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• Romance in the Air? Take a Deep Breath and Disclose

  Image courtesy of tiverylucky, at FreeDigitalPhotos.net Valentine’s Day may be a time to celebrate romance, but first you need a relationship. When you have chronic hepatitis B, starting a relationship and initiating sex is fraught with stress, hard disclosures, and the potential for break-up before an intimate relationship can even begin. Recently, the Hepatitis B Foundation received this heart-breaking post from a 33 year-old man who thought his “inactive” hepatitis B could not be transmitted sexually. “I’ve lived my entire life with this, but always thought it was just a normal thing (my mother said many Asians have it) and thought it was nothing to be concerned about as I never showed symptoms,” he wrote. “My doctor never said anything either. I lived my life thinking being a carrier was nothing out of the ordinary, and that I … could transfer it via blood, but could not sexually. “I recently became sexually active with a wonderful girl who I care about dearly. The thought of my inactive hep-B never crossed my mind until after the act. It was irresponsible of me to not look into this more before we had sex, I admit, but I was not educated on the severity of this disease. “After reading a bunch about it, I learned that even in the inactive state, it is possible, though not too likely, to transmit it sexually,” he explained. “I told her about this and she was understandably very upset. I asked her to get tested and to get the vaccine and also the immune globulin, which she will, but the conversation did not go over too well. “I betrayed her trust and though she understands I wasn’t ‘hiding’ this from her, she said it was incredibly irresponsible of me to not understand my own condition and now have it potentially affect her (she is right). I’m not trying to pass the buck here, but I wish my doctor and parents told me more details about this when I was growing up. Regardless of what her tests come back as, I doubt our

  http://www.hepb.org/blog/romance-in-the-air-take-a-deep-breath-and-disclose/
• Can People with HBeAg-Negative Hepatitis B Ever Stop Taking Antivirals?

  Image courtesy of rakratchada torsap, at FreeDigitalPhotos.net. Medical guidelines suggest that individuals with HBeAg-negative hepatitis B with signs of liver damage face an "indefinite" or even lifetime commitment to taking daily antiviral pills. In this week’s blog, we explore when—if ever—individuals with hard-to-treat HBeAg-negative hepatitis B can ever stop taking antivirals. First of all, what is HBeAg-negative hepatitis B? Many people infected with hepatitis B at birth and who remain infected into their 40s, 50s or 60s, develop HBeAg-negative hepatitis B. Researchers believe that over time the virus mutates to evade the immune system. Though individuals may have lost the hepatitis B “e” antigen (HBeAg) and developed the “e” antibody, this mutated virus develops the ability to keep replicating despite the loss of HBeAg. And this mutated virus is capable of putting people at higher risk of liver damage. Generally, doctors recommend treatment to HBeAg-negative patients when their viral load exceeds 2,000 IU/ML and their ALT liver enzyme levels, which rise when liver cells are damaged, are even moderately elevated. (Normal ALT levels are less than 30 for men and 19 for women.) The most common antiviral treatments are either entecavir (Baraclude) or tenofovir (Viread). These two are considered the most powerful at quickly reducing viral load (HBV DNA) and have a very low risk of causing drug resistance, which is critical considering the long-term treatment required by HBeAg-negative patients. But can individuals with HBeAg-negative hepatitis B ever stop treatment? Antivirals are expensive, without insurance tenofovir costs about $1,000 a month and generic entecavir costs about $407 in the U.S. Additionally, long-term antiviral treatment can cause bone loss. Late last year, hepatitis B experts with the American Association for the Study of Liver Disease (AASLD) tackled this question and reviewed recent studies that followed HBeAg-negative hepatitis B

  http://www.hepb.org/blog/can-people-with-hbeag-negative-hepatitis-b-ever-stop-taking-antivirals/
• I've Lost the Hepatitis B "e" Antigen (HBeAg), So When Can I Stop Treatment?

