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Category Archives: Hepatitis B Diagnosis & Monitoring

Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention, Liver Cancer

Journey to the Cure: What Does Liver Cancer Research Look Like? ft. Aejaz Sayeed, PhD

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 fourth episode (part 2), Kristine Alarcon, MPH sits down with Aejaz Sayeed, PhD, Assistant Professor at the Baruch S. Blumberg Institute, to talk about his research in liver cancer. For any questions about hepatitis B, please email info@hepb.org.

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.

Edited by:
Kristine Alarcon, MPH

Special thanks:
Samantha Young

Music:
Modern – iMovie Library Collection

Script:

Welcome to “Journey to the Cure!” Every month, we’ll sit down with scientists from the Hepatitis B Foundationand the Baruch S. Blumberg Instituteto 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:
Can you tell me about your research?

Aejaz Sayeed, PhD:
That’s an interesting question. I’vespent a lot of time pursuing breast cancer and prostate cancer. I just started working on the liver cancer. There are millions of people who are pursuing cancer research, but the challenge is that we have done a lot of progress in some cancers, but some cancers, still, we do not have a handle on. For example, we have done a lot of progress in breast and prostate cancer. We have not done much in pancreatic and liver cancer. And, the five-year survival rates of breast and prostate and other cancers have drastically increased, but we have not done much of a progress in pancreatic or a specific form of brain cancer or pancreatic cancer or liver cancer. The problem, again, is that we’re not able to detect the disease at an early stage, and if we had a good set of biomarkers available, there’s a good opportunity, there’s a good chance that we should be able to control these diseases as well.

Kristine Alarcon, MPH:
What attracted you to studying liver cancer?

Aejaz Sayeed, PhD:
I’ve been working on breast cancer and prostate cancer, so in liver cancer, I want to use the tools and techniques, which I used in breast and prostate cancer. That’s why there’s that desire to use the similar strategies, which I used in breast and prostate cancer to discover and characterize markers. That’s why I’m still setting up collaborations with transplant surgeons because liver cancer is treated generally by either resecting the tumor or transplanting the liver. The liver is such an important organ that you cannot really take the liver away. You need the liver. Transplanting the liver is another strategy of treating these patients, so, yes, it is basically that desire that we have more biomarkers, and I can use the knowledge that I gained in breast and prostate to recapitulate the same kind of events, so that we can make a dent.

Kristine Alarcon, MPH:
Yeah; that’s so cool.

Aejaz Sayeed, PhD:
Thank you.

Kristine Alarcon, MPH:
Well, thank you for joining us on this episode of “Journey to the Cure.” Please join us next time for our next episode. Thank you for joining us!

Aejaz Sayeed, PhD:
Thank you!

Hepatitis B Diagnosis & Monitoring

Newly Diagnosed with Hepatitis B? How Did I Get this? Learning the HBV Transmission Basics

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If you have just been diagnosed with hepatitis B virus (HBV) then you need to understand how HBV is transmitted. This is important whether you have an acute or chronic infection.  You must understand you are infectious and can transmit the virus to others.

How is hepatitis B transmitted?

Hepatitis B is transmitted through direct contact with infected blood or certain bodily fluids. The virus is most commonly transmitted from an infected pregnant person to their baby during childbirth, due to the blood exchange that happens between mother and baby. It is also transmitted through unsterile medical or dental equipment, unprotected sex, or unsterile needles. For kids, pediatric experts report that the fluid that oozes from cuts and open sores is also highly infectious, so keep those open cuts covered. Hepatitis B can also be transmitted inadvertently by the sharing of personal items such as razors, toothbrushes, nail clippers, body jewelry and other personal items that have small amounts of blood on them.

Hepatitis B is not transmitted casually by sneezing or coughing, shaking hands, hugging or sharing or preparing a meal. In fact, the virus is not contracted during most of life’s daily activities. You don’t need to keep cups, bowls, plates or utensils separate. Hugging, or even kissing won’t cause infection unless there are bleeding gums or open sores during the exchange. It’s really all about trace amounts of infected blood, though the virus is in other bodily fluids in lower concentrations. For example, it’s not the saliva on the toothbrush that is a big concern, but rather the potential for trace amounts of blood that could be exchanged with a shared toothbrush.

