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

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Presentation on theme: "Hepatitis B Virus: An Overview: What your patient needs to know. Christine Landon Deborah Jones Alka Maru Tracy Owen."— Presentation transcript:

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

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 2 If your liver does not work well, you may get sick

3 Liver disease has several causes: many can be prevented and treated 3 Potential Causes Examples Prevention/ Treatment Viruses 1,2 Hepatitis A, B, C* Vaccines (for hepatitis A and B), avoid risk factors, screening, medication Alcohol 1 Alcoholic liver disease Consume alcohol in moderation/cease drinking Drugs 1 Certain medications can damage your liver (e.g. OTC pain medications) Follow your doctor’s recommendations Hereditary 3 Iron overload (Hemochromatosis) Remove excess iron from body Abnormal liver cell growth 4 Hepatitis B-induced liver cancer Hepatitis B vaccines/screening to prevent HCC, cancer treatment (e.g. radiotherapy, chemotherapy) *No vaccine is currently available for hepatitis C, and hepatitis A is generally not treated with medications

4 What Is Hepatitis? 4

5 5 What is Hepatitis? Hepatitis means “inflammation of the liver” 1 Viral hepatitis is the most common cause of liver disease 2 The most common types of viral hepatitis are 1 : –Hepatitis A –Hepatitis B –Hepatitis C 1. Centers for Disease Control and Prevention. Hepatitis B FAQs. Accessed April 1, 2009. 2. American Liver Foundation. Liver Wellness. Accessed March 11, 2009. Hepatitis B Virus Image from ICTVdB - The Universal Virus Database, version 4.

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

7 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

8 Vertical transmission (Mother to Child) Hepatitis B transmission routes 1 8 Razors/ needles Unprotected sexual contact with HBV+ Transfusion/ organ transplant Contact with infected fluids 8

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

10 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 exposure 2 –The immune system usually suppresses the virus 1 –Complete recovery may occur within a few months 1

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

12 12 Chronic Hepatitis B (CHB) Is a long-term disease that occurs when your immune system does not get rid of the virus 1 –You may not have obvious symptoms 1,2 –Patients often find out they are ill when they develop serious liver damage 2 –CHB is a serious disease; it can lead to cirrhosis, liver cancer, and death 2

13 Healthy liverFibrotic liver 1 Cirrhotic liver 2 Liver cancer 3 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 Types of liver disease: potentially caused by Chronic Hepatitis B (CHB) 13

14 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

15 How Is Hepatitis B Diagnosed? 15

16 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

17 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

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 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

21 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

22 Lower Risk Higher Risk Treatment for Hepatitis B may reduce the risk of cirrhosis and liver cancer Cirrhosis Liver Cancer 22 Iloeje UH, et al. Gastroenterol. 2006;130:678-686. Chen CJ, et al. JAMA. 2006;295:65-73. Hepatitis B Virus Treatment

23 Can Hepatitis B Be Prevented? 23

24 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

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 Not Hepatitis B is Not transmitted by Sharing food, water, utensils or drinking glasses Mosquitoes Tears, sweat, urine or stools 27

28 28 Common myths about hepatitis B transmission Hugging or kissingBreastfeeding Coughing or sneezing Not Hepatitis B is Not transmitted by Asian Liver Center. 2007 Physician’s Guide to Hepatitis B: A Silent Killer. Accessed April 1, 2009.

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


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