1. An Overview: What your patient needs to know.
Hepatitis B Virus:
An Overview: What your patient needs to know.
Christine Landon
Deborah Jones
Alka Maru
Tracy Owen 1

2. Understanding your liver
Your liver is essential to life.
It is like a factory
It builds proteins and sugars for other parts of your body to use
It is like a warehouse
It stores vitamins, sugars, fats and nutrients and releases them when your body needs them
It is like a recycling centre
It filters blood and breaks down chemicals that your body cannot use
It is important to understand why the liver is essential to life and why it is important to keep your liver healthy.
The liver is the largest gland in the body; it is essential to life because it acts as a factory to produce and modify a variety of substances necessary for life. For example, the liver processes proteins. Its role in protein metabolism is so pivotal that the body cannot live without the liver’s protein processing functions for more than a few days. While other tissues also contribute to the metabolism of sugars, the liver serves as an important organ for the breakdown of sugars and formation of compounds for other biochemical reactions.
The liver also serves as a warehouse or storage depot. For example, the liver takes simple sugars and links them together to form storage carbohydrate known as glycogen. It also synthesizes fat and cholesterol and makes proteins to carry the fatty molecules to the various organs. It also stores vitamins and other essential nutrients and makes them available in times of need.
The liver also functions as a recycling center. That is, it removes excess sugar from the blood and then recycles it when needed. The liver also removes products of metabolism from the blood and either recycles it or prepares those end-products for excretion in either the bile or from the kidneys.
Because of the liver’s pivotal role in metabolism of sugars, proteins, and fats, it is reasonable to believe that diseases of the liver can impair its function to a degree in which patients become very sick or even die. Thus, it is important to know about the various types of liver disease and their prevention/treatment.
Reference
Barrett KE. Gastrointestinal Physiology McGraw-Hill. Accessed April 16, 2009.
If your liver does not work well, you may get sick 2

3. Liver disease has several causes: many can be prevented and treated
Potential Causes
Examples
Prevention/ Treatment
Viruses1,2
Hepatitis A , B, C*
Vaccines (for hepatitis A and B), avoid risk factors, screening,
medication
Alcohol1
Alcoholic liver disease
Consume alcohol in moderation/cease drinking
Drugs1
Certain medications can damage your liver (e.g. OTC pain medications)
Follow your doctor’s recommendations
Hereditary3
Iron overload (Hemochromatosis)
Remove excess iron from body
Abnormal liver cell growth4
Hepatitis B-induced liver cancer
Hepatitis B vaccines/screening to prevent HCC, cancer treatment (e.g. radiotherapy, chemotherapy)
There are numerous causes of liver disease, examples of which are listed in the table above. Some of these liver diseases can be prevented and/or treated. However, this list is not exhaustive: that is, there are a number of other diseases not listed.
Liver diseases can be produced by infections, toxins, and various drugs. While some types of liver disease are hereditary (passed from parents to child), others result from changes in growth factors within the liver that cause the liver cells to begin to overgrow—a characteristic of cancer.
In the following slides, we are going to focus on viral infections of the liver: a disorder known as viral hepatitis.
References
Ghany M, Hoofnagle JH. Liver and biliary tract disease. In: Harrison’s Principles of Internal Medicine. 15th ed. Braunwald E, Hauser S, Fauci AS, et al, eds. New York: McGraw-Hill; 2001.
American Liver Foundation. Liver Wellness. Accessed April 1, 2009.
American Liver Foundation. Hemochromatosis. Accessed April 1, 2009.
American Liver Foundation. Cirrhosis. Accessed April 1, 2009. 3
*No vaccine is currently available for hepatitis C, and hepatitis A is generally not treated with medications

4. What Is Hepatitis? 4

5. What is Hepatitis? Hepatitis means “inflammation of the liver”1
Viral hepatitis is the most common cause of liver disease2
The most common types of viral hepatitis are1:
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis B Virus
Image from ICTVdB - The Universal Virus Database, version 4. 5
Centers for Disease Control and Prevention. Hepatitis B FAQs Accessed April 1, 2009.
American Liver Foundation. Liver Wellness. Accessed March 11, 2009. 5