How did I get this? If you have been diagnosed with hepatitis B virus you are likely racking your brain trying to figure out how you could have gotten HBV.  Some can immediately track their likely exposure to a recent event, or perhaps a time period in their life where they were more likely to have been exposed. They may fit into an at-risk category for hepatitis B due to lifestyle choices, country of origin, frequent travel and exposure in endemic areas of the world, or an unsafe blood transfusion, or medical or dental procedures performed without proper infection control. Some may never know how they were infected. What is important is that you are now aware.

Since HBV is a silent infection there can be years before it is detected.  Many individuals born in endemic parts of the globe find out later in life that they are hepatitis B positive, even though they have likely had HBV since birth or early-childhood. Children are especially vulnerable to chronic HBV. Greater than 90% of babies and up to 50% of young children infected with HBV will remain chronically infected, and most will have no symptoms.  Often it remains undetected until it is caught in routine blood work, blood donation, or later in life after there is liver inflammation or disease progression. In Asia, vertical transmission from mother to child is particularly common; whereas in Africa, horizontal transmission at a young age may be more likely.

Although not casually transmitted, there are inadvertent opportunities for exposure to hepatitis B. If you are from an area where HBV is very common, then the odds of exposure, transmission, and infection will be higher. Many are surprised when family is tested, and they learn hepatitis B appears to “run in their family”.  Hepatitis B is NOT genetic! It is not carried on the sperm of a man or the egg of a woman, but it is very easily passed from an HBsAg positive mom to her baby at birth. Hep B is a vaccine preventable disease, but not all moms living with the virus have access to the birth dose for their baby or able to complete the vaccine series, or they have a high viral load resulting in failure of HBV birth prophylaxis. The good news is that today we can prevent the transmission of hepatitis B to the next generation.

If you do, or have participated in high-risk activities at some point in your life, you are also at greater risk. This is not a time to judge or be judged.

Time to move forward. Unless your infection is acute and you can definitively identify your exposure, I would advise that you let it go and move forward. I spent a number of years wondering about the details of my daughter’s infection, but ultimately, it really didn’t matter. What is important is seeing a doctor to learn more about your infection, getting treatment if you need it, preventing transmission to others, and moving forward with your life.

Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention

Journey to the Cure: How is Hepatitis B Related to Liver Cancer ft. Aejaz Sayeed, PhD

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 four episode (part 1), Kristine Alarcon, MPH talks with Aejaz Sayeed, PhD, Assistant Professor of the Baruch S. Blumberg Institute. They talk about how hepatitis B is connected to liver cancer and doctors and scientists tell if a patient has cancer.

For any questions about hepatitis B, please email info@hepb.org.

The Hepatitis B Foundation is a national nonprofit organization dedicated to finding a cure and improving the lives of those affected by hepatitis B worldwide through research, education and patient advocacy. Visit us at www.hepb.org, on Facebook at www.facebook.com/hepbfoundation, on Twitter at @hepbfoundation, and our Blog at www.hepb.org/blog

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.

Edited:
Kristine Alarcon, MPH

Special thanks:
Samantha Young

Music:
Modern – iMovie Library Collection

 

 

Hepatitis B Advocacy, Hepatitis B Diagnosis & Monitoring

Finding the Missing Millions in Ghana

Theobald Owusu-Ansah, President of the Hepatitis Foundation of Ghana and Hepatitis Coalition of Ghana and Guest Blogger, shares his efforts to eliminate hepatitis B in Ghana.

Viral Hepatitis is very common in Ghana, but awareness and testing has remained low. The Hepatitis Foundation of Ghana is working hard to address these gaps. Our mission is to eliminate viral hepatitis and improve the quality of life for those living with chronic hepatitis B and C in Ghana. We have a robust viral hepatitis community screening and awareness program. Through this program, we are working to reduce hepatitis B and C transmission among people in Agona, a farming community in the Nzema East Municipality of the Western region, Ketu South of the Volta Region, Kumasi in the Ashanti Region and Sekondi Komfoase and Takoradi in the Western; and also raise awareness on viral hepatitis infection, reducing stigma and discrimination through free screening, vaccination and education activities. Since this program started, we have made great progress towards these goals! Read on to learn about our most recent successes:

EVENT AT AGONA ON 22ND DECEMBER, 2017

The Hepatitis Foundation of Ghana held a free hepatitis B screening, education and community gathering in Agona, a farming community in the Nzema East Municipality of the Western region A total of 101 persons were screened for hepatitis B. In all, 6 people tested positive for hepatitis B. Those who tested positive were counselled and referred to the district hospital for proper care and treatment.