  Image courtesy of Naypong at FreeDigitalPhotos.net Eighteen years ago, doctors started treating hepatitis B patients with antivirals and today liver specialists have a wealth of knowledge about how these drugs stop the virus from replicating and reduce viral load. But one thing they're still not certain about is when patients can safely stop taking their daily antiviral pill. In this week’s blog, we’ll explore when experts think it's safe for patients, who have lost the hepatitis B “e” antigen (HBeAg) during antiviral treatment, to stop . Next week, we’ll look at when it's safe for patients who were already HBeAg-negative when they began antiviral treatment to stop. Today, doctors prescribe one of two antivirals—either entecavir (Baraclude) or tenofovir (Viread). Among the antivirals developed since 1998, these two are considered the most powerful in quickly reducing viral load (HBV DNA) and they carry the lowest risk of drug resistance. Doctors usually prescribe antivirals when our viral load is elevated and we have sign of liver damage--indicated by elevated liver enzymes (ALT or SGPT). Antivirals quickly knock down viral load, which in turn is believed to lower our risk of liver damage and cancer. But antivirals work for only as long as we take them. When we stop, the virus usually reactivates although this is very rarely fatal or results in a liver transplant. Studies show that at least 78 percent of people who stop antivirals have an increase in viral load, 44 percent have a rise in ALT levels indicating liver damage, and among those who lose HBeAg during treatment, at least 9 percent experienced a return of HBeAg. But what about individuals who take antivirals for long periods and enjoyed years of undetectable viral load, no signs of liver damage, loss of HBeAg, and development of the “e” antibody? Can they stop? After all, antivirals are expensive. Without insurance, a month's supply of tenofovir costs about $1,000 and generic entecavir

  http://www.hepb.org/blog/thanks-to-antivirals-youve-lost-the-hepatitis-b-e-antigen-so-when-can-you-stop-treatment/
• Why Won’t Doctors Treat Young Adults with High Viral Load and No Signs of Liver Damage?

  Image courtesy of Graur Razvan Ionut at FreeDigitalPhotos.net. If antiviral medications almost always lower viral loads, why don’t doctors treat young adults with high viral loads with this daily pill? After all, don’t high viral loads lead to liver damage and even liver cancer? This is one of the most common questions posed to the Hepatitis B Foundation, and at first glance the decision not to treat a high viral load with antivirals seems counter-intuitive or plain wrong. If antivirals reduce the number of hepatitis B virus (HBV) in the body, won’t that give the immune system an opportunity to clear out the remaining residual HBV? Unfortunately, it doesn't work that way. It’s complicated, as are many aspect of hepatitis B. It’s common for young adults (up to age 30) who live with hepatitis B to be in the “immune tolerant” stage of infection with extremely high viral load (HBV DNA) but with no signs of liver damage. When we’re born to mothers infected with hepatitis B, unless we’re immunized at birth 90 percent of us become infected from exposure to infectious blood and body fluids during delivery. And when infants are infected, their immature immune systems don’t recognize the virus. The young immune system misses the “red flag” signature on this hepatitis B virus and “tolerates” the infection instead of attacking it. In contrast, when we’re infected as healthy adults, our immune systems immediately detect and identify hepatitis B as a viral invader and aggressively attacks the virus and any infected liver cells. In adults, it generally can take up to six months for the immune system to eradicate the virus. When we’re infected as children, it can take up to three or even four decades for our immune systems to notice the virus and shift into “immune active” battle mode. Until the immune systems notice the virus and begins to fight the infection, children and young adults remain in the “immune tolerant” stage, with sky high

  http://www.hepb.org/blog/why-wont-doctors-treat-young-adults-with-high-viral-load-and-no-signs-of-liver-damage/
• Navigating Our Emotions When We’re First Diagnosed with Hepatitis B

