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Beyond the Liver: The broader impact of living with chronic hepatitis B

 

 

 

 

 

 

 

 

 

When we talk about chronic hepatitis B virus (HBV) infection, the focus is usually on the liver and for good reason. HBV is a leading cause of liver cirrhosis and liver cancer. However, new research shows that HBV’s impact goes far beyond the liver. It can increase the risk of other cancers in the body.  

Hepatitis B and non-liver cancers 

A major population-based study in China found that people with chronic hepatitis B had significantly higher risks of several types of cancer beyond liver cancer. These included stomach, colorectal, pancreatic, oral cancers, and lymphoma (a type of cancer that affects the immune system). For example, the risk of lymphoma was nearly double in HBV-positive individuals compared to those without the virus (Song et al., 2019). This suggests that HBV may play a role in cancer development outside the liver, possibly through long-term inflammation or high viral load that affects other tissues and nearby cells. 

How hepatitis B affects other organs 

Hepatitis B isn’t limited to liver cells. It can also be found in the pancreas, kidneys, and blood cells, where it may cause inflammation and target the immune system (Tang, 2020). Long-term inflammation, especially without proper treatment or management, caused by hepatitis B can raise the risk of cancer, and, because the virus can stay in different parts of the body, not just the liver, it may help explain why it’s linked to other types of cancers.  

In addition to cancer, hep B can also cause inflammation in other organs. One example is kidneys. Some people with HBV develop a condition called glomerulonephritis, which is a type of kidney inflammation. Over time, this can lead to serious kidney damage if not treated. 

HBV may also be linked to certain blood disorders and metabolic issues, especially when combined with other health problems such as diabetes or MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease. These conditions can make it harder for the body to stay balanced and healthy (Karayiannis, 2017). 

Mental and emotional health 

Living with chronic hepatitis B often can affect a person’s mental health. Some people feel anxious, stressed, or even depressed because of the stigma, the fear of passing the virus to others, or worries about their future health. These feelings can make it more challenging to stay on top of treatment and care. 

What Can Be Done? 

Fortunately, hepatitis B is manageable. Antiviral medications can suppress the virus, which may reduce the risk of complications and help with inflammation of not just liver cells but also other cells and tissues in the body. Regular monitoring and early treatment are key, not just for liver health, but for preventing other health issues linked to hepatitis B. Learn more about hepatitis B management and updated recommendations here. Check out our Liver Cancer Connect program to learn more about liver cancer prevention and management. 

While liver cancer is one of the most serious outcomes of chronic hepatitis B, the virus can also harm other parts of the body, including the stomach, pancreas, and even the immune system. That’s why managing hepatitis B isn’t just about protecting the liver; it’s about protecting your whole health. Staying connected to care, getting regular checkups, and following treatment plans are key to detecting problems early and living well with hepatitis B.  

References: 

Song, C., Lv, J., Liu, Y., et al. (2019). Associations between hepatitis B virus infection and risk of all cancer types. JAMA Network Open, 2(6), e195718. https://doi.org/10.1001/jamanetworkopen.2019.5718  

Tang, H. (2020). Hepatitis B Virus Infection: Molecular Virology to Antiviral Drugs. Springer. https://doi.org/10.1007/978-981-13-9151-4  

Karayiannis, P. (2017). Hepatitis B virus: virology, molecular biology, life cycle and intrahepatic spread. Journal of Gastroenterology, https://doi.org/10.1007/s12072-017-9829- 

ASCO: Updated Guidelines for Hepatitis B Screening

 

 

ASCO: Updated Guidelines for Hepatitis B Screening

The American Society of Clinical Oncology (ASCO), recently updated their hepatitis B screening guidelines. The Provisional Clinical Opinion on hepatitis B is based on a rigorous, evidence-based approach and is periodically updated to reflect recently published data.

Recommendations

The American Society of Clinical Oncology updated their 2020 guidelines on hepatitis B and cancer screening. Most importantly, ASCO recommends universal screening for hepatitis B for patients undergoing cancer therapy.  ASCO states that all cancer patients anticipating systemic anticancer therapy should be screened for hepatitis B through three tests. People living with chronic hepatitis B (HBV) receiving any systemic anticancer therapy should receive antiviral prophylaxis for the duration of anticancer therapy, as well as for at least 12 months after receipt of the last anticancer therapy. Antiviral therapy and management for cancer patients should follow national HBV guidelines, independent of cancer therapy, including management by a clinician experienced in HBV management for prevention of liver diseases such as cirrhosis or liver cancer. Patients with past HBV receiving anticancer therapies associated with an established high risk of HBV reactivation should be started on antiviral prophylaxis at the beginning of anticancer therapy and continued on antiviral therapy for at least 12 months after anticancer therapy ends. Patients with past HBV infection undergoing anticancer therapies that are not clearly associated with a high risk of HBV reactivation should be followed carefully during cancer treatment, with HBsAg and ALT testing every 3 months.

Risk Factors for HBV Reactivation

The article states a few risk factors for hepatitis B reactivation. These risk factors include types of cancers, various anticancer therapies, immunotherapy, radiation therapy and transarterial chemoembolization, other B-cell agents, and special situations. Because of these risk factors for hepatitis B reactivation, it is important for health care professionals to screen for hepatitis B prior to cancer treatment.

What Does This Mean for Providers

Oncologists and healthcare providers have a responsibility to screen their cancer patients for hepatitis B prior to treatment. Screening is especially important among vulnerable populations such as persons of Asian, Pacific Islander and African descent who are disproportionately affected by hepatitis B.

What Does This Mean for Patients

Patients with cancer should also advocate for themselves in healthcare settings to ask for a hepatitis B panel screening before treatment. Your provider will be able to interpret your test results, but here is a simple table to help you understand your hepatitis B panel screening results.

 

Read the full article here.

 

Reference

Hwang, J. P., Feld, J. J., Hammond, S. P., Wang, S. H., Alston-Johnson, D. E., Cryer, D. R., Hershman, D. L., Loehrer, A. P., Sabichi, A. L., Symington, B. E., Terrault, N., Wong, M. L., Somerfield, M. R., & Artz, A. S. (2020). Hepatitis B Virus Screening and Management for Patients With Cancer Prior to Therapy: ASCO Provisional Clinical Opinion Update. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, JCO2001757. Advance online publication. https://doi.org/10.1200/JCO.20.01757

Author

Evangeline Wang, Public Health Program and Outreach Coordinator at the Hepatitis B Foundation

Contact Information: info@hepb.org