EVENT AT KETU SOUTH ON 23RD DECEMBER, 2017

Hepatitis B free screening and education were held at Ketu South, a community in the Volta region. A total of 244 persons were screened for hepatitis B. In all, 6 people tested positive. They were counselled and referred to the district hospital for proper care and treatment.

There have been some deaths reported within the community as a result of viral hepatitis according to the people in the community. Interestingly, a majority of the people attributed them to some form of spiritual or traditional mishaps. This was due to the lack of awareness on the risks of viral hepatitis. To help overcome these myths, hepatitis educational materials such as pamphlets and stickers were delivered to the community.

EVENT WITH VOLTIC GHANA LTD IN KUMASI ON 1st MARCH, 2018.

VENUE: KNUST CAMPUS. 

We worked with the Zoom Lion division of the Voltic Ghana Ltd, providing free hepatitis B and C testing.

Those who tested negative were provided with the first two doses of the hepatitis B vaccine. They were also educated and encouraged to spread the knowledge they had received. The people expressed their appreciation for the gesture at the end of the program and promised to get their last dose of hepatitis B vaccine!

EVENT AT SEKONDI KOMFOASE AND TAKORADI ON THE 25TH TO 26TH MAY, 2018

This special event began with a health walk through the streets in the Sekondi Komfoase area and followed with a hepatitis health talk and screening. Most of the people were afraid to come and do the hepatitis B and C tests because of some common perceptions on the radio and TV. I was able to share my family story with them, and that helped some of them come forward to do the test. The screening continued the next day at Home Church in Takoradi. Overcoming misperceptions about hepatitis B is very challenging – but we were able to screen179 persons, and are following up with all of those who tested positive.

There is a lot of work still to be done in Ghana, but we will keep working to change knowledge, overcome challenges and get people tested, vaccinated and treated!

Thank you to Theobald for serving as our guest blogger this week! If you would like more information from Theobald Owusu-Ansah or the Hepatitis Foundation of Ghana, please visit their website or contact them here. 

Hepatitis B Diagnosis & Monitoring, Living with Hepatitis B

Recently Diagnosed with Hepatitis B? Getting Through the Next Months Waiting to Confirm if Your Infection is Acute or Chronic

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Have you recently been told you have hepatitis B?  Dealing with the diagnosis and waiting out the next six months to determine if your infection will resolve itself or learning that it is a chronic infection can be nerve-wracking.

Fortunately, greater than 90 percent of healthy adults who are newly infected will clear or resolve an acute hepatitis B infection.  On the hand, greater than 90% of babies and up to 50% of children infected with hepatitis B will have lifelong, chronic infection. Sometimes people are surprised to learn they have a chronic infection. It can be confusing since there are typically few or no symptoms for decades. If a person continues to test hepatitis B positive for longer than 6 months, then it is considered a chronic infection. Repeat testing is the only way to know for sure.

Acute hepatitis B patients rarely require hospitalization, or even medication.  If you are symptomatic, (some symptoms include jaundice, dark urine, abdominal pain, fever, general malaise)  you may be anxiously conferring with your doctor, but if you are asymptomatic, you might not feel compelled to take the diagnosis seriously.  Ignoring your diagnosis can be very serious. If you have concerning symptoms like jaundice (yellow eyes and skin), a bloated abdomen or severe nausea and vomiting, please see your doctor immediately. Your doctor will be monitoring your blood work over the next few months to see if you clear the virus, or monitoring your liver if there are concerning symptoms.

Your job is to start loving your liver …today.  STOP drinking alcoholic beverages.  Refrain from smoking cigarettes.  Your liver is a non-complaining organ, but you cannot live without it.  Make your diet liver-friendly and healthy filled with a rainbow of vegetables and fruits, whole grains, fish and lean meats. Minimize processed foods, saturated fats and sugar.  Drink plenty of water.

Talk to your doctor before taking prescription medications, herbal remedies, supplements or over-the-counter drugs.  Some can be dangerous to a liver that is battling hepatitis B.  Get plenty of rest, and exercise if you are able.

Don’t forget that you are infectious during this time, and that loved ones, sexual partners and household contacts should be tested to see if they need to be vaccinated to protect against hepatitis B.  Sometimes family members or close household contacts may find that they have a current infection or have recovered from a past HBV infection.  If anyone fears exposure, ensure them that hepatitis B is not transmitted casually. They should get tested, and vaccinated if needed, and take simple precautions. Remind them that 1/3 of the world’s population will be infected with the hepatitis B virus during their lifetime.

