Author Archives: hepbtalk

Yesterday the Hepatitis B Foundation participated in the American Association for the Study of Liver Diseases (AASLD) annual “Liver Capitol Hill Day” visits. This is a great opportunity to get in front of state Senators and Congressmen in order to … Continue reading

The study published by Healio Hepatology, March 8, 2013 discusses the increased risk of mother-to-infant transmission in HBV positive moms who are HBeAg positive and have a high viral load. Current prophylaxis, where infants of HBsAg+ moms receive the first … Continue reading

Justice Department Settles with the UMDNJ Over Discrimination Against People with Hepatitis B

Direct from the Department of Justice (see below), the first DOJ settlement of an American with Disabilities Act (ADA) case involving people with hepatitis B was announced.  The Hepatitis B Foundation is proud to have played a critical role in successfully advocating for these students who suffered from discrimination as a result of chronic hepatitis B infection.

You may recall an earlier story posted both in the HBF Spring Newsletter, 2012 and the HBF’s Hep B Blog, “Dreams on Hold – A personal story of an aspiring medical student .“ This was one of four cases that spurred the HBF into action on behalf of these students and their rights.

July 2011, a meeting was convened by the CDC, with the HBF and others, resulting in the July 2012 CDC update “Recommendations for the Management of Hepatitis B virus-Infected Health Care Providers and Students. ”These recommendations were cited in the DOJ statement and clearly contributed to the DOJ settlement on behalf of people living with chronic HBV eliminating them from being excluded or discriminated against due to health issues. Since all applicants are from the Asian American Pacific Islander (AAPI) community, which accounts for more than 50% of Americans living with chronic HBV, The DOJ assures that the Civil Rights Division is committed to ensuring discrimination does not occur in this community as a result of this disability.  On behalf of those living with HBV, the HBF applauds this decision by the DOJ. 

The Justice Department announced today that it has reached a settlement with the University of Medicine and Dentistry of New Jersey School (UMDNJ) under the Americans with Disabilities Act (ADA).   The settlement resolves complaints that the UMDNJ School of Medicine and the UMDNJ School of Osteopathic Medicine unlawfully excluded applicants because they have hepatitis B.   This is the first ADA settlement ever reached by the Justice Department on behalf of people with hepatitis B.In 2011, the two applicants in this matter applied and were accepted to the UMDNJ School of Osteopathic Medicine, and one of them was also accepted to the UMDNJ School of Medicine. The schools later revoked the acceptances when the schools learned that the applicants have hepatitis B.   The Justice Department determined that the schools had no lawful basis for excluding the applicants, especially because students at the schools are not even required to perform invasive surgical procedures, and that the exclusion of the applicants contradicts the Centers for Disease Control and Prevention’s (CDC) updated guidance on this issue.

According to the CDC’s July 2012 “Updated Recommendations for Preventing Transmission and Medical Management of Hepatitis B Virus (HBV) – Infected Health Care Workers and Students,” no transmission of Hepatitis B has been reported in the United States from primary care providers, clinicians, medical or dental students, residents, nurses, or other health care providers to patients since 1991.

“Excluding people with disabilities from higher education based on unfounded fears or incorrect scientific information is unacceptable,” said Thomas E. Perez, Assistant Attorney General for the Civil Rights Division.   “We applaud the UMDNJ for working cooperatively with the Justice Department to resolve these matters in a fair manner.”

“It is especially important that a public institution of higher learning – especially one with a mission to prepare future generations of medical professionals – strictly follow the laws Congress has enacted to protect from discrimination those people who have health issues,” said U.S. Attorney for the District of New Jersey Paul Fishman. “The remedies to which the school has agreed should ensure this does not happen again.”

Under the settlement agreement, the UMDNJ must adopt a disability rights policy that is based on the CDC’s Hepatitis B recommendations, permit the applicants to enroll in the schools, provide ADA training to their employees and provide the applicants a total of $75,000 in compensation and tuition credits.

