Which is Worse Chronic Hepatitis B or C? What Do You Think?

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From HBF’s expert Guest Blogger, Dr. Thomas London

If you ask doctors in the United States, or patients with liver disease, or the average person on the street, the answer that you usually get is that Hepatitis C is worse.  Hepatitis C has a bad reputation in the media and with the public. We, at the Hepatitis B Foundation, tend to think that hepatitis B is the worse disease, but until now we have not had any basis for that answer. Now we do.

Recently a group of investigators from Johns Hopkins University published a paper with the title “Comparative Risk of Liver-Related Mortality from Chronic Hepatitis B Versus Chronic Hepatitis C Virus Infection”.  The answer from this publication is that hepatitis B is more likely to cause liver related death than hepatitis C.  It is worth dwelling on how the authors came to this conclusion: unexpectedly, the AIDS epidemic triggered the studies, which made the conclusion possible.

Acquired immune deficiency disease (AIDS) was first reported in the United States in 1981. The disease appeared to be deadly, and it was thought-to-be confined to homosexual men. In fact, it was initially called Gay Related Immune Deficiency or GRID.  Although it was soon proven that this new immune deficiency disease was not limited to gay men, it is true that men who had sex with men (MSM) accounted for most of the early cases.  In the 1970’s there were several reports that MSM had a high incidence of hepatitis B.  For the initial clinical trial of the then new hepatitis B vaccine, MSM in New York City were selected as the study population because of their high risk for hepatitis B infection. In the trial about 27% of the unvaccinated population became infected with hepatitis B virus (HBV) within 18 months, whereas less than 3% of the men who received the vaccine became infected over the same time interval.  This result proved the efficacy of the vaccine.

Fast forward to 1984 before the virus causing AIDS was clearly identified, several researchers suggested that a variant of hepatitis B was the cause. A group of investigators proposed a prospective study of MSM who had been tested for hepatitis B and a newly reported anti-HIV antibody, but who did not have immune deficiency disease.  By following the men over time, the thought was that it would be possible to observe which infection – HIV or hepatitis B or a combination of both – led to AIDS.

MSM were recruited from 4 cities in the USA (Baltimore, Chicago, Pittsburgh, Los Angeles); thereafter called the Multicenter Cohort Study (MACS).  Over four time intervals from 1984 to 2002, 6972 MSM were enrolled.  The men were followed until 2010, on average for more than 8 years. Serum samples were collected every 6 months, frozen and stored.  Although the hepatitis C virus had not yet been identified in 1984, all the samples were later tested for HIV, HBV and hepatitis C virus (HCV).  All deaths were recorded as were all liver related deaths.

The results were surprising. Comparable numbers of men were infected with HBV and HCV, but MSM with chronic hepatitis B were twice as likely to die a liver related death as the men with chronic hepatitis C.  The statistical analyses were carefully done to account for the treatments of HCV, HBV, and HIV that were used during the course of the study.  Immunodeficiency further increased the risk of liver death in the men with hepatitis B over that in the men with chronic hepatitis C.

The study showed that in the two and a half decades after 1984, hepatitis B infection was more serious than hepatitis C. Now, in 2012, this difference is even greater. Chronic hepatitis C has become a curable disease.  Chronic hepatitis B is manageable, but not yet curable.  This means that hepatitis B, which was already a worse disease than hepatitis C before the new therapies for HCV, is now a much more important unsolved health problem.

- Dr. Tom London

20 Responses to Which is Worse Chronic Hepatitis B or C? What Do You Think?

  1. Very interesting post, and thank you for sharing. I have a few questions (probably complicated answers!). As someone with chronic HBV (diagnosed 11 years ago and no complications so far – regularly monitored), it somewhat concerns me that HCV is considered a “curable disease”. I realise this may come across a bit selfish, but given HBV has been around longer than HCV, how is it that HCV has achieved this status over HBV?

    What is being done to get HBV to a “curable disease” status like HCV? I know there are lots of things that go into this (political, financial, technical, scientific etc).

    What are the new up and coming developments likely in the next 5-10 years or so that I can look forward to in treating or curing HBV?

