B Hero is an important read for future generations and their families! Getting the conversation started early about hepatitis B will address the stigma and discrimination associated with it. When children are talking about hepatitis B and are knowledgeable about it, hepatitis B isn’t a scary topic anymore. The message of hepatitis B as a family matter highlights the importance of educating and testing family members.
For more information, check out their press release, and to purchase Little Hep B Hero, visit Hepatitis Victoria’s website here.
Welcome to “Journey to the Cure.” This is a web series that chronicles the progress at the Hepatitis B Foundation and Baruch S. Blumberg Institute towards finding the cure for hepatitis B.
In the second episode (part 2), Kristine Alarcon, MPH sits down with Chari Cohen, DrPH, MPH, Vice President of Public Health Programs of the Hepatitis B Foundation, to talk about public health research at the Hepatitis B Foundation.
Disclaimer: The information provided in this audio post is not intended to serve as medical advice of endorsement of any product. The Hepatitis B Foundation strongly recommends each person discuss this information and their questions with a qualified health care provider.
Kristine Alarcon, MPH and Samantha Young
Modern – iMovie Library Collection
Welcome to Journey to the Cure! Every month, we’ll sit down with scientists from the Hepatitis B Foundation and the Baruch S. Blumberg Institute to talk to you about hepatitis B and efforts to find a cure for hepatitis B. There’s still a long way to go, but we’re here to walk you through our journey.
Kristine Alarcon, MPH:
In our last episode, Dr. Block was talking about how the Hep B Foundation is dedicated to public health research. Can you tell us more about that?
Chari Cohen, DrPH, MPH: One of our major goals is to get everyone in the United States – or in the world really – but primarily in the US, everyone who has hepatitis B should be aware of their diagnosis and should be able to access to care. In order to do that, we have to do research. We have to figure out what are the best ways to get people tested and into care. In order to do that, we have to first figure out why people aren’t getting tested now, what barriers are people facing, what challenges are people facing to get tested, and how can we help them overcome those challenges. Every time we do a public health program, we are also doing research, so we are collecting a lot of data. And then, we use the data to develop new programs, and we share it with others as well. We also collect information and data on prevalence, so looking at where some of the high risk and highly impacted communities are in the U.S. We will do testing ourselves. We’ll go into communities in Philadelphia, and we’ll do hepatitis B testing. Through that, we know which communities need more care.
Kristine Alarcon, MPH: What types of public health programs are you carrying out right now?
Chari Cohen, DrPH, MPH: We have a number of different programs right now. One is our Hep B United Philadelphia program, where we like to train the trainers. In Philadelphia, we’re training people who do health education; we’re training community leaders; and we’re helping them to learn about hep B, so that that they can go into high risk communities and teach other people about hep B. We’re also screening a lot of people. This year, we screened a little over 200 people for hepatitis B. When we find people to be infected, we link them into care. We’re also working on a new project, looking at the challenges that African immigrants face in the US in terms of hepatitis B testing. We’re trying to figure out what are the best ways to overcome those challenges and what are the best ways to get people tested and into care. And then, we have our #justB program, which is our national patient storytelling program, where people who have hep B or with family members who have hep B tell their stories and make videos, and they share how hep B has impacted their lives.
Kristine Alarcon, MPH: Thank you so much for joining us in this episode!
Approximately 5-10% of people do not develop protective antibodies following the completion of the hepatitis B vaccine series. This is confirmed with a blood test called an anti-HBs titer test which is given 4 weeks following the completion of the series. If the test shows the titer is less then 10 mIU/mL the general recommendation is to complete the series again using a different brand of vaccine (e.g. if you received Engerix B, the first time, switch to Recombivax the 2nd time or vice-versa). A person is considered to be a “non-responder” if they have completed 2 full vaccination series’ without producing adequate protective antibodies.
Another vaccine option is the new two-dose hepatitis B vaccine, HEPLISAV-BTM. The new vaccine is expected to increase immunization rates for adults in the United States and is administered over a one-month period. The vaccine provides greater seroprotection, which can mean a greater antibody response especially in adults who may be older, obese or live with type 2 diabetes making it an effective vaccine option.
It is also possible that a person who does not respond to the vaccine may already be infected with hepatitis B. Therefore, testing for the presence of the hepatitis B virus (hepatitis B surface antigen or HBsAg) is recommended before diagnosing a person as a “vaccine non-responder.”
