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NSW HEPATITIS INFOLINE

Free smart phone app for people about to start hep C treatment

Free smart phone app for people about to start hep C treatment

Free smart phone app for people about to start hep C treatmentThe Hepatitis NSW Hep Connect program helps people living with hep C with everything from testing to treatment to cure.

The Perx Health smart phone app can help you remember to take your medication on a daily basis, as well as remind you to do other important health tasks like attending appointments and picking up prescriptions. The app features games, community connection, education, and some exciting challenges. And there are rewards!

If you are about to start hep C treatment, please think about downloading the app and join us for free.

“What a great tool to keep our patients on track! Great initiative. Simple and easy.”
Nurse Prescriber, WSLHD

We would love to have you on board. There are no restrictions on who can get supported.

It is simple to join!

  • The app is completely free and takes less than a minute to download.
  • Simply click on the survey link, answer the four basic eligibility questions, and you’re in!
  • the only prerequisites for participation are a smartphone and an email address.

Features of the Perx Health app

  • The Perx Health app contains no advertising, and no data is shared with third parties.
  • Consistent disclosure and consent to privacy in accordance with NSW Health guidelines.
  • App users are greeted with automated welcome emails and SMS messages.
  • Reward-based – offer vouchers in exchange for medication adherence and appointment attendance.
  • App users can contribute by filling out our feedback surveys.
  • Are if you’re out of data the app will continue to function for a month.

Want to come onboard? To start the survey >>>CLICK HERE

“Thank you so much from the deepest depth of my heart for your help. I got my SVR results today – I am now hep C free. Thank you and your organisation! I could not have done it without your support and will recommend it to anyone.”
Tony, Hep Connect client, 27 July 2020

If you would like to know more about the Hep Connect Perx program, please contact:

Susanne Wilkinson, Project Officer
email: [email protected]

Published 9 August, 2021

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Media Release: Despite COVID, hepatitis can’t wait this World Hepatitis Day

Understanding hepatitis B - part 1Wednesday, 28 July marks World Hepatitis Day 2021, an important opportunity to give visibility to, and raise awareness of viral hepatitis, as well to drive better outcomes for people affected by viral hepatitis.

This year’s theme is “Hepatitis can’t wait”, conveying the urgency of efforts needed to eliminate hepatitis as a public health threat by 2030. Even in the current COVID-19 crisis, we can’t wait to act on viral hepatitis. Viral hepatitis doesn’t care about other health crises. Left unchecked both hep B and hep C will continue to find new people to infect and continue to damage the livers of those already living with the viruses.

The good news is that recent changes to Medicare means Australians can have access to management, care and treatment of hep B or treatment and cure of hep C from the comfort, privacy and safety of their own home using telehealth. Even testing for hep C can be done at home using a free Dried Blood Spot (DBS) test kit ordered from www.health.nsw.gov.au/dbstest/Pages/order.aspx

Hepatitis NSW CEO, Mr Steven Drew said, “Advances have been made in Australia and New South Wales on many fronts for both hep B and hep C. While much has been achieved through the combined and concerted efforts of community health organisations, clinicians, health departments, and researchers, we all agree that there is still much to be done to meet elimination targets in this country.”

In NSW, World Hepatitis Day falls within Hepatitis Awareness Week which runs 26-31 July. The week includes a range of local and state-wide activities, events, and initiatives to improve population outcomes for both hep B and hep C.

Mr Drew said, “A key activity this year is the roll out of HEP CURED, a campaign using simple messaging and strong imagery to promote the availability and effectiveness of cures for hepatitis C. The core message of the campaign instils a sense of connection with loved ones, or significant others.”

Three key posters were designed based on research showing the importance of “connection to others” as motivations to seek cure. The posters serve as conversation starters that lead to engagement around hepatitis C testing and treatment.

HEP CURED utilises posters in clinics and services, advertising in shopping centres and washrooms, laneway and regional billboard advertising, railway billboards, and selected bus shelters and street furniture.

Hepatitis NSW is also running a separate social media initiative featuring ten video and display adverts across Facebook, Instagram, YouTube and Google. Each advertisement – be it about hep B, hep C, or liver health – links to relevant pages on the Hepatitis NSW website, providing information and resources on testing and treatment. This initiative aims to support the ongoing push to eliminate viral hepatitis.

