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  • Diagnosed With Chronic Hepatitis B? What Does Your HBV DNA Test (Viral Load) Tell You?

    Image courtesy of Praisaeng, at FreeDigitalPhotos.net. If you have been diagnosed with chronic hepatitis B, your doctor has probably run several blood tests that show if the infection is harming your liver and identify what stage of infection you are in.  Doctors consider all of these results when deciding if you need treatment and how often you should be monitored. In this blog, we'll examine how one of the tests -- the HBV DNA or viral load test --can give you a snapshot into your hepatitis B infection and your health. The HBV DNA test  is performed on a blood sample using a Polymerase Chain Reaction (PCR) technique that rapidly generates HBV DNA fragments so they can be measured. Today, viral load is usually measured using international units per milliliter (IU/mL). However, in the past it was measured in copies per milliliter (copies/mL), and in some regions and labs, it is still used. If you ever need to convert copies into international units, there are about 5.6 copies in one international unit, so 5,000 copies/mL equals about 893 IU/mL. Remember to keep copies of your lab information on file so you can track your status. An Excel spreadsheet works great. The sensitivity of HBV DNA tests may vary with each lab so it’s a good idea to use the same lab for your test. Labs usually measure down to less than 200 IU/mL. Below the threshold, the viral load is considered “undetectable” – something everyone with chronic hepatitis B wants to hear. How HBV DNA results are presented mathematically on your lab report can be confusing. Because the amount of virus in the blood may be very high – in the millions or billions – the result may be displayed as an exponent or a log, rather than a whole number. You may need to convert these numbers to fully understand them. What does viral load say about what stage of the virus you are in? Your viral load also varies over time depending  on the “stage” of hepatitis B infection. That is why regular monitoring

    https://www.hepb.org/blog/diagnosed-with-chronic-hepatitis-b-what-does-your-hbv-dna-test-tell-you/
  • 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/
  • Global leader, physician treating people living with hepatitis B takes new role with Hepatitis B Foundation

    Su Wang, MD, MPH, FACP, will be the Foundation’s Senior Advisor for Global Health. Doylestown, Pa., March 27, 2023 – Su Wang, MD, MPH, FACP, a prominent leader in the global hepatitis community and a member the Hepatitis B Foundation’s Board of Directors, has become the Foundation’s first Senior Advisor for Global Health.  Dr. Su Wang This position will leverage Dr. Wang’s expertise to help lead the Foundation’s global advocacy and engagement programs, by representing the Foundation at specific meetings and activities, developing partnerships and helping strengthen the international hepatitis B movement. “Dr. Wang is a truly dedicated advocate for improving awareness, screening, linkage-to-care and treatment for people living with hepatitis B,” Chari A. Cohen, DrPH, MPH, president of the Foundation, said. “I’m thrilled that Dr. Wang, who has worked with us for many years and is a recognized leader worldwide, has agreed to take this prominent new position.” A practicing internist, Dr. Wang is medical director of Viral Hepatitis Programs and the Center for Asian Health at Cooperman Barnabas Medical Center, RWJBarnabas Health in Livingston, N.J. She also is living with hepatitis B, having been diagnosed as a college student when she donated blood. “I am excited to apply my lived experience of hepatitis B and work as a physician and advocate to elevate hepatitis B globally in my new position at the Foundation.” says Dr. Wang. Dr. Wang is the immediate past president of the World Hepatitis Alliance, a patient-led international organization whose mission is to harness the power of people living with viral hepatitis to achieve its elimination. The Hepatitis B Foundation presented its Community Commitment Award to Dr. Wang at its annual Gala on March 10. In her response, Dr. Wang said the organization plays a unique role in the hepatitis B community. “I’d like to thank Joan Block, Tim Block, Chari Cohen and the entire team at the Hepatitis B Foundation for all you’ve created and accomplished,” Dr. Wang said. “Thank you for bringing into the light what has been in the darkness for too long, for speaking out on behalf of us, for fighting for our rights, for fighting for a cure, and for never giving up. Thank you for creating a home for us.”

    https://www.hepb.org/news-and-events/news-2/global-leader-physician-treating-people-living-with-hepatitis-b-takes-new-role-with-hepatitis-b-foundation/
  • What should I do if I am diagnosed with chronic hepatitis B?

