Hepatitis B: Don’t Forget Me

In the world of COVID, hepatitis B, a common and potentially deadly virus, should not be forgotten. It can cause both acute and chronic disease. Although not commonly seen, some people with acute hepatitis B may rapidly need to undergo a liver transplant to survive.

Hepatitis B is commonly acquired from either sexual contact or through exposure to contaminated body fluids such as blood, saliva, semen, etc. Casual contact does not lead to the spread of hepatitis B. However, close intimate contact with someone infected with Hepatitis B can lead to disease acquisition. Therefore, it is recommended that all household and close contacts of persons with hepatitis B be given the hepatitis B vaccine. The hepatitis B vaccine is given either in two injections over a two-month period or three injections over a six-month period. Once complete, person should be checked for immunity. Once immunity has been achieved, there is lifelong protection against hepatitis B.

The incidence of acute hepatitis B has steadily declined in the U.S. likely due to widespread availability of vaccination. Despite this, chronic hepatitis B affects an estimated three to four hundred million people worldwide and more than two million Americans. It is most common in Asian-Americans and African-Americans. The prevalence of hepatitis B is higher in men than in women.

Chronic hepatitis B is characterized in the blood by a positive hepatitis B surface antigen and the presence of hepatitis B virus in the blood. This condition is worrisome and people suffering from this virus have an increased chance of developing cirrhosis, liver cancer and needing a liver transplantation due to liver failure.

Therapy is available for people chronically infected with hepatitis B. Luckily, therapy is not indicated for all patients as the majority of patients will not develop significant progressive disease. A medical professional must determine who is an appropriate candidate for treatment as treatments may be costly and in many cases, is indefinite. Hepatitis B is not a curable disease and therefore the goal of therapy is to slow or prevent the progression of disease.

The first approved therapy for hepatitis B was interferon, a naturally occurring substance whose function is to help rid the body of viral infection. Once weekly injections of pegylated interferon for one year’s duration has been shown to be excellent first line therapy for the treatment of patients with low levels of hepatitis B virus in the blood and high liver enzymes. This therapy also appears to be more effective in the specific types of hepatitis B termed genotype A and B. Unfortunately, this therapy has significant side effects and is not well accepted by patients.

Oral medications, such as entecavir and tenofovir, are available for treating hepatitis B. These are once-a-day medications which are well tolerated with minimal side effects. Once started, therapy for hepatitis B is usually lifelong. Therapy has been associated with an improvement in liver fibrosis, regression of cirrhosis and a decreased incidence of liver cancer. Usually, people on hepatitis B therapy need to be followed up with every six months for specific blood tests and abdominal imaging.

Current therapies offer promise that we can control this common and deadly disease. There is significant research to develop treatments to cure hepatitis B but real cure is likely many years away from being available.

David Bernstein
David Bernstein, MD, is a columnist for Long Island Weekly and chief of gastroenterology, hepatology and nutrition at North Shore University Hospital and Long Island Jewish Medical Center.

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