Both of the applicants in this matter come from the Asian American Pacific Islander community. The CDC reports that Asian American Pacific Islanders (AAPIs) make up less than 5 percent of the total population in the United States, but account for more than 50 percent of Americans living with chronic Hepatitis B.   Nearly 70 percent of AAPIs living in the United States were born, or have parents who were born, in countries where hepatitis B is common. Most AAPIs with Hepatitis B contracted Hepatitis B during childbirth .   The Civil Rights Division is committed to ensuring that this community is not subjected to discrimination because of disability.

Title II of the ADA prohibits state and local government entities, like the UMDNJ, from discriminating against individuals with disabilities in programs, services, and activities. State and local governments must also make reasonable modifications in policies, practices, and procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless those modifications would result in a fundamental alteration.

More information about the Civil Rights Division and the laws it enforces is available at the website www.justice.gov/crt.  More information about the ADA and today’s agreement with UMDNJ can be accessed at the ADA website at www.ada.gov or by calling the toll-free ADA information line at 800-514-0301 or 800-514-0383 (TTY).

 

 

 

 

 

Liver Cancer Webinar Series: What You Need to Know

Missed the webinar? Download the March 6th Webinar and listen to Hepatitis B and Liver Cancer: What You Need to Know, by Dr. Robert Gish

Due to an overwhelming response, continued registration for  this Wednesday’s webinar with Dr. Gish is closed. Stay tuned as the webinar will be recorded in it’s entirety, and will be made available. Stay tuned for details! 

Did you know?

Liver cancer is the third leading cause of cancer-related deaths and the seventh most common cancer worldwide. But the major causes of liver cancer— such as chronic hepatitis B or hepatitis C, and cirrhosis— are largely preventable. And treatments for liver cancer are available.

Learn more about liver cancer

Join The Hepatitis B Foundation’s webinar series to learn about the risk factors for liver cancer and the importance of liver cancer screening and surveillance. The expert presenters will describe currently available treatment options and clinical trials.

The first webinar of the series will be Liver Cancer and Hepatitis B: What You Need to Know, presented by Robert G. Gish, MD, an internationally renowned liver diseases expert.

Dr. Gish is a Clinical Professor of Medicine, Section Chief of Hepatology, and Co-Director of the Center for Hepatobiliary Disease and Abdominal Transplantation at the University of California, San Diego Health Systems.

Dr. Gish has an active research program in viral hepatitis and has published more than 600 original articles, abstracts, and book chapters, and more than 120 peer-reviewed publications.

Liver Cancer and Hepatitis B: What You Need to Know webinar details:

Presented by:Dr. Robert G. Gish
Date: Wednesday, March 6, 2013
Time: 12 noon EST; 9 am PST
Click here to register

For additional accurate, easy-to-understand information on liver cancer, visit the Hepatitis B Foundation’s new, dedicated website, www.LiverCancerConnect.org.

 

HBsAg Levels Linked with Fibrosis in HBeAg-Positive Patients

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Below is a publication from “Healio Hepatology, February 21, 2013 – HbsAg Levels Linked with Fibrosis in HBeAg-Positive Patients” , showing the correlation between HBsAg and HBV DNV virus levels and the risk of moderate to severe fibrosis in HBeAg … Continue reading

Launch of New Patient-Focused Website at LiverCancerConnect.org

A dedicated program of the Hepatitis B Foundation for patients and families 

The statistics are sobering. Liver cancer is the seventh most common cancer in the world, but the third leading cause of cancer-related deaths. Worldwide, more than 700,000 people are diagnosed with primary liver cancer each year, accounting for more than 600,000 deaths annually. Equally disturbing is the fact that while the incidence rates of most cancers have declined in recent years, the incidence rate for liver cancer is increasing.