  Image courtesy of Tuomas_Lehtinen at FreeDigitalPhotos.net. When we’re first diagnosed with hepatitis B, our physical health isn't the only thing we need to focus on. Many of us experience powerful surges of fear, anger, sadness, powerlessness, depression, and anxiety. No matter what you’re feeling, you have a right to feel whatever emotions are welling up – sometimes unexpectedly – inside you. There are no right or wrong feelings, they just are, and it’s up to you to decide what choices you make and how to respond to them. When my daughter was first diagnosed, she was a toddler and happened to be coming down with a cold. I knew nothing about hepatitis B and was convinced she would soon die from it given her crankiness, lethargy, and nonstop sleeping. Within a day or two, she was her smiling, energetic self again, and I happily slipped into denial. Surely the test was wrong or there was a mix-up in the result. My husband dragged his feet for weeks before he agreed to be screened for hepatitis B so great was his denial and fear. Denial is a normal first reaction, it can give us some  breathing room to get used to the idea that we’re infected. But denial can also be dangerous, especially if we’re in a sexual relationship with someone and don’t take precautions. Denial can be dangerous when we hide our infection and don’t tell our family members or partners, even though they may have been exposed. Denial is dangerous when we don’t tell our parents, who may not know they’re infected and unknowingly passed the virus to us at birth. It’s important to talk out our feelings with a doctor, a therapist, or a friend you trust. We need to move through denial so we can begin to receive the care and support we need, and talk to others who may also be at risk. Anger is another common and natural feeling after a diagnosis. It’s OK to get upset about how we or our family members were infected, or get angry that our parents or lovers didn’t know they

  http://www.hepb.org/blog/navigating-our-emotions-when-were-first-diagnosed-with-hepatitis-b/
• I’m living with hepatitis B, what should I do to reduce my risk of developing liver cancer?

  There are several ways you could reduce your risk of liver cancer. First, start by learning about hepatitis B, and what people living with hepatitis B should do regularly to maintain a healthy liver. Make sure to visit your doctor regularly to check your liver enzymes (ALT/AST), viral load (HBV DNA), platelet count and other liver function tests along with an ultrasound (every 6 months or at least annually). Ask your doctor about using simple blood tests to look at your Fibrosis-4 Index (FIB-4) for liver fibrosis. Discuss treatment with antivirals with your doctor.  (First line antivirals include tenofovir (TDF), tenofovir (TAF) and entecavir). These antivirals are effective at suppressing and controlling the virus, reducing liver damage resulting from the inflammatory response to the virus, and lowering the risk of developing liver cancer. Learn here about other important questions to ask your doctor. Make healthy lifestyle choices! You can make lifestyle choices that will put you in control during your journey with hepatitis B. You can support your liver by not drinking alcohol, not smoking and maintaining a healthy weight by eating a well-balanced diet and getting regular exercise. Here is some information on how to maintain a healthy liver. You may want to listen to this podcast about what a person with hepatitis B should eat, and you may find this guide helpful. Also be very careful with other prescription and over-the-counter medications or herbal remedies and supplements. Herbal remedies and supplements are not tested or regulated for purity and safety. Some supplements and herbs can do more harm than good. Join the Hep B Community! There, you will be able to engage online in discussions with scientists, clinicians, and people living with chronic hepatitis B from around the world, exchanging ideas, and experiences and knowledge about hepatitis B. Find more Frequently Asked Questions here.    Page updated 12/27/2022

  https://www.hepb.org/what-is-hepatitis-b/faqs/im-living-with-hepatitis-b-what-should-i-do-to-reduce-my-risk-of-developing-liver-cancer/
• FK's Story

  After overcoming a difficult childhood in Burkina Faso, FK worked hard to move to the United States and eventually, her mother joined her. FK was diagnosed with hepatitis B six months after arriving, so she began educating herself and encouraging family and friends to get screened. Despite the stigma and lack of knowledge around hepatitis B in her community, which has impacted her relationships, FK is working to address these misconceptions and is hopeful for the future.   FK's story is available in English and French. English French

  https://www.hepb.org/research-and-programs/patient-story-telling-project/fks-story/
• Is the hepatitis B vaccine safe during pregnancy?

  Yes. The hepatitis B vaccine is safe to be administered during pregnancy. Please remember that even if a mother receives the hepatitis B vaccine during pregnancy, her baby will have to be vaccinated after birth. The protective antibodies are not transmitted from the mother to her baby. Therefore, all babies should receive the birth dose of the hepatitis B vaccine. However, this is particularly critical for babies born to mothers living with chronic hepatitis B.  Find more Frequently Asked Questions here.  Page updated 02/09/2022

  https://www.hepb.org/what-is-hepatitis-b/faqs/is-the-hepatitis-b-vaccine-safe-during-pregnancy/
• Can a hepatitis B infection be prevented? How can I protect my loved ones?

