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An Overview: What your patient needs to know.

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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?

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?

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?

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?

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


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