    If you test positive for the hepatitis B virus for longer than 6 months, this indicates that you have a chronic hepatitis B infection. You should make an appointment with a hepatologist (liver specialist) or gastroenterologist familiar with hepatitis B. This specialist will order blood tests and possibly a liver ultrasound to evaluate your hepatitis B status and the health of your liver. Your doctor will probably want to see you at least once or twice a year to monitor your hepatitis B and determine if you would benefit from treatment. Most people chronically infected with hepatitis B can expect to live long, healthy lives. You can support your liver by avoiding alcohol, avoiding smoking and maintaining a healthy weight by eating a well-balanced diet and getting regular exercise. Here is more information on how to maintain a healthy liver. Once you are diagnosed with chronic hepatitis B, the virus may stay in your blood and liver for a lifetime. It is important to know that you can pass the virus along to others, even if you don’t feel sick. This is why it’s so important that you make sure that all close household contacts and sex partners are tested and vaccinated against hepatitis B. Please visit our webpage to learn more about hepatitis B transmission, and how to protect your loved ones. Additional Resources: Healthy Liver Tips Hepatitis B Transmission Find more Frequently Asked Questions here.  Page updated 02/09/2022

    https://www.hepb.org/what-is-hepatitis-b/faqs/what-should-i-do-if-i-am-diagnosed-with-chronic-hepatitis-b/
  • Hepatitis B Foundation stands in solidarity with black communities, calls for action against institutional racism

    Doylestown, Pa., June 4, 2020  The tragic killings of George Floyd, Breonna Taylor, Tony McDade and Ahmaud Arbery in recent weeks have highlighted institutional racism and injustice towards Black Americans and communities of color in the United States. We have seen lives tragically lost due to institutionalized racism and police brutality. This comes at a time when communities of color are already disproportionately impacted by COVID-19 in addition to a number of other health disparities, including hepatitis B. These recent events are devastating to communities of color in the U.S. Institutionalized racism is a public health crisis, and we must all work together to address it. As a nonprofit organization, the Hepatitis B Foundation has spent 30 years dedicated to improving the lives of underserved and underrepresented communities. We are committed to working with our colleagues around the world to achieve social justice for all communities. Black lives matter and we strongly stand with our partners and communities fighting for justice and equity. As a national public health institution, we are aware that an individual’s socioeconomic status, ethnicity and zip code can dictate their life expectancy and overall health outcomes. Many of the populations we devote our work to are communities of color and we will continue to fight together to address health inequities for our most vulnerable populations as we have always done. We call on our leaders to take action that will contribute to positive change in both culture and policy to ensure the safety and health of our most vulnerable communities. We at the Foundation are committed to self-reflection on how we can improve as an organization of diversity and inclusion. We will continue to advocate on behalf of the communities we serve, and to work with our partners around the U.S. and the world to repair the systems that enable racism to impact the lives and health of our communities. # # #  

    https://www.hepb.org/news-and-events/news-2/hepatitis-b-foundation-stands-in-solidarity-with-black-communities-calls-for-action-against-institutional-racism/
  • Hep B United Applauds Bipartisan Legislation to Combat the Opioid Crisis and Opioid Related Infectious Diseases

