Hepatitis B Positive Speakers Discuss HepB with Geraldine Doogue

Heartfelt discussion with the “Hepatitis B Positive Speakers Group”, led by Australia’s Geraldine Doogue, ABC TV and Radio. Join Yvonne, David, Trevor, Linh and “Tina”, as they discuss their personal hepatitis B experiences -living with the stigma, and discrimination you can both see and “not quite put your finger on”, and their willingness to give back, and to increase community awareness.

If you’re on the Hepatitis B Information and Support Listserve, you may recognize Yvonne, one of the list moderators who mentions the emotional support she gets from her her cyber friends. 

Thank you Hepatitis Australia for sharing this discussion! 

 

HBV Journal Review – September 2014

ChrisKHBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
 latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

  • New Study Finds HBV Genotype E Responds Poorly to Entecavir
  • HBV Genotypes Help Tell the Human Story of Slavery in the Americas
  • Researchers Find Tenofovir Increases Hip Bone Loss in Older Patients
  • Decline in HBV RNA Indicates Who Loses HBeAg During Antiviral Treatment
  •  Shortened Vaccination Schedule May Get More Drug Users Immunized
  • Primary Care Doctors Rarely Screen Patients for Cirrhosis
  • Tenofovir or Telbivudine Recommended for Pregnant Women with High Viral Loads
  • Access to Healthy Food Vital for HBV Patients, but Many Live in Food “Deserts”
  • Scientists Create Viable Liver Cells in a Lab for HBV Research
  • Nerve Damage Prompts Warning Against Telbivudine-Interferon Combo Treatment

HBV Journal Review

September 1, 2014
Volume 11, Issue 9
by Christine M. Kukka

New Study Finds HBV Genotype E Responds Poorly to Entecavir
Experts know some hepatitis B virus (HBV) strains called genotypes respond better to interferon treatment than others, but now scientists are discovering that genotypes respond differently to antiviral treatment too.

HBV genotypes are found in different regions of the world and each evolved over centuries to have slightly different molecular make-ups with unique traits. Some carry a higher risk of liver damage and cancer, while other genotypes are less virulent.

In a recent study, Italian researchers compared how well patients with genotypes A, D and E fared after three years of treatment with the antiviral entecavir (Baraclude). All of the patients tested negative for the hepatitis B “e” antigen (HBeAg-negative). The scientists measured hepatitis B surface antigen (HBsAg) levels and HBV DNA (viral load) every three months during the first year of treatment and then every six months over the study period.

They found the rates of HBsAg declines resulting from antiviral treatment varied markedly between genotypes. They extrapolated how many years of entecavir treatment each genotype required before a patient would clear HBsAg and achieve undetectable viral load.

HBV genotype A: It would take on average 15.6 years of entecavir treatment for an HBeAg-negative patient with HBV genotype A to lose HBsAg. This genotype is found in northern Europe, North America, India and southern Africa.

HBV genotype D: It would take 17 years for genotype D patients to lose HBsAg. This strain is found primarily in Russia, the Middle East, the Mediterranean region, and India.

HBV genotype E: This genotype, found in Central Africa, responded the most poorly to entecavir. Scientists estimated it would take 24.6 years for these patients to lose HBsAg, according to the report published in the August issue of the Journal of Medical Virology.

Source: www.ncbi.nlm.nih.gov/pubmed/25131947

HBV Genotypes Help Tell the Human Story of Slavery in the Americas
Because HBV genotypes develop in specific regions around the world, their distribution around the world today can help tell the story of mass human migrations, including the enslavement and forced migration of millions of Africans to Brazil since the 1500s.

Read the HBV Journal Review in its entirety here. 

‘Think Again’ About Hepatitis – World Hepatitis Day Events in Ghana

imagesTheobald Owusu-Ansah of the Theobald Hepatitis B Foundation works tirelessly to raise the profile of hepatitis B in Ghana, where the HBV prevalence is approximately 30% in blood donors. Through collaboration with others, and heightening awareness with Ghanaian celebrities, Theobald and others were able to raise viral hepatitis awareness, and provide free screening and HBV vaccination during their World Hepatitis Day event this year. Read his account below and check out Theobald and the work he and his foundation are doing at the www.theobaldhepb.org or find THBF on Facebook

Viral hepatitis is the leading cause of liver cancer, which is the second most common cause of cancer deaths in Africa. On World Hepatitis Day, we urged the government to take actions ASAP to improve hepatitis awareness, monitoring, prevention and treatment.
 ASAP is a blue print framework for Global action, developed by the WHO to guide national government on the effective ways to prevent and control the transmission of viral hepatitis. This framework has four axes:

1.  Awareness raising, partnership promotion and resource mobilization,
2.  Scientific evidence that drives policies and actions,
3.  Access to immunization and information to prevent transmission,
4.  Provision of screening, care and treatment.