Persons who do not respond to the primary hepatitis B vaccine series (i.e., anti-HBs <10 mIU/mL) should complete a second 3-dose vaccine series or be evaluated to determine if they are HBsAg-positive. Persons who do not respond to an initial 3-dose vaccine series have a 30%–50% chance of responding to a second 3-dose series.
Revaccinated persons should be retested at the completion of the second vaccine series, 1-2 months following the last shot of the series.
Persons exposed to HBsAg-positive blood or body fluids who are known not to have responded to a primary vaccine series should receive a single dose of hepatitis B immunoglobulin (HBIG) and restart the hepatitis B vaccine series with the first dose of the hepatitis B vaccine as soon as possible after exposure. Alternatively, they should receive two doses of HBIG, one dose as soon as possible after exposure, and the second dose 1 month later.
The option of administering one dose of HBIG and restarting the vaccine series is preferred for non-responders who did not complete a second 3-dose vaccine series.
For persons who previously completed a second vaccine series but failed to respond, two doses of HBIG are preferred.
Hepatitis B vaccine “non-responders” who test negative for hepatitis B infection are at risk for being infected and should be counseled regarding how to prevent a hepatitis B infection and to seek immediate medical care to receive a dose of hepatitis B immunoglobulin (HBIG) if they have been exposed to potentially infected blood.
“Non-responders” who test negative for hepatitis B infection as well as friends and family members should practice ways to prevent the spread of hepatitis B, including washing hands, using condoms during sex, avoid direct contact with blood and bodily fluids, and more.
Hepatitis B vaccine “non-responders” to vaccination who test positive for hepatitis B infection should be counseled regarding how to prevent transmitting the hepatitis B virus to others and the need for regular medical care and monitoring for their chronic infection.
In the case of possible exposures to HBV infected blood or body fluids, it is recommended that non-responders receive 2 doses of hepatitis B immunoglobulin (HBIG) – the first dose should be given within 24 hours of the exposure, and the second dose should be given 1 month later. The CDC has recommendations online for what to do in case a susceptible person is possibly exposed to the hepatitis B virus.
Around the world, millions of people with chronic hepatitis B face wrenching discrimination that limits their dreams, education, careers, income and personal relationships.
Discrimination is unethical, unnecessary and a violation of human rights. Hepatitis B is simply not transmitted through casual contact. The stigma that persists is based on ignorance and it impacts millions around the world daily. The United Nations created Zero Discrimination Day to highlight the negative impact of discrimination and promote tolerance, compassion and peace. Many hepatitis activist organizations, including the Hepatitis B Foundation, used this commemorative day to draw attention to global hepatitis B discrimination. Even though Zero Discrimination Day was on March 1, we still need to recognize the importance of stopping hepatitis B discrimination.
Every day is zero discrimination day, and ending discrimination starts with each of us working in any way we can in our communities to end this stigma.
No one is to blame for hepatitis B, and people who have hepatitis B deserve the same opportunities to live fulfilling lives – at work, at home and in the community. . There is a safe and effective vaccine that prevents hepatitis B infection. When people are protected, there is no reason to fear that healthcare workers or hotel maids will spread this infection. Even without vaccination hepatitis B transmission can be avoided with simple prevention measures. Hepatitis B is not transmitted casually.
People who have hepatitis B are part of our global community. They are our mothers, brothers, doctors, teachers, spouses and friends. To learn about how the fear of discrimination affects people who have hepatitis B, check out some of our #justB patient stories. Jin’s story tells us how a vibrant young woman handles her fear, and Carolyn’s story shows us the devastating consequences of hiding a hepatitis B diagnosis.
It is morally reprehensible that given the tools and knowledge we have that discrimination against people who have hepatitis B should continue today. So we ask you to help us end this discrimination.
One way you can fight hepatitis B discrimination is by joining the World Health Alliance in their #StigmaStops awareness campaign. It is a year-long campaign that highlights the stigma and discrimination associated with hepatitis around the world. #StigmaStops provides people living with hepatitis a platform to strengthen their voice and speak about the stigma and its impact as well as dispel myths and misconceptions of hepatitis B. Another way to help is to talk about hepatitis B – with your colleagues, friends and family members. The more we talk openly about hepatitis B, the less it will be stigmatized. And feel free to share our #justB videos – they can be a great conversation starter!