Included in the initiative are videos featuring some of our many amazing and inspiring lived experience speakers. These people bravely share their own very personal stories and perspectives on life with hep B or hep C, and what management or cure, respectively, means to them.
Mr Drew said, “These stories are a powerful reminder that while we focus on the disease, at the heart of all we do and what we want to achieve, are real people. People with hopes, dreams, families, friends, and a desire to get the most out of life.

“I encourage people to contact the Hepatitis NSW Infoline on 1800 803 990 for more information about the treatment options available or hepatitis generally. You can also contact us using our online chat function on our website,” said Mr Drew.

For more information, please contact:

Hepatitis NSW
Steven Drew, CEO
[email protected]
0402 518 285

Published 28 July, 2021

General information about hep B and hep C

Tens of thousands of people in NSW are living with viral hepatitis. Both hep B and hep C are viruses that can, without appropriate medical intervention, become life-long chronic conditions, eventually leading to liver cirrhosis, liver cancer and sadly, all too often, death. A significant percentage of people living with hep B or hep C are unaware they have it. Even where people know their status, many thousands experience barriers to access healthcare, treatment, or cure – this must change.

With hepatitis B, while there is currently no cure for this virus, babies born in Australia are vaccinated against it. Any adult who needs to be vaccinated can be. Testing is available, and encouraged, for anyone from an at-risk group. Should a person be found to be living with hep B, regular monitoring of their liver health is strongly recommended, and, if required, treatment can be prescribed to manage their viral load and prevent the onset of liver disease.

For hepatitis C, all Australians over the age of 12 have access to effective and affordable Direct Acting Antiviral (DAA) cures. This year marks the fifth anniversary of DAAs being made widely available in Australia through Medicare. Since 2016, more than 75,000 Australians have been cured of hepatitis C. It is no exaggeration to say that being cured of hep C can improve quality of life – many people who have finished their course of treatment report feeling greater levels of energy and alertness.

Hep C medications have a cure rate of 95 per cent. They can be prescribed by any general practitioner, or authorised nurse practitioners. Cure is usually achieved within 8 or 12 weeks, with minimal or no side-effects.

“These oral pill treatments have offered a revolutionary opportunity,” said Mr Drew. “It is important that people see their health professional to be treated and get their best life back. While hepatitis C initially has almost no symptoms, if left untreated it can ultimately result in significant liver disease.”

Testing for hep C is simple and as easy as getting your GP to do a blood test. Should someone learn they have hep C, they should seriously consider commencing treatment and get cured.

“It is not often we get the chance to eliminate a chronic disease, but we have that opportunity now with hep C,” said Mr Drew. “I encourage anyone who hasn’t yet sought out this medication to explore their treatment options,” adding that Hepatitis NSW could provide information and support to anyone living with, or affected by hepatitis including family and friends of people living with hepatitis C.

 

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Media Release: New website reaches priority hepatitis B communities

Media Release: New website reaches priority hepatitis B communitiesHepatitis NSW has launched a dedicated hepatitis B website for Chinese and Korean communities – hepB.org.au. This new site has been developed to support and inform people from these populations, in New South Wales, who are impacted by hepatitis B. The website will support efforts to eliminate hepatitis B in Australia. Current data shows targets are not being met; achievement of hepatitis B elimination targets is unlikely before 2040 which is ten years later than the agreed target.

Why hepatitis B elimination is important

Hepatitis NSW CEO, Mr Steven Drew, said “Chronic hepatitis B is the most prevalent blood‐borne virus in Australia, and is a significant contributor to liver disease, including cancer.”

Approximately one percent of the Australian population lives with the virus; people born overseas, and Aboriginal and Torres Strait Islander peoples, represent three-quarters of those affected.

Educating migrants has become a priority

An increase in migration of people from endemic populations has seen a rise in the number of individuals living with hepatitis B in Australia. This is despite infant hepatitis B vaccination programs here, and overseas, reducing overall transmission of the virus.

“As such”, said Mr Drew, “the prevalence of hepatitis B within new and existing adult migrants will remain an issue. Targeted efforts and campaigns are required for some time yet. Within New South Wales, and in pockets of Sydney specifically, Korean and Chinese communities bear the bulk of this burden.”

Even though Australia has committed to several national hepatitis B targets – 80% of people diagnosed, 20% on treatment, and a 30% reduction in deaths by 2022 – those targets are not being met. As of 2018, approximately 68% were diagnosed, with only 8.7% receiving treatment – less than one‐third of those estimated to be eligible.

“Unfortunately, deaths attributable to liver cancer have been increasing in Australia faster than deaths caused by any other cancer, with liver cancer now the sixth most common cause of cancer death,” said Mr Drew.