    Thanks again
    David

    • David,
      The answer to your question involves, science, politics and money.
      The scientific reason that HBV has been a more difficult nut to crack
      than HCV is due to the method of HBV’s replication. In the infected
      liver cell, HBV is lodged inside a structure called a mini chromosome.
      Within that structure, the template for HBV’s replication is a molecule
      called cccDNA (covalently closed circular DNA). HBV copies made from the
      cccDNA template are suppressed by treatment with the available
      anti-viral drugs, but the cccDNA is not affected.

      The political/financial reason is HCV research has received much more
      funding in the US than HBV research. And the reason for that is that is
      that government data implied that HCV disease was more common and more
      severe than HBV liver disease. That view can now be put to rest.
      I am optimistic about the future. Scientists at the HBF have some good
      leads on how to attack HBV cccDNA. If they prove to be right, then a
      curative therapy might be available in less than 5 years.
      Thomas London

  2. Thanks for the great blog entry, Dr. London. This is very well explained and very informative. Wishing HBF and all HBV researchers around the world all the very best as they seek a cure for HBV.

  3. Thanks to Dr. London, for highlighting this problem, and to the Hopkins researchers, for their enlightening publication. We understand that both hepatitis B and hepatitis C can be devastating diseases, and cause significant suffering and death. My own family is still recovering from the death of my husband’s Mom from hep-C related liver cancer. As a public health community, we all celebrate the success of the new hep C curative medications – it is truly wonderful for those suffering from hep C, and makes me so happy that fewer families will have to deal with the devastating loss that we did.

    What we can’t ignore, however, is the disproportionate amount of attention and funding that hep C gets versus hep B. Hepatitis B continues to be under-recognized and under-prioritized in the U.S., while millions of families are still waiting for their cure. It is critical that hepatitis B be given the funding necessary to move our own cure research into the realm of cure, and to provide more “on the ground” public health programming to get people tested and into care.

    People seem to think that hepatitis B is a fading problem – maybe it is because there is a vaccine, maybe we just haven’t made enough noise. It is time that everyone understands just how bad hepatitis B can be. So, not only do we need more studies like this one done at Hopkins, but we need to give way more attention to these publications when they do come out.

  4. Thank you so much Dr. Tom London for the valuable information.
    I am anxiously looking forward to the cure for Hepatitis B since I have been on Viread for over 5 years. I was on Interferon (Pegasys) treatment for 7 months recently but it didn’t work so I was put back on Viread again.
    Please keep us updated as you normally would and I will look forward to the good news.
    Thank you so much.

    Sean

  5. hello…heppB i was reading and thinking about my problem im a victim of HepaB- antigen the doctor told me when im going to medical..he said im going to whole body medication but im not going becouz im scared to know everything…its is a nessesary to do..if im not going im died how long my life when im carried this HepaB- antigen…im so curious and scared ….what i should do? you have a medication this HepaB -antigen..how ? then im pregnant if possible my baby carry also in HepaB….now my babay is 5mos.. then i have a bf im leave in now..when he do medical the doctor said he got also a HepaB….if possible my HepaB thrue w/ him he take my Hepa or he got already …becoz he always drunk and he take to much cigarrete i dont knw f he take my HepaB- antigen or becoz hes to much drinking alcohol….please give me some adise i want to know thank you and im waiting to your reply…………

    sincerly: jane

    • Please do not avoid learning about HBV because you are scared. It is important that you see a liver specialist who can talk to you about your hepatitis B infection. It is important to learn how HBV is transmitted so you can prevent transmission to others. HBV positive mothers should have their newborn receive the first dose of the HBV vaccine and a shot of HBIG within 12 hours of birth in order to prevent transmission from mother to baby. There are good treatments for those who would benefit from treatment, but you need to be thoroughly evaluated with blood work and a physical examination and health history. Remember to take care of your general and liver health, by avoiding alcohol, avoiding cigarettes and eating a healthy diet.

  6. A year or so ago, my doctor told me that HBV has a curable rate of about 10% with Viread treatment. Is this opinion still correct?

    • Assuming conversion to HBsAg negative is a “cure”, the occurrence is very uncommon, and is only 3% to 5% with long-term treatment with Viread/tenofovir. However, 75% to 80% will develop very low or undetectable HBV DNA levels.

