Hepatitis B Virus:An Overview: What your patient

needs to know.

Christine LandonDeborah Jones

Alka MaruTracy Owen

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

Liver disease has several causes: many can be prevented and treated

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Potential Causes

ExamplesPrevention/Treatment

Viruses1,2 Hepatitis A , B, C*

Vaccines (for hepatitis A and B), avoid risk factors,

screening,medication

Alcohol1Alcoholic liver

diseaseConsume 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)

*No vaccine is currently available for hepatitis C, and hepatitis A is generally not treated with medications

What Is Hepatitis?

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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 1. Centers for Disease Control and Prevention. Hepatitis B FAQs.

http://www.cdc.gov/print.do?url=http%3A//www.cdc.gov/hepatitis/B/bFAQ.htm%23overview. Accessed April 1, 2009.2. American Liver Foundation. Liver Wellness. http://www.liverfoundation.org/downloads/alf_download_29.pdf. Accessed March 11, 2009.

Hepatitis B Virus

Image from ICTVdB - The Universal Virus Database, version 4. http://www.ncbi.nlm.nih.gov/ICTVdb/ICTVdB/

Hepatitis B is a global problem

8% = High

2-7% =Intermediate

<2% =Low

HBsAg prevalence

6Data from 2008

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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.

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Vertical transmission(Mother to Child)

Hepatitis B transmission routes1

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Razors/needles

Unprotected sexual contact

with HBV+

Transfusion/organ transplant

Contact with infected fluids

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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% Virus Persists

Chronic Hepatitis B

10-30%Acute Infection

Full Recovery

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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

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Loss ofappetite

Nausea and vomiting

Dark urine

Yellow eyes and skin (jaundice)

Abdominalpain

Common symptoms of acute Hepatitis B

Fatigue

Joint pain

Weakness11

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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

Healthy liver Fibrotic liver1 Cirrhotic liver2 Liver cancer3

This is ahealthy liver

The continuous inflammation of theliver caused byhepatitis B can leadto 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 inthe liver

Types of liver disease:potentially caused by Chronic Hepatitis B

(CHB)

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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

How Is Hepatitis B Diagnosed?

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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 unprotectedso they can be vaccinated

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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

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

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Can Hepatitis B Be Treated?

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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 appointmentsto 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

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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

Treatment for Hepatitis B may reduce the risk of cirrhosis and liver cancer

Cirrhosis

Liver Cancer

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Iloeje UH, et al. Gastroenterol. 2006;130:678-686.Chen CJ, et al. JAMA. 2006;295:65-73.

Hepatitis B Virus

TreatmentTreatment

Can Hepatitis B Be Prevented?

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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

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

What Are The Common Myths About Hepatitis B?

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Common myths about hepatitis B transmission

Hepatitis B is NotNot transmitted by

Sharing food, water, utensils or drinking

glassesMosquitoes Tears, sweat,

urine or stools 27

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Common myths about hepatitis B transmission

Hugging or kissing Breastfeeding Coughing or sneezing

Hepatitis B is NotNot transmitted by

Asian Liver Center. 2007 Physician’s Guide to Hepatitis B: A Silent Killer. http://liver.stanford.edu/Education/2007Handbook.pdf. Accessed April 1, 2009.

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Conclusions•Globally, about 1 in 20 people (400 million) are living with chronic hepatitis B1,2

•Hepatitis B is a silent disease; many peoplewith chronic hepatitis B feel perfectly healthy and do not have symptoms2

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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

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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.