However, with regular testing and, where needed, effective ongoing treatment, it is possible to keep the damage done by hepatitis B at bay and safely managed.

Mr Drew said, “The difficulty is in addressing language barriers, cultural stigmas, and myths and misinformation so that people start regular testing and understand the risks of delaying medical attention.”

There is demand for Korean and Chinese language sections

“Our 2020 web-traffic statistics showed clear demand in the Korean and Chinese language sections of our primary English language site, so we expanded our existing online material to produce a dedicated in-language site.”

“With this new, special website for Korean and Chinese communities, we hope to communicate directly to people seeking advice and information for themselves or loved ones”, said Mr Drew.

hepB.org.au will enable us to provide information covering testing, transmission, prevention and vaccination, treatment, and monitoring – as well as personal stories and specialist articles – to Chinese and Korean people residing in New South Wales.

For more information, please contact:

Hepatitis NSW
Steven Drew, CEO
[email protected]
0402 518 285

Published 28 May, 2021

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Media Release: Great achievements after five years of hepatitis C elimination – but more work needed

Media Release: Great achievements after five years of hepatitis C elimination – but more work neededMonday March 1st marks the five-year anniversary of the Pharmaceutical Benefits Scheme listing of new, affordable, highly effective treatments for hepatitis C. Direct-acting antivirals (DAAs) that cure hepatitis C were made broadly available to all eligible Australians.

With the groundbreaking hep C treatment, we are closer to our goals

Steven Drew, Hepatitis NSW CEO, said, “Thanks to those groundbreaking medications, elimination of hepatitis C has become an achievable goal, in line with Australian and NSW Government commitments. We are within reach of achieving elimination of hep C by 2030.”

Mr Drew continued, “However, elimination will require the ongoing combined efforts of government, the health sector, and community to be fully realised.”

So far, an estimated 30,200 people in New South Wales have started treatment for, and been cured of, hepatitis C since 2016. This represents a saving to the NSW Health Care System of over $93.6m.

Of treatment initiations since March 2016, 1,514 were accessed by Aboriginal and Torres Strait Islander people under the Closing the Gap scheme. Many more Indigenous Australians have accessed treatment through medical specialists, GPs, and health service providers outside of the Closing the Gap scheme.

The hep C DAA medications, which have a cure rate of 95 per cent, can be prescribed by medical specialists, general practitioners, and nurse practitioners. Cure is achieved within 8 or 12 weeks, with minimal or no side-effects. It is important that people are tested and treated; while hepatitis C initially has almost no symptoms, if left untreated it can ultimately result in significant liver disease and possibly death.

The new hep C treatments have been improved

Susan Hawkeswood lived with hepatitis C for over twenty years before being diagnosed with the virus in the early 2010s. “Interferon was the only treatment available then, it was not very effective and had many unpleasant, often debilitating, side-effects and I chose not to use it.”

“Fortunately, the new direct acting antivirals came along before my liver was damaged by the virus. I had no side effects from the DAA treatment and was cured in just three months,” said Susan. “While living with hepatitis C I often felt exhausted, but with cure my energy has returned.”

It is essential to continue promoting these groundbreaking cures

Mr Drew said, “While these many successes are a great achievement for our community, there are still tens of thousands across the state that are yet to seek treatment and cure, and treatment uptake is now declining.”

“It is essential to reinvigorate promotion of these ground-breaking cures to a broad audience, and to ensure that all people in New South Wales can live their best life, free from hepatitis C,” said Mr Drew. “With that in mind, it is very concerning that new legislation being considered and supported by both the NSW Government and Opposition could significantly undermine those efforts.”

For more information, please contact:

Hepatitis NSW
Steven Drew, CEO
[email protected]
0402 518 285

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Media Release: NSW’s Mandatory Disease Testing Bill ill-conceived and flawed

Media Release: NSW’s Mandatory Disease Testing Bill ill-conceived and flawedSpeaking at a NSW Legislative Committee Inquiry into the Mandatory Disease Testing Bill 2020, on Thursday 11 February, Hepatitis NSW restated our concerns related to this ill-conceived and flawed legislation.

Hepatitis NSW CEO Steven Drew said, “Hepatitis NSW absolutely supports frontline health and emergency services workers. We collaborate with many of them every day through our work. They should not be subjected to unnecessary threats or risk as they go about their job and it is abhorrent that attacks do occur that create health related stress and concern.”