Thousands of Ghanaians live with viral hepatitis. About a third of Ghanaians living with viral hepatitis are unaware of their status and are not receiving care and treatment for the condition. It is estimated that hepatitis B kills over 1 million people each year, and an estimated 1 in 12 persons are currently infected and have to face life with chronic liver disease.

Ghana belongs to one of the areas where the prevalence of chronic HBV infection is high (≥8%), and that of hepatitis C is from 5-10%. There is high prevalence in approximately 30% among blood donors.
 In the year ending 2010, the incidence of viral hepatitis in Ghana was 43/100,000 population, with 102 deaths, which represents a 30% increase as compared to the year 2006 incidence of 30/100,000 population. (Source: www.theobaldhepb.org)

Ghana is rated a high-risk country for hepatitis B & C with between 10 and 15 percent prevalence rate. Out of every 100 Ghanaians, 13 may test positive for hepatitis B, which is far more prevalent than HIV/AIDS.

On the 20th July 2014, Celebrities in Ghana united to raise funds to support free Hepatitis B screening and vaccination. The program was under the theme “Celebrities Car Wash”.  Celebrities including Okyeame Kwame, Ghana Rap Doctor, former national black stars captain Stephen Appiah, Ghanaian actor Van Vicker and others volunteered to wash public cars for a fee to raise funds to support the programme.

The staff of Theobald Hepatitis B Foundation, Okyeame Kwame Foundation and other medical officials joined the celebrities for the car washing fundraising event. Members of the public took advantage of the celebrities’ car wash to bring their cars to be washed by their favorite’s celebrities. Celebrities expressed their interest in becoming viral hepatitis ambassadors in Ghana.

The event showed that you don’t need a big bank account to be able to make a difference, but with a bit of vision, one can create awareness.

On that day, we are calling on the government to develop and implement coordinated national action plans to fight viral hepatitis. The Theobald Hepatitis B Foundation in collaboration with the Hepatitis Coalition of Ghana, Okyeame Kwame Foundation together with MDS Lancet Laboratories, Roche and Ridge Hospital RPD on Saturday 26th July, 2014, offered free hepatitis B screening and vaccination to hundreds of people at James Town – Mantse Abgona in Accra. Out of 359 people screened, 49 people tested positive and they received counseling on what to do and what not to do, in terms of treatments and other biochemical tests they needed to undergo.

The Rapper observed that the youth turned out for the screening this year and expressed appreciation for the turnout. “I am really glad to see most of the young people come for the screening. This is to say that the youth is giving attention to health and this also indicates that we are moving in the right direction as a people,” says Okyeame Kwame.

The president of the Theobald Hepatitis B Foundation, Mr. Theobald Owusu Ansah delivered his speech for the occasion on the theme: “HEPATITIS: THINK AGAIN”, calling on the government to give much attention to Hepatitis B.

Thank you to all World Hepatitis Day supporters, sponsors and the media who volunteered their time, supplies, and/or funds to support this year’s events, and raising the profile of viral hepatitis in Ghana.

 

Video

Perspective on the Liver Biopsy – “The Gold Standard”

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Have you noticed fewer patients living with chronic HBV seem to get liver biopsies to assess liver damage?  Here is a perspective on the Liver Biopsy, known as the “gold standard”, by William Carey, MD, Division of Gastroenterology and Hepatology of the Cleveland Clinic.

Published in Healio , July 14, 2014 

Liver biopsy is referred to as the “gold standard” in assessing both the activity and degree of fibrosis in many chronic liver diseases including hepatitis B. It is not likely to retain this lofty status much longer. Liver biopsy has several important drawbacks. Among them are cost, risk for complications, need for additional health care resources, patient and physician aversion to the procedure, inadequate specimen size and the lack of specific findings.

Liver biopsy adds between $2,500 to $3,500 to the cost of an evaluation (even higher for transvenous liver biopsy). Approximately 20% of patients will experience significant pain following percutaneous liver biopsy. More severe complications include pneumothorax, major bleeding, inadvertent biopsy of the kidney or colon, and perforation of the gallbladder. Death, most often due to uncontrolled bleeding, may occur in up to 1 in 1,000 biopsies. Underappreciated is the risk of no-representative sampling, either because of the small size of biopsy specimen or patchy distribution of fibrosis.

Noninvasive measures to assess hepatic fibrosis have been around for a generation and are increasingly used as a substitute for liver biopsy. The 2014 medley of noninvasive estimates of hepatic fibrosis includes FibroTest/FibroSure, APRI, FIB-4, other serum based test combinations, and elastography (either ultrasound- or MRI-based). Noninvasive tests have potential both for determination of current liver damage and for monitoring disease progression. They can be done at a fraction of the cost of a liver biopsy. Salkic and colleagues have reported the results of an exquisitely performed meta-analysis of peer reviewed published reports and confirmed the value of FibroTest/FibroSure in hepatitis B — mainly in excluding the diagnosis of cirrhosis. The findings of this review are restricted to hepatitis B, but others have shown similar findings in hepatitis C and alcoholic liver disease.