    WASHINGTON, D.C. (October 24, 2018) – Hep B United today released the following statement, commending Congress for working together to pass the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. The legislation was signed into law by the president, following overwhelming bipartisan Congressional support. The legislation supports a range of services, programs, and funding, across multiple federal agencies, to help combat the nation’s ongoing opioid epidemic and related infectious diseases, including hepatitis B. The SUPPORT for Patients and Communities Act brings together several pieces of legislation focused on different aspects of the opioid epidemic, from promoting evidence-based prevention strategies, to researching new, non-addictive pain management drugs, and expanding access to substance use disorder treatment. The package includes the Eliminating Opioid Related Infectious Diseases Act of 2018, which authorizes $40 million annually for five years to the Centers for Disease Control and Prevention (CDC) to support state and local data collection on infectious diseases that can be spread through injection drug use – such as viral hepatitis, including hepatitis B (HBV) and hepatitis C (HCV), HIV, and infective endocarditis – as well as to increase viral hepatitis and HIV testing, prevention, and linkage to care and treatment. “We commend this legislation for addressing viral hepatitis as one of the long-term public health consequences of the opioid crisis and for authorizing much-needed resources to prevent further spread of hepatitis B and other infectious diseases,” said Chari Cohen, DrPH, MPH, vice president for public health and programs at the Hepatitis B Foundation and co-chair of Hep B United. “Improving hepatitis B testing, vaccination, and linkage to care among high-risk populations, including people who inject drugs, is a critical strategy in the fight to eliminate hepatitis B, and we are glad to see Congress has incorporated these activities in their response to the opioid epidemic.” In 2015, the number of acute hepatitis B cases nationwide increased by 20.7%, rising for the first time since 2006. In recent years, the largest increases in acute HBV infection have occurred primarily in states heavily impacted by opioid addiction, including Kentucky, Tennessee, West Virginia, North Carolina, and Maine. Despite the availability of a highly effective vaccine to prevent new cases of hepatitis B, low rates of HBV vaccination coverage among adults – less than 25% overall – and increased rates of injection drug use has left a large segment of the population at high risk for HBV infection. Unlike hepatitis C, there is no cure for hepatitis B. If left undiagnosed and untreated, chronic hepatitis B can lead to serious and costly complications, and it is a leading cause of liver cancer. “We are pleased that Congress and the administration are taking this important step towards providing relief for families and communities affected by this ongoing public health crisis,” said Jeffrey Caballero, MPH, executive director of the Association of Asian Pacific Community Health Organizations (AAPCHO) and co-chair of Hep B United. “We look forward to continuing our work together to ensure individuals living with hepatitis B and others impacted by the opioid crisis have access to the care and support they need.” About Hepatitis B: Hepatitis B is the most common serious liver infection in the world. It is caused by the hepatitis B virus that attacks and injures the liver. Each year up to 1 million people die from hepatitis B worldwide despite the fact that it is preventable and treatable. Hepatitis B is a “silent epidemic” because most people do not have symptoms when they are newly infected or chronically infected. Thus, they can unknowingly spread the virus to others and continue the silent spread of hepatitis B. For people who are chronically infected but don’t have any symptoms, their liver is still being silently damaged which can develop into serious liver disease such as cirrhosis or liver cancer. About Hep B United: Hep B United is a national coalition co-chaired by the Hepatitis B Foundation and the Association of Asian Pacific Community Health Organizations dedicated to reducing the health disparities associated with hepatitis B by increasing awareness, screening, vaccination, and linkage to care for high-risk communities across the United States. To learn more, visit www.hepbunited.org. 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, visit 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. About the Association of Asian Pacific Community Health Organizations: The Association of Asian Pacific Community Health Organizations (AAPCHO) is a national association of community health organizations dedicated to promoting advocacy, collaboration, and leadership that improves the health status and access of Asian Americans, Native Hawaiians, and other Pacific Islanders in the United States. To learn more, visit www.aapcho.org. # # #

    https://www.hepb.org/news-and-events/news-2/opioid/
  • Commonly Asked Questions

    If you test positive for the hepatitis B virus for longer than 6 months, this indicates that you have a chronic hepatitis B infection. You should make an appointment with a hepatologist (liver specialist) or gastroenterologist familiar with hepatitis B. This specialist will order blood tests and possibly a liver ultrasound to evaluate your hepatitis B status and the health of your liver. Your doctor will probably want to see you at least once or twice a year to monitor your hepatitis B and determine if you would benefit from treatment. Most people chronically infected with hepatitis B can expect to live long, healthy lives. Once you are diagnosed with chronic hepatitis B, the virus may stay in your blood and liver for a lifetime. It is important to know that you can pass the virus along to others, even if you don’t feel sick. This is why it’s so important that you make sure that all close household contacts and sex partners are tested and vaccinated against hepatitis B. Right now, there is no cure for chronic hepatitis B, but the good news is there are treatments that can help slow the progression of liver disease in chronically infected persons by slowing down the virus. If there is less hepatitis B virus being produced, then there is less damage being done to the liver. Sometimes these drugs can even get rid of the virus, although this is not common.  With all of the new exciting research, there is great hope that a complete cure will soon be found for chronic hepatitis B. Visit our Drug Watch for a list of other promising drugs in development. It is important to understand that not every person with chronic hepatitis B needs to be on medication. You should talk to your doctor about whether you are a good candidate for drug therapy or a clinical trial. Be sure that you understand the pros and cons of each treatment option. Whether you decide to start treatment or not, you should be seen regularly by a liver specialist or a doctor knowledgeable about hepatitis B. No. The blood bank will not accept any blood that has been exposed to hepatitis B, even if you have recovered from an acute infection. 

    https://www.hepb.org/treatment-and-management/adults-with-hepatitis-b/commonly-asked-questions/