6. Hepatitis B is a global problem
HBsAg prevalence
8% = High
2-7% = Intermediate
<2% = Low
Data from 2008 6 6 6

7. Hepatitis B is an infectious viral illness
HBV is up to 100 times more infectious than HIV
HBV can live outside the body for 7 days
Many people who are chronically infected with HBV do not have any symptoms
Early detection is the key to preventing hepatitis B-associated disease and death
Infection acquired in the UK (around 200 per year) but an estimated 7,000 chronic cases of hepatitis B come to the UK every year as a result of immigration to the UK from high prevalence areas. 7 7 7

8. Hepatitis B transmission routes1
Unprotected sexual contact with HBV+
Vertical transmission
(Mother to Child)
Contact with infected fluids
Transfusion/ organ transplant
Razors/ needles 8 8 8

9. Course of Hepatitis B virus infection
Course of HBV Infection
Adult
Infant
90-95%
Acute Infection
Full Recovery
Chronic
Hepatitis B
5-10%
Virus Persists
70-90%
10-30% 9 9 9

10. Acute Hepatitis B
Is a short-term disease that occurs when a person is first infected with the hepatitis B virus (HBV)1
Symptoms may occur in approximately 70% of patients about 12 weeks after exposure2
The immune system usually suppresses the virus1
Complete recovery may occur within a few months1 10 10

11. Common symptoms of acute Hepatitis B
Yellow eyes and skin (jaundice)
Loss of
appetite
Abdominal pain
Nausea and vomiting
Joint pain
Dark urine
Fatigue
Weakness 11 11 11

12. Chronic Hepatitis B (CHB)
Is a long-term disease that occurs when your immune system does not get rid of the virus1
You may not have obvious symptoms1,2
Patients often find out they are ill when they develop serious liver damage2
CHB is a serious disease; it can lead to cirrhosis, liver cancer, and death2 12 12

13. Types of liver disease: potentially caused by Chronic Hepatitis B (CHB)
Healthy liver
Fibrotic liver1
Cirrhotic liver2
Liver cancer3
This is a healthy liver
The continuous inflammation of the liver caused by hepatitis B can lead to fibrosis - a formation of scar tissue in the liver
In cirrhosis of the liver, scar tissue replaces normal, healthy tissue, blocking the flow of blood through the liver and preventing it from working properly
Liver cancer is the formation of a malignant tumor in the liver 13 13

14. Untreated Hepatitis B can cause liver cancer
Hepatitis B virus is second only to tobacco smoke in causing cancer deaths globally
The incidence of liver cancer is 9 times higher in Asian American men than their white counterparts
Hepatitis B-associated liver cancer destroying a normal liver 14 14

15. How Is Hepatitis B Diagnosed?15

16. Why is Chronic Hepatitis B screening important?
A simple blood test is the only way to detect HBV infection
Screening for hepatitis B is necessary to:
Identify people who have chronic hepatitis B so they can receive medical treatment
Identify those who are unprotected so they can be vaccinated 16 16

17. Who may be screened for Chronic Hepatitis B?
All patients who have abnormal LFTs or who are HCV +
All foreign-born persons from areas where the rate of HBV infection is moderate to high
Household and sexual contacts of infected persons
Pregnant women
HIV-positive people
Haemodialysis patients
Injecting drug users
People with selected medical conditions*
e.g. requiring chemotherapy, immunosuppressive drugs (steroids) etc
The Centers for Disease Control and Prevention have identified groups of individuals at high risk for HBV infection. These groups include:1
All foreign-born persons from areas where the rate of HBV infection is moderate to high
Household and sexual contacts of HBV-infected persons
Pregnant women
HIV-infected persons
Hemodialysis patients
Injection drug users
Persons with selected medical conditions
Proper screening of at-risk individuals is necessary to identify HBV-infected people who will require monitoring and/or treatment. Early identification of chronic hepatitis B can prevent serious complications, including liver cancer and death.2
Additionally, screening for immunity to HBV can identify people who require the hepatitis B vaccine, as well as those who received the vaccine but did not develop immunity. 2
Reference
Centers for Disease Control and Prevention. MMWR. 2008;57(RR-8).
Asian Liver Center Physician’s Guide to Hepatitis B: A Silent Killer. Accessed April 1, 2009. 17 17