While there is growing consensus that noninvasive markers provide valuable information, allowing the clinician to make important decisions about treatment, screening for varices and hepatocellular carcinoma, it is essential to understand limitations of FibroTest, including distortions in results in individuals with Gilbert’s syndrome and in those with hemolysis. This study reiterates the relative insensitivity of noninvasive tests in discriminating between lesser degrees of fibrosis (F0, F1, and F2).

Data are accumulating to suggest noninvasive markers (combining a noninvasive test plus ultrasound-based elastrography, for example) are powerful tools in assessing natural history of individuals with many chronic liver diseases including hepatitis B, providing indices of disease activity, progression and fibrosis regression after treatment. Convenience, lower cost, and ease of repeated measurements over time favor widespread acceptance of these tools in clinical practice.

HBV Journal Review – August 2014

ChrisKHBF is pleased to connect our blog readers to Christine Kukka’s monthly HBV Journal Review that she writes for the HBV Advocate. The journal presents the
 latest in hepatitis B research, treatment, and prevention from recent academic and medical journals. This month, the following topics are explored:

  • Health Concerns Grow as Researchers Uncover the Risks of “Occult”
  • Are Current Hepatitis B Tests Missing Some Infections?
  • First Case of Tenofovir Resistance Found in Patient with Prior Entecavir Resistance
  • Even Specialists Fail to Treat Hepatitis in Patients Who Qualify for Treatment
  • No Benefit Found from Antiviral Treatment after Liver Cancer Surgery
  • Another Study Confirms Success of Sequential Antiviral and Interferon Treatment
  • Snapshot of Hepatitis B in the United States
  • Metformin Safe and Effective in Cirrhotic Patients with Diabetes Type 2

HBV Journal Review

August 1, 2014
Volume 11, Issue 8
by Christine M. Kukka

Health Concerns Grow as Researchers Uncover the Risks of “Occult” Hepatitis B
Researchers studying the health effects of “occult” hepatitis B are finding that this infection that can “hide” from conventional lab tests carries a higher risk of liver cancer and poses a risk to the general population when undiagnosed.

This type of hepatitis B occurs when a mutation in the virus’ outer coat, made up of the hepatitis B surface antigen (HBsAg), makes it impossible for common lab tests that look for that protein to identify an active HBV infection. The HBsAg lab test is commonly used to identify hepatitis B in patients and even blood supplies.

When lab tests fail to identity HBV infection, people can unknowingly spread the infection to their partners, family members and newborns. And when occult HBV infection goes untreated, a patient’s risk of liver cancer is 3.7-fold higher than in patients with “regular” or non-occult hepatitis B, according to a recent report in the August issue of the Journal of Hepatology.

HBsAg has three proteins and in the case of occult HBV, the immune system attacks one of the three surface proteins–the same protein that lab tests look for when screening blood for HBsAg.

Most vaccines contain this exact same HBsAg protein in order to spur production of surface antibodies to fight off an actual infection. In most cases, the vaccine is very effective, but when occult hepatitis B occurs, the vaccine-induced antibodies are powerless against the remaining two surface proteins and viral reproduction and infection can continue.

This concern has grown recently as scientists find a number of children born to HBV-infected mothers, who were immunized at birth, have developed “occult” hepatitis B. Additionally, people with occult hepatitis B can transmit the mutated, “occult” version of HBV to partners and close contacts (even if they’re vaccinated), adding to the spread of this hard-to-identify viral hepatitis infection.

Because of the unique genetic make-up of this mutated HBsAg and how it interacts with liver cells, this mutation appears to cause more rapid liver damage and cancer.

Scientists suggest that drug resistance, especially to the antiviral lamivudine (Epivir-HBV), may contribute to development of this mutation.

“Recent studies have reported that (surface mutations) tend to (emerge) with the drug resistance-associated mutations in lamivudine-treated patients, and that the (mutations) …. play a supportive role in the replication of lamivudine-resistant viruses,” Italian researchers wrote in the report.

“Therefore it appears of the utmost importance that patients with chronic hepatitis B are screened for the presence of (surface antigen) mutant infection,” they recommended. “The detection of these specific HBV variants may indeed be useful for the identification of those patients requiring a preventive and appropriate treatment and a more intensive follow-up strategy for early detection of liver cancer.”

Source: www.journal-of-hepatology.eu/article/S0168-8278(14)00304-3/fulltext

Are Current Hepatitis B Tests Missing Some Infections?
When do hepatitis B tests miss true infections?A number of confounding factors, ranging from “occult” hepatitis B increase (see above article), failure of lab tests to pick up extremely low levels of HBsAg, immunizations, and the rapidly changing progression of HBV infection can all conspire to mask the infection from conventional laboratory tests.

Read the HBV Journal Review in its entirety