“Frontline workers must be informed and educated in advance, and reassured by experts that, based on science and evidence, the likelihood of the transmission of a blood-borne virus as the result of spitting or skin contact with blood is non-existent,” said Mr Drew. On this basis, the inclusion of saliva within the definition of ‘body fluids’ which can be used to seek a mandatory testing order in the Bill is redundant and raises questions as to the real purpose of this legislation.

“We are part of a concerted effort by the community, government, and health sectors to eliminate both hepatitis B and hepatitis C in New South Wales by 2028,” said Mr Drew. “Efforts to date have resulted in the hard won ongoing decline in prevalence of hepatitis B and hepatitis C. Both viruses now present a numerically small and ever diminishing health risk in NSW.”

“There is an effective cure for hepatitis C and a vaccination for hepatitis B. This means the fear and worry, which this legislation validates, is unwarranted and not justifiable. Instead, rather than entrench stigma and discrimination, we need scientific, evidence-based information and education to reduce stress and anxiety for frontline workers who are at risk of incidents of exposure. This reflects New South Wales world leading approach and response to public health issues.”

This Bill will make it harder to reach the very people we must still reach to make good on elimination.

Since 2000, a comprehensive hepatitis B vaccination program in NSW means an entire generation of young people are not at, and pose no risk of, infection. Additionally, frontline workers should already be vaccinated against hepatitis B to mitigate occupational health and safety risks of blood borne virus transmission.

Furthermore, an effective cure for hepatitis C is universally available through the PBS, including for young people aged 12 and above. That this Bill applies to young people aged 14 years and above is as unjustifiable as it is abhorrent.

“The importance of protecting and promoting the health, well-being, and mental health of staff, employees, workers and indeed the public is something we all agree on. Workplaces have an obligation to do everything possible to protect staff from injury and harm while carrying out their duties. Although the rationale for this Bill is to protect and promote the health and well-being of frontline workers we already, in fact, have the tools to do so.”

The current system already places the health and safety of the worker at the centre of risk assessment and prevention. It prioritises evidence-based assessment, treatment, and care. In the event of an incident, focus should always be placed on access to immediate assessment of risk by a qualified health practitioner, counselling, and support to the person. This support would see the commencement of any recommended aftercare, including post-exposure prophylaxis.

Mr Drew said, “Requiring an alleged assailant to undertake a blood test, potentially without consent and under duress, does not provide peace of mind. It would be an unnecessary and fallible substitute for the immediate clinical assessment of the affected worker by an expert and appropriate care protocols.”

It is important to state clearly and unambiguously that enacting this Bill will disproportionately and adversely impact an already disadvantaged population, notably street present and marginalised people – specifically Aboriginal and Torres Strait Islander people, as well as people who have substance dependence, gender identity, and mental health issues.

“The Bill will effectively offer no increased peace of mind to frontline workers,” said Mr Drew, “but would instead expose predominantly marginalised individuals to unnecessary and invasive blood testing, potentially inflaming violent behaviour and increasing the risk of injury to both the alleged assailant and the frontline worker.”

  • Download our submission>>> CLICK HERE
  • Read other submissions – NSW Parliament site>>> CLICK HERE

For more information, please contact:

Hepatitis NSW
Steven Drew, CEO
[email protected]
0402 518 285

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What you need to know about hep B | part 4

What you need to know about hep B | part 4

This article – part 4 of 8 – was written by Dr Alice Lee , Gastroenterologist and Hepatologist, Concord Repatriation General Hospital.

Liver cancer | part 1

One of the most serious complications of hepatitis B is the development of liver cancer. All people with chronic hepatitis B infection are potentially at risk of developing liver cancer. Even so, some are at higher risks than others. There are screening protocols for those at high risk, regardless everyone with hepatitis B should be considered for screening.

The primary cause of liver cancer is hepatitis B, not alcohol

High risk hepatitis B groups for increased risk of liver cancer are anyone with cirrhosis, a family history of liver cancer, and older people (men over 40 years and women over 50 years). However, people outside of this group can still develop liver cancers and they require close monitoring. As discussed previously, all people with hepatitis B require lifelong monitoring for both the liver condition and for consideration of liver cancer screening.

There are different types of cancers that can affect the liver. Primary liver cancers are cancers that develop in the liver cells – known as “hepatocytes”. Other types of liver cells such as bile duct cells can also lead to cancer, but this is not directly related to hepatitis B. Cancers from other sites can also spread to the liver so that liver cancers can be secondary to cancers that have started elsewhere. This article will discuss the primary type, which is refered to as liver cancer or hepatocellular cancer.

