Around the world, older adults bear the greatest burden of hepatitis B. Born before the childhood vaccination became available, about 4.7 percent of U.S. adults over age 50 have been infected and their chronic hepatitis B rate is nearly two-fold higher than in younger adults.
The 50-plus generation has lived with with chronic hepatitis B for decades, and over time their risk of liver damage, cirrhosis, and cancer has steadily increased. That is why it is very important that older adults living with this infection see their physicians regularly and have tests for liver damage and cancer performed as needed.
Our immune system and liver weaken with age: With age, our immune system loses its edge. Think chicken pox—that virus stays dormant in the body and emerges as shingles later in life when aging immune systems can no longer keep the virus in check.
As our immune systems age and weaken, they may no longer be able to suppress reproduction of the hepatitis B virus and you may notice an increase in your viral load (HBV DNA). Even when there is no notable increase in viral load, you can still experience liver damage, scarring (cirrhosis) and even cancer as you age. This is why getting your alanine aminotransferase (ALT) tested regularly for tell-tale signs of liver damage is essential.
When estrogen declines, women may be at greater risk of liver damage: Estrogen appears to confer some protection against liver damage, but as women age and estrogen levels decline, their risk of liver damage increases, which means monitoring may need to occur more frequently.
The liver loses its resiliency with age: According to researchers, over time our livers lose some of their ability to regenerate and their blood flow and screening capacity declines, leaving them more vulnerable to inflammation, scarring and cancer from the hepatitis B virus that hijacks liver cells to replicate.
Decades of exposure to environmental toxins take their toll: The cumulative effect of decades of exposure to environmental toxins impacts our liver health over time. It is the liver’s job to screen out those toxins, and the older we are, the greater the impact those toxins have had on our livers.
Other medical conditions affect hepatitis B: As we age, we often develop other medical conditions that weaken our immune system and impact our hepatitis B, which is why it’s always important to remind all of your doctors, including specialists, that you have hepatitis B, especially when they prescribe new medications. Immune-suppressing drugs, such as chemotherapy or rheumatoid arthritis treatments, can cause hepatitis B to reactivate.
Weight gain matters! As we age, we become less active and our metabolism slows, which is why so many of us pack on the pounds. In addition to risking diabetes, we also risk developing a fatty liver if we consume fatty foods, sugary drinks and alcohol. Fatty liver disease by itself increases the risk of liver damage and cirrhosis, when combined with hepatitis B, it can be deadly.
How often your hepatitis B is monitored depends on your medical history, and whether you have had elevated viral loads and ALT levels and other signs of liver damage in the past. Now that you’re older, talk to your doctor about whether more frequent screening is needed. For a summary of medical guidelines to monitor and manage hepatitis B click here.
This blog, and future ones, will explore different aspects of aging with chronic hepatitis B.
For an in-depth description of managing hepatitis B in the elderly, read Viral Hepatitis in the Elderly