But there is encouraging progress in the fight against liver cancer. Scientific research into new treatments is yielding promising results. And perhaps more significantly, the major causes of liver cancer— such as chronic hepatitis B or hepatitis C infections, and cirrhosis — are largely preventable. A safe and effective vaccine against hepatitis B has been available since 1986. In fact, this vaccine was named the world’s first “anti-cancer” vaccine, because it prevents chronic hepatitis B infection, the world’s leading cause of liver cancer. While no vaccine for hepatitis C currently exists, new drugs can eliminate the virus, thereby halting the progression to liver cancer. And cirrhosis can be avoided by preventing chronic hepatitis B and C infections, limiting alcohol intake, and preventing fatty liver disease associated with obesity.

Knowing that these risk factors are preventable makes it all the more important to identify people at risk for liver cancer, educate them about prevention and treatment options, and direct them to appropriate medical care.

To provide accurate, easy-to-understand information to people diagnosed with liver cancer, the Hepatitis B Foundation has created the first patient-focused website, www.LiverCancerConnect.org. The website aims to help people better understand how liver cancer is diagnosed and how it can be treated or prevented. In addition, wwwLiverCancerConnect.org includes a Drug Watch of potential new liver cancer therapies, an expanding directory of liver cancer specialists, and a clinical trials listing.

The Hepatitis B Foundation is also organizing a series of webinars in 2013 to educate the public about the link between liver cancer and its main risk factors, namely hepatitis B and C infections and cirrhosis caused by fatty liver disease. The webinars, presented by leading international experts in liver diseases, will explain what primary liver cancer is, the importance of liver cancer screening and surveillance, and the treatment options and clinical trials that are currently available. Additional information will be announced on both the Liver Cancer Connect website and HBF’s blog when it is available.

The Foundation invites you to use www.LiverCancerConnect.org to learn about liver cancer and its treatment options, and to locate liver cancer specialists and clinical trials. We welcome your feedback and suggestions at connect@livercancerconnect.org so that we may continue to build on this valuable resource for the global liver cancer community.

Liver Cancer Connect is available on Facebook and Twitter. Join LCC on Facebook at http://www.facebook.com/LiverCancerConnect and follow LCC on twitter with the handle @LiverCancerConn.

 

 

 

HBV Genotype C Carries Greater Risk for HCC Than Other Genotypes

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Below is a publication from “Healio Hepatology, January 23, 2013 -HBV Genotype C Carries Greater Risk for HCC Than Other Genotypes“, showing the risk of hepatocellular carcinoma among the different hepatitis B genotypes based on a meta-analysis of 43 studies. There are … Continue reading

Checking In On Your Hepatitis B Related 2013 Resolutions

It’s week two of 2013.  How are your New Years’ Resolutions going?  When you were making your resolutions, did you consider hepatitis B specific New Year’s resolutions?  Here are a few ideas…

