Transcript View / the Hepatitis B presentation

Hepatitis B Virus:
An Overview: What your patient needs
to know.
Christine Landon
Deborah Jones
Alka Maru
Tracy 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
If your liver does
not work well,
you may get sick
2
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
Hepatitis B-induced
liver cancer
Hepatitis B
vaccines/screening to
prevent HCC, cancer
treatment (e.g. radiotherapy,
chemotherapy)
Abnormal
liver cell
growth4
*No vaccine is currently available for hepatitis C, and hepatitis A is generally not treated with medications
3
What Is Hepatitis?
4
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.
http://www.ncbi.nlm.nih.gov/ICTVdb/ICTVdB/
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.
5
Hepatitis B is a global
problem
HBsAg prevalence
8% = High
2-7% =Intermediate
<2% =Low
Data from 2008
6
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
Hepatitis B transmission
routes1
Vertical transmission
(Mother to Child)
Contact with
infected fluids
Unprotected
sexual contact
with HBV+
Transfusion/
organ transplant
Razors/
needles
88
Course of Hepatitis B virus
infection
Course of HBV Infection
Adult
Infant
90-95%
Acute Infection
5-10%
Virus Persists
70-90%
Virus Persists
10-30%
Acute Infection
Full Recovery
Chronic
Hepatitis B
Chronic
Hepatitis B
Full Recovery
9
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
Common symptoms of acute
Hepatitis B
Yellow eyes and
skin (jaundice)
Abdominal
pain
Loss of
appetite
Nausea and
vomiting
Joint pain
Dark urine
Fatigue
Weakness
11
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
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
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
How Is Hepatitis B
Diagnosed?
15
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
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
17
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
Can Hepatitis B Be
Treated?
19
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
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
Treatment for Hepatitis B may reduce
the risk of cirrhosis and liver cancer
Treatment
Higher
Lower Risk
Risk
Cirrhosis
Hepatitis B Virus
Liver Cancer
22
Iloeje UH, et al. Gastroenterol. 2006;130:678-686.
Chen CJ, et al. JAMA. 2006;295:65-73.
Can Hepatitis B Be
Prevented?
23
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
Pregnancy is a time for Hepatitis B
screening and prevention
• Pregnant women can be tested for
chronic hepatitis B at an early prenatal 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?
26
Common myths about
hepatitis B transmission
Hepatitis B is Not transmitted by
Sharing food, water,
utensils or drinking
glasses
Mosquitoes
Tears, sweat,
urine or stools
27
Common myths about hepatitis B
transmission
Hepatitis B is Not transmitted by
Hugging or kissing
Breastfeeding
Asian Liver Center. 2007 Physician’s Guide to Hepatitis B: A Silent Killer.
http://liver.stanford.edu/Education/2007Handbook.pdf. Accessed April 1, 2009.
Coughing or sneezing
28
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
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
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.