On the flip-side… Do not let this new hepatitis B diagnosis consume you.  As the weeks and months pass, you might find that the infection is not resolving, and you might worry that you have a chronic infection.  The associated stress and anxiety can be challenging, even overwhelming.  It can contribute to physical symptoms you may be experiencing.  Find a family member, friend, or health care professional with whom you can share your concerns.

If you are told you have recovered from an acute HBV infection (you are now HBsAg negative, HBcAb positive and HBsAb positive) be sure to get copies of your lab reports to ensure there are no mistakes. Compare them with our easy to use blood tests chart.   If something looks wrong, or if you’re confused, speak up and ask your doctor. Once confirmed, be sure to include hepatitis B as part of your personal health history. This is important in case you have conditions requiring treatment later in life that might once again warrant monitoring of your hepatitis B. It is possible for a past HBV  infection to reactivate if a person requires longterm immune suppressing drugs .

No one wants to learn they have chronic hepatitis B but it is a manageable disease. You’ll want to see a doctor with experience treating chronic HBV so they can run additional tests. There are very effective treatments available, though not everyone with chronic HBV needs treatment. All people living with chronic HBV benefit from regular monitoring since things can change with time. Please do not panic or ignore a chronic hepatitis B diagnosis. Take a deep breath and get started today learning more about your HBV infection and the health of your liver.  Things are going to be okay!

If you are confused about your diagnosis, please feel free to contact the Hepatitis B Foundation at info@hepb.org.

Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention, Hepatitis B Treatment, Living with Hepatitis B

If Hepatitis B Is Sexually Transmitted, How Come My Partner Isn’t Infected?

Image courtesy of Canva

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 can be transmitted sexually, so why do some people — who were not vaccinated — never get hepatitis B from their sexual partners?

It comes down to factors, such as the type of sexual activity partners engage in, the viral load (HBV DNA) of the infected partner, and who is on the receiving end of infectious body fluids, especially blood (which contains the most virus), and semen.

Having one partner infected, while the other is 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 may play a role in transmission of hepatitis B infection through sexual activity.

Viral load: Semen, vaginal fluids and blood all contain the hepatitis B virus (HBV), and the higher the viral load in the blood of an infected individual, the more infectious they are considered to be. Having an undetectable viral load might reduce or eliminate the chance of transmitting the virus to someone during unprotected sex; research is still trying to assess whether a person with an undetectable viral load in the blood is able to transmit the virus through sex. This is a good reason for individuals living with hepatitis B to talk to their doctor about the benefits of starting antivirals if they have detectable HBV viral load in their blood; treatment which lowers the viral load in the blood might also serve as a prevention measure for transmitting the virus.

Once an individual tests positive for hepatitis B surface antigen (HBsAg), they should encourage their partners to get screened for hepatitis B, and vaccinated if they are still susceptible to the virus.

The timing of sexual activity: An infected person who is menstruating is more likely to transmit hepatitis B infection to an unvaccinated partner, because menstrual blood can contain higher levels of HBV than vaginal secretions. That is why dental dams and condoms are recommended to provide a reasonable barrier against exposure, during that time of the month.

The type of sexual activity: Certain sexual activities are far more efficient at transmitting hepatitis B virus than others. Oral sex appears to have a lower rate of hepatitis B transmission than vaginal sex. Anal sex carries a higher risk of transmission because of tears in the skin that can occur during penetration, which increases the likelihood of transmission of HBV to an unvaccinated partner.

Fingering carries a lesser risk, unless the infected partner is menstruating while the other partner has bruises or cuts on their hands that could allow entry of hepatitis B virus from the body fluid into the bloodstream. In such cases, gloves are highly recommended.

The hepatitis B status of the other partner: The “uninfected” partner could have already been infected and cleared the virus, or vaccinated as an infant. 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 advised to receive the hepatitis B vaccine as soon as possible. However, this does not mean that they were never infected.

Testing for the hepatitis B surface antibody (also known as anti-HBs or HBsAb), and hepatitis B core antibody (HBcAb) is the only way to identify a past recovered infection or prior vaccination.