  • Organize your hepatitis B lab data and make a table with the date of the blood draw and the associated blood test results. You’ll want to start by requesting copies of all of your labs from your doctor. Then you can generate data tables using Excel, Word or a pencil and paper table for your charted data.  It will help you visualize your HBV over time, and you may find your doctor likes to see both the lab results and your table of results.
  • Generate a list of questions for your next appointment with your liver specialist.  People get nervous anticipating what their doctor might say about their health. It is very easy to forget those important questions, so be sure to write them down. If the option is available, have a family member or friend attend the appointment with you. That will allow you to pay closer attention while your friend or family member takes notes for you.
  • Avoid the use of alcohol. Hepatitis B and alcohol is a dangerous combination. An annual toast to the New Year? Sure. Drinking daily, weekly or even monthly? Not a good idea.  Binge drinking? Dangerous. A recent study shows an increased risk for liver cancer among cirrhotic patients with HBV. Don’t let it get that far. If you have HBV and you are still drinking alcohol, seek the help you need to stop.
  • Exercise. Many people think that having a chronic illness precludes them from exercise. This is rarely the case, but if you have concerns, talk to your doctor. If you consistently exercise, keep up the good work. If you don’t, please start slowly and work your way up to a more strenuous routine, and follow general physical activity guidelines for adults. Join a gym or find an exercise buddy. Don’t compare yourself to others and work at your own pace. Set realistic workout goals. You don’t need to run a marathon. Brisk, daily walking is great, too. You may find that you experience both physical and emotional benefits, and if you exercise with friends, you’ll also benefit socially. Clinical and experimental studies show that physical exercise helps prevent the progression of liver cancer and improves quality of life. Get moving. It’s good for your overall health and specifically your liver!
  • Maintain a healthy weight by eating a well-balanced diet. This is a favorite on the New Year’s Resolution list for just about everyone with or without HBV. You can’t prevent or cure HBV with a healthy diet, but it does help, and it helps prevent additional problems like the onset of fatty liver or diabetes. If you’ve been following trending health problems, then you are well aware that fatty liver disease and type 2 diabetes are huge problems in the U.S. and are growing issues globally. Both fatty liver disease and type 2 diabetes can often be prevented with a healthy diet and regular exercise. If you are overweight, or make unhealthy choices, make a commitment to change this year. Start by avoiding fast foods, and processed foods. Cut down on fatty foods. Reduce the amount of saturated fats, trans fats and hydrogenated fats in your diet. Saturated fats are found in deep fried foods, red meats and dairy products. Trans and hydrogenated fats are found in processed foods. The liver stores excess dietary fat, and which can eventually lead to fatty liver disease. A fatty liver slows down the digestion of fats. If you have hepatitis B, you want to avoid any additional complications that may arise with fatty liver disease. Diabetes and HBV together can also be very complicated.  Your doctor won’t mind if you try to avoid “white foods”, or foods that that are white in color and have been processed and refined. This includes foods like white flour, rice, pasta, bread, crackers, cereal, simple sugars and high fructose corn syrup.  (Feel free to eat plenty of white cauliflower, turnips, white beans, etc) Avoid sugary treats and drinks. So what should you eat? Eat plenty of fresh vegetables, fresh fruits, whole grains and lean meats.  Go back to the basics! If you have specific questions about your diet, be sure to talk to your doctor.
  • Don’t worry, be happy… Easy to say, but not so easy to accomplish. Anxiety and depression associated with a chronic illness are challenging problems that may be short term, or can worm their way into nearly every aspect of your life. They can even create physical symptoms that may be confusing and may result in even more worry. Please talk to your doctor if you believe your anxiety or depression is something you are unable to manage on your own. Consider joining a support group where you can talk to others facing the same challenges. Personally I found the Hepatitis B Information and Support List a wonderful source of information and support. Chronic illness can feel very lonely – especially with a disease like HBV that has a stigma associated with it. Find a trusted confident with whom you can share your story.

HBF is entering the Philly DoGooder contest with the fantastic video by HBF’s own, Daniel Chen. Click and watch below. There will be 5 winners total, so if we win we’ll be splitting the $250,000 prize money with 4 other … Continue reading

Aspirin Use Associated With Lower Risk of Developing Hepatocellular Carcinoma and Dying of Chronic Liver Disease

HBF welcomes special guest bloggers, Vikrant V. Sahasrabuddhe, M.B.B.S., M.P.H., Dr.P.H and Katherine A. McGlynn, Ph.D, M.P.H. both researchers at the National Cancer Institute of the NIH, and study authors of the recent Journal of the National Cancer Institute publication.

Hepatocellular carcinoma (HCC) is the most common type of liver cancer.  New cases of HCC and deaths related to HCC have been increasing in the United States since the 1980s.  Most cases of HCC occur in individuals with chronic liver disease (CLD).  CLD is caused by chronic inflammation related to viral infection, excess alcohol consumption or other causes.  While HCC is relatively rare in the U.S., occurring in fewer than 10 per 100,000 persons per year, CLD is more common.  Unfortunately, CLD is among the top 10 causes of death in adults between the ages of 45 and 75 years.

In a new study from the National Cancer Institute, researchers investigated whether reduction of inflammation, through the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, could reduce the risk of developing HCC or death due to CLD. The study was published in the Journal of the National Cancer Institute on November 28, 2012.