18. What do results of Hepatitis B screening mean?
Hepatitis B Surface Antigen (HBsAg)
Negative: Normal
Positive >6 months: Patient has chronic hepatitis B
Hepatitis B surface antibody (Anti-HBs)
Negative: Not immune
Positive: Immunity to hepatitis B from either previous infection or vaccination 18

19. Can Hepatitis B Be Treated?19

20. What should I do if I am diagnosed with Chronic Hepatitis B?
Although there is no cure, chronic hepatitis B can be managed
Many patients, once treated, can live normal and healthy lives
Early detection and proper management can help save lives
Take care of yourself by scheduling regular doctor appointments to monitor your chronic hepatitis B progression
Protect your family by avoiding transmission of the virus
Receive treatments to help delay and prevent liver damage from chronic hepatitis B 20 20

21. Medications used to treat Chronic Hepatitis B
Oral medications:
Adefovir dipivoxil
Entecavir
Lamivudine
Telbivudine
Tenofovir disoproxil fumarate
Two injectable medications:
Interferon alfa-2b
Peginterferon alfa-2a 21 21

22. Treatment for Hepatitis B may reduce the risk of cirrhosis and liver cancer
Lower Risk
Higher Risk
Treatment
Cirrhosis
Hepatitis B Virus
Liver Cancer 22
Iloeje UH, et al. Gastroenterol. 2006;130:
Chen CJ, et al. JAMA. 2006;295:65-73.

23. Can Hepatitis B Be Prevented?23

24. Hepatitis B Can Be Prevented
Vaccination is the best way to protect yourself and others
Some other ways to guard against infection include:
Learn more about hepatitis, its prevention and treatment
Use condoms during intimate contact
Don’t share razors or toothbrushes with an infected person
Prevent transmission to infants by making sure the infant receives vaccination
Consider the risks before getting a tattoo or body piercing, shaving
If you have had hepatitis B, don’t donate blood, organs or semen 24 24

25. Pregnancy is a time for Hepatitis B screening and prevention
Pregnant women can be tested for chronic hepatitis B at an early pre-natal visit
Infants born to women with chronic hepatitis B should receive hepatitis B vaccination +/- hepatitis B immune globulin (HBIG)
After giving birth, women with chronic hepatitis B should talk to their doctors about managing their chronic hepatitis B 25

26. What Are The Common Myths About Hepatitis B?26

27. Common myths about hepatitis B transmission
Hepatitis B is Not transmitted by
Sharing food, water, utensils or drinking glasses
Tears, sweat, urine or stools
Mosquitoes 27 27

28. Common myths about hepatitis B transmission
Hepatitis B is Not transmitted by
Hugging or kissing
Breastfeeding
Coughing or sneezing 28
Asian Liver Center Physician’s Guide to Hepatitis B: A Silent Killer. Accessed April 1, 2009. 28

29. Conclusions
Globally, about 1 in 20 people (400 million) are living with chronic hepatitis B1,2
Hepatitis B is a silent disease; many people with chronic hepatitis B feel perfectly healthy and do not have symptoms2 29 29 29 29

30. Conclusions People in risk groups should be tested
Chronic hepatitis B can be a manageable disease
Early detection and proper management may help save lives
Available treatments can help delay and may prevent liver damage from chronic hepatitis B
Travelling - Get yourself and your family vaccinated for Hepatitis B 30 30

31. HEPATITIS B VACCINATIONS
IF YOU HAVE HEPATITIS B, YOU WILL NOT REQUIRE THE VACCINATION.
HEPATITIS B VACCINATION WILL BE OFFERED IF YOU ARE AT RISK.
GET VACCINATED AGAINST HEPATITIS B.