Hepatitis B is often called the “silent” infection because many people who get hepatitis B may not experience any of the alarming symptoms (like fever or jaundice). As a result, many individuals may never realize they were infected. A partner 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 vaccinated without proper screening, then tested for HBsAb after 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 partner is diagnosed with hepatitis B and the other is not, it might seem unusual, but it is not uncommon. Just like any other virus, there is not a 100% chance of transmission with exposure. The undiagnosed partner should get tested using the 3-panel blood test (HBsAg, HBsAb, and HBcAb) and immediately vaccinated if they are still vulnerable to a hepatitis B infection (HBsAb negative).

The is safe, effective, and provides lifelong protection.

Take a quiz to find out how much you know about hepatitis B transmission: click here.

Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention, Hepatitis B Treatment

Journey to the Cure: What do I do if I’m pregnant and have hep B? ft. Maureen Kamischke

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 third episode (part 1), Kristine Alarcon, MPH sits down with Maureen Kamischke, Hepatitis B Foundation Social Media Manager, to discuss what expectant mothers can do when they have hepatitis B.

For any questions about hepatitis B, please email info@hepb.org.

The Hepatitis B Foundation is a national nonprofit organization dedicated to finding a cure and improving the lives of those affected by hepatitis B worldwide through research, education and patient advocacy. Visit us at www.hepb.org, on Facebook at www.facebook.com/hepbfoundation, on Twitter at @hepbfoundation, and our Blog at www.hepb.org/blog

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.

Edited:
Kristine Alarcon, MPH

Special thanks:
Samantha Young

Music:
Modern – iMovie Library Collection

Hepatitis B Diagnosis & Monitoring, Hepatitis B Treatment, Hepatitis Delta (HDV)

What New Treatments Are on the Horizon for Hepatitis B/D Coinfected Patients?

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.

Myrcludex B

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.

Ezetimibe

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.

Lonafarnib

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.

Rep 2139

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

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.

ALN-HDV

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.

For more information about hepatitis B/D coinfection, please visit www.hepdconnect.org or email us at connect@hepdconnect.org.

Hepatitis B Diagnosis & Monitoring, Hepatitis Delta (HDV)

I Have Hepatitis B. Could I Also Be Infected with Hepatitis D?

By Sierra Pellechio, Hepatitis Delta Connect Coordinator

Hepatitis delta, or hepatitis D, is an aggressive form of hepatitis that can only infect someone who is also infected with hepatitis B.

People can become infected with hepatitis B and hepatitis D from the same exposure, or people who are already infected with hepatitis B can later be infected with hepatitis D. Coinfection can promote more rapid progression to cirrhosis and liver cancer than being infected with hepatitis B alone and will require an altered treatment and management plan. Being aware could save your life!

Hepatitis D can be spread similarly to hepatitis B, through exposure to blood or bodily fluids of an infected person. People with hepatitis B are likely to develop a chronic hepatitis delta coinfection if they are exposed to the virus, making it important for you and your doctor to be aware of the signs of a coinfection.

Cues to suspect a coinfection:

  • You have chronic hepatitis B but are not responding to antiviral treatment, or you have signs of liver damage even though your viral load is low (HBV DNA below 2,000 IU/mL)

Note: Fatty liver disease (caused by obesity) and liver damage from alcohol or environmental toxins should be ruled out as causes of liver damage before testing for hepatitis D.

It is also important for hepatitis B patients who originate from Sub-Saharan Africa, China, Russia, the Middle East, Mongolia, Romania, Georgia, Turkey, Pakistan and the Amazonian River Basin to be tested for hepatitis D, where it is more common. Most of the time, patients do not have any signs or symptoms to let them know they are coinfected, so a simple blood test is the only way to know for sure! Talk to your liver specialist about testing at your next appointment.

Hepatitis Delta Connect is a dedicated program of the Hepatitis B Foundation aimed to provide information and support for those affected by hepatitis D. Please visit our website, www.hepdconnect.org for more information and follow us on Facebook, Twitter and Instagram to stay up to date on the latest hepatitis D news! If you are a patient or provider and have questions or concerns, please email us at connect@hepdconnect.org.

Check out our previous posts about hepatitis D here, here, and here.

Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention, Hepatitis B Treatment

What Do I Do if I’m a Hepatitis B Vaccine Non-Responder?

Image courtesy of Pixabay

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.”

CDC Recommendations for Hepatitis B Vaccine Non-Responders

  • 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.

Check out our previous post on the topic here.

References:

CDC Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Postexposure Management. Retrieved from: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6210a1.htm

HEPLISAV-B. Retrieved from: https://heplisavb.com/

Baruch S. Blumberg Institute