The researchers studied a cohort of over 300,000 men and women between the ages of 50 and  71 years who were enrolled in the NIH-AARP Diet and Health Study.  Aspirin and non-aspirin NSAID (for example Advil, Motrin) use was compared among persons who developed HCC or died from CLD and those who did not develop these outcomes.  In all, 250 study participants developed HCC and 428 died from CLD.  Almost three-fourths of the participants reported using aspirin and approximately one-half reported using non-aspirin NSAIDs.

The study found that participants who reported taking aspirin were 41% less likely to develop HCC, and 45% less likely to die from CLD than those who did not take aspirin. Use of non-aspirin NSAIDS did not reduce the risk of developing HCC, but did reduce the risk of dying from CLD by 26%. The researchers note that additional studies will be required to confirm these findings.

While this study will not lead to any immediate changes in clinical practice, it raises interesting new questions on the role of inflammation in risk for HCC.  Although the researchers took into consideration the effect of alcohol intake (a major risk factor for HCC) as well as smoking and body mass index, the study had no information on hepatitis B virus (HBV) or hepatitis C virus (HCV) status of the study participants.  In addition, NSAID use was only measured for the past 12 months, and the study had no information on the indication, duration or dose.  To partially overcome such limitations, results were analyzed after excluding participants who reported hypertension or cardiovascular disease at the beginning of the study. Those individuals might be taking a low-dose aspirin for a longer duration for the prevention of cardiovascular disease. The results were similar after excluding these participants, which suggests that the main results are likely valid regardless of the indication, duration or dose of aspirin.

The study is the largest population-based study to date to assess development of HCC and risk of death due to CLD in relation to NSAID use.  HCC and CLD involve chronic, long-term inflammatory changes in liver cells, which are caused by enzymes such as cyclooxygenases (COX).  One of the primary ways that NSAIDs modulate the risk of chronic inflammation is by stopping or inhibiting the action of COX enzymes; thus inflammatory changes that contribute to the development of CLD and HCC are reduced.  It is also speculated that aspirin may have other anti-inflammatory mechanisms.  NCI researchers are investigating these hypotheses through basic and translational research studies, as well as assessing the risk of developing HCC and dying of CLD in association with NSAID intake in other epidemiologic studies.

The full study is by:

Vikrant V. Sahasrabuddhe, Munira Z. Gunja, Barry I. Graubard, Britton Trabert, Lauren M. Schwartz, Yikyung Park, Albert R. Hollenbeck, Neal D. Freedman and Katherine A. McGlynn. Nonsteroidal Anti-inflammatory Drug Use, Chronic Liver Disease, and Hepatocellular Carcinoma. J Natl Cancer Inst (2012). Published online at: doi: 10.1093/jnci/djs452

Editorial Comments by W. Thomas London, HBF Senior Medical Advisor

In previous blogs I reported that several drugs commonly used to treat or prevent diseases or conditions other than liver cancer or chronic liver disease may also prevent these serious liver diseases.  These included propranolol used to reduce pressure in the portal vein; metformin used to treat diabetes; and statins for the lowering of cholesterol and reducing the risk of heart disease.

The above report adds aspirin to this list, but people with chronic hepatitis B or C should not begin taking aspirin immediately.  Aspirin may cause serious bleeding that is sometimes fatal.  In order for blood to clot, platelets (cell fragments in blood) must clump.  One of aspirin’s actions is to prevent platelets from aggregating (clumping). This action may be the main reason that regular aspirin may prevent heart attacks. Patients with CLD are already at risk of developing serious bleeding.  The take home message is that patients with chronic hepatitis B or C should consult their doctor before taking aspirin or any other drug.

About the blog authors:

Vikrant Sahasrabuddhe,M.B.B.S., M.P.H., Dr.P.H.

Associate Investigator in the Hormonal and Reproductive Epidemiology Branch and is currently detailed to the NCI from the faculty at Vanderbilt University School of Medicine.

Katherine A. McGlynn, Ph.D., M.P.H.

Deputy Chief, Hormonal and Reproductive Epidemiology Branch