  7. Dear Dr. Tom London,
    I have a question:
    The government’s view on HCV previously as a more epidemic and more common disease so they spent more money on the research but HCV has now become curable so the previous view can be put to rest as you stated.
    At this point, is the government beginning to view HBV as a very common disease as they did to HCV?
    If not, when?
    Any advice will be appreciated it.
    Thank you.
    Sean

  8. Thank David, Sean, and Chari. All of your inputs are accurate. I am chronic HBV carrier since childhood (I do not know when started). I had flare since 2010. I have been taken Baraclude since then. It costs around $900 a month. I cannot aford if I do not have medical insurance with full time work.

    As most of HBV carriers, I pray the Federal Government or drug manufacturers to treat HBV as same as HCV or other dieases. Maybe we (HBV carriers) have not made big noise!!! But there are many carriers in the world.

  9. Thank you for your input as well Sherry.
    I totally agree with you that the government needs to be heard our voice out and loud.
    My understanding is, Hep C was quite common in the military back then, a lot of soldiers got contracted from one to another so it spread out pretty fast so that caught the government’s attention. So they spent money on it.
    At this point, I don’t know if the government would care about the civilians who have Hep B.
    I think they would rather care about their soldiers who have Hep C than the civilians who have Hep B.

    Any comments are welcome.

    Sean

  10. Hi, I totally agree with theses responses from affected patients around the world who have been living with Hepatitis B all there lives or who have aquired the disease at a later stage it doesn’t matter how you got it. We are all in the same boat and we all need to keep sending our voice into this fearful disease that most of us hve been to afraid TO talk about about in the past. I am from Australia and it shows that we are all the same all over the world, the fear the shame. I think you never really accept it but live with it and you have no choice. It’s true that Hep C has always been the focus and not hep B because of vaccincatoin. But that is all changing know thanks to people around the world speaking up. I pray for everyone around the world that all that fear will disappear. That it was all just a BAD DREAM>>>> A CURE IS ON THE HORIZON.

  11. Hi, I have had hepB since childhood. My liver count was very high and now I am on Baraclude for about a month. Could some please advice how long will I need to be on Baraclude for…? Any side effects of Baraclude?

    • Baraclude is an excellent antiviral used to treat chronic HBV. There are typically few or no side effects, but talk to your doctor if you experience any. Treatment with an antiviral is often for years or even for life. Please take baraclude daily, as directed. Stopping baraclude may result in flares that can result in liver damage. Please discuss this with your doctor.

  12. Dear Dr. Tom London,
    Thank you for your educative narration about HBV and the insight provided. I’am a HBV victim with no information about when or how it started. Though i can recall that i was treated with Hepatitis about 15 years ago but the Dr. then did not explain further especially about the fatality or it being incurable, which made me continue to live my life unchecked until about 8 years ago when i was diagnosed. However, though diagnosed and have been doing health check 1 to 3 times yearly since over 5 years my Dr. has not prescribed any HBV related medication. Due to language issues in this part of the world i am sometimes concerned whether there are things i should know or be doing that i am not doing about it. Therefore, i would appreciate some kind of clarification about this virus from a specialist like you.
    Is there any kind of HBV that could be there though high than normal but stays there for life time ?
    The scary part is that i do drink alcohol sometimes perhaps because of the way i feel.
    To be honest i do not feel anything different other than some minor fever or headaches when i have cooled. I still play football though i gets tired faster than before which i thought could be related to my age. By the way, i am 36 years old going to 37.
    Please let me know if there’s anything i need to know to about this that would ensure i continue to live a normal life.
    Sincerely,
    Iyke.

    • Dr. London is on vacation. Yes, chronic HBV is not uncommon and at this time there is no complete cure.There are good treatments, but not everyone needs treatment. I would encourage you to see a liver specialist to learn more about your HBV infection and your liver health, and whether or not you need treatment at this time, or in the future. HBV and drinking is a dangerous combination. Lifestyle changes can make a big difference in your liver health so consider changes that are good for your liver: do not drink alcohol, do not smoke and maintain a healthy weight by eating a well balanced diet and getting plenty of exercise. Most importantly be sure you are evaluated and regularly monitored by a liver specialist. These are all very important and certainly help you live a long, full life filled with work, love, family and friends.

  13. Dear Dr. Tom London,

    Thank you very much for all the inputs you gave us but i have another question. My question is, How long a person with Hepatitis B on treatment will live?

    with regards,

    GKHN

  14. Being a HVB positive can it be a barrier to marriage?

    • Having HBV should not be a barrier to marriage. We are so fortunate to have a safe and effective vaccine so your future spouse and children can be protected against HBV!

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