  Yes, hepatitis B is preventable through a safe and effective vaccine. The hepatitis B vaccine provides lifelong protection. If you, or someone you love, have been diagnosed with hepatitis B, make sure other household members are screened for hepatitis B, and those who are not infected or vaccinated should receive the hepatitis B vaccine.  Hepatitis B is not spread casually, but is transmitted through direct contact with blood and sexual fluids. This can occur through direct blood-to-blood contact, unprotected sex, unsterile needles, and from an infected woman to her newborn during the delivery process. Other possible routes of infection include sharing any sharp instruments such as razors, nail clippers, toothbrushes or earrings, since small amounts of blood can be exchanged through these items. Also, body piercing and tattooing are potential sources of infection if unsterile needles are used. Please visit our webpage to learn more about hepatitis B transmission, and how to protect your loved ones. Find more Frequently Asked Questions here.  Page updated 05/09/2022

  https://www.hepb.org/what-is-hepatitis-b/faqs/can-a-hepatitis-b-infection-be-prevented-how-can-i-protect-my-loved-ones/
• Hepatitis B Foundation Applauds FDA Approval of New Hepatitis B Vaccine

  FDA Approved HEPLISAV-B, the First New Hepatitis B Vaccine in More than 25 Years DOYLESTOWN, PA (November 10, 2017): Today on World Immunization Day, the Hepatitis B Foundation applauded the U.S. Food and Drug Administration’s (FDA) approval of HEPLISAV-B™, the first new hepatitis B vaccine in more than 25 years and the only two-dose schedule for the prevention of infection in adults. Hepatitis B (HBV) is an extremely infectious virus (100 times more infectious than HIV/AIDS), and it is the most common serious liver infection in the world. More than 257 million people worldwide and up to 2.2 million in the United States are chronically infected with hepatitis B. Each year up to 1 million people die from HBV despite the fact that it is preventable and treatable. “The new two-dose vaccine is a game changer,” said Timothy Block, PhD, president of the Hepatitis B Foundation. “Current vaccines require three doses over 6 months, which makes it hard for some people to get all doses. With the new vaccine, people can be fully protected with two doses, in just one month. As we work towards finding a cure and eliminating hepatitis B in the U.S. and globally, having this new tool in our arsenal will play a critical role in preventing infections.” Hepatitis B is associated with significant health disparities in the U.S., disproportionately affecting Asian American, Pacific Islander, and African communities. Asian Americans and Pacific Islanders make up 50% of the HBV infection burden in the U.S., and have liver cancer rates that are up to 13 times higher than Caucasian populations. In addition, for the first time since 2006, the number of reported cases of acute HBV infection across the country is rising, and increased by 20.7% in 2015 alone. Parts of the country that are hardest hit by the opioid epidemic are now facing a rise in acute HBV infection associated with injection drug use. While the current three-dose HBV vaccine series offers lifelong protection from HBV infection, data from 2013 indicated that only 32.6% of adults aged 19 to 49 years were covered by the vaccine. Coverage is estimated to be even lower among injection drug users. Moving from a three-dose vaccine to a two-dose vaccine can help overcome challenges to vaccine completion, and lead to higher coverage and protection rates, especially for high-risk communities. “It is critical to increase HBV vaccination coverage, particularly among high-risk populations and young adults born prior to 1991, when HBV vaccination for infants became routine,” said Chari Cohen, DrPH, MPH, vice president for public health and programs at the Hepatitis B Foundation and co-chair of the Hep B United coalition. “We are very excited about the new two-dose vaccine and look forward to working with our partners to ensure all communities have access to this life-long protection from hepatitis B and liver cancer.” About the Hepatitis B Foundation The Hepatitis B Foundation is the nation’s leading nonprofit organization solely dedicated to finding a cure for hepatitis B and improving the quality of life for those affected worldwide through research, education and patient advocacy. To learn more, go to www.hepb.org, read our blog at hepb.org/blog, follow us on Twitter @HepBFoundation, find us on Facebook at facebook.com/hepbfoundation or call 215-489-4900. # # #    

  https://www.hepb.org/news-and-events/news-2/heplisav-approval/