Liver cancer is one of the most common cancers in the world

Primary liver cancer is one of the most common cancers in the world – ranking fifth – and is the second leading cause of cancer related deaths in the world. It is one of the cancers that is continuing to increase in number. Apart from hepatitis B, there are other conditions that can increase the chance of developing liver cancer. This includes cirrhosis from any cause. This could include alcohol, fatty liver, hepatitis C, autoimmune liver disease, iron storage disease as well as metabolic conditions. Cirrhosis is a condition of severe liver scarring that covers a wide spectrum of symptoms, and so some patients may not realise that they have cirrhosis until they are very sick. It can sometimes be picked up early by blood tests as well as some imaging studies. Anyone with ongoing abnormal liver tests should ask their doctor about how their liver is doing.

It’s not easy to find liver cancer – multiple tests are needed

Screening for liver cancer is recommended in groups of patients at increased risk. This is done using a liver ultrasound and, in some cases, a tumour marker blood test – an alpha fetoprotein (AFP) – every six months. Since liver inflammation, cirrhosis and non-related liver diseases such as pregnancy and testicular cancer can cause an elevated AFP, there is ongoing research to try and find an accurate and simple blood test to identify liver cancer early.

Liver ultrasound is simple and safe as there is no radiation exposure. Preparation for the procedure requires fasting. As with all tests, there are limitations. It relies on the skills of the sonographer, the patient’s body build/physique and fasting state. Patients are asked to fast because the bowel can get in the way and overlying gas can limit the views of the liver. In very large patients with fatty liver, the fat in the liver can make visualization difficult so that small liver lesions may not be found. Other liver conditions such as liver cirrhosis and the presence of many cysts can also interfere with getting good visualisation.

Liver cancer is more dangerous without symptoms

In a liver ultrasound, doctors are looking to find new, very small liver spots – often less than 1 cm across. Screening with an ultrasound is usually just a lead-in to other tests that will clarify the nature of any new liver spot. Not all new lesions are cancer, but all new liver lesions in people with underlying risk factor for liver cancer need further close scrutiny.

Next: In Part 5, to be published next week, Dr Lee will write more about liver cancer.

Published 4 February, 2021

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Hepatitis NSW Submission: Mandatory Disease Testing Bill 2020

Mandatory Disease Testing a futile and stigmatising exerciseHepatitis NSW has provided a submission on the Mandatory Disease Testing Bill 2020 currently being considered by the State Government, and will shortly be attending a committee hearing at NSW Parliament House. Hepatitis NSW has opposed mandatory disease testing since it was first considered following recommendations arising in the 2017 NSW Legislative Assembly Committee on Law and Safety Report. Our position remains unchanged.

Download our submission>>> CLICK HERE

The proposed bill won’t address risk to frontline workers

We strongly believe that the wellbeing and safety of frontline workers in NSW is vitally important. In terms of wellbeing and safety, we are referring not just to the physical but also to mental and emotional wellbeing. Our frontline workers deserve the community’s respect and should not be subject to acts of intimidation, threats or violence in any form. They must be protected as much as is reasonably possible in a high-level occupational risk environment.

In providing that protection, it is essential that the strategies designed and used are scientifically informed, evidence-based and effective in meeting the aim; that they are fit for purpose. Where the issue being addressed is a health issue, the response must be health based, not based on criminalising affected people.

A health informed and based response provides a holistic, wraparound approach that draws on appropriate health promotion, medical support, interventions and care to the primarily affected person. Force and criminalisation against a third party is punitive and does not provide sanctuary for a victim.

This Bill is a blunt instrument that is wholly incapable of achieving anything other than a perpetuation of fear, loathing, discrimination and privileging that is inconsistent with the inclusive, fair and responsible society and behaviour we would all desire. It will not address the stress and concerns of frontline workers around the exceedingly low risk of infection. Indeed, greater results will be achieved through supporting them with accurate information about risks, addressing their concerns, and providing professional wellbeing, support and counselling.

We do not support mandatory testing

Mandatory testing is not in line with the Australian National HIV, Hepatitis B or Hepatitis C Testing Policies, or supported by global health bodies. The key principles guiding blood borne virus (BBV) testing in Australia are that testing is conducted ethically, is voluntary and performed with the informed consent of the person being tested.

Mandatory testing does not meet these principles. Mandatory testing laws are not supported by global health bodies such as UNAIDS and the World Health Organization on the basis that it breaches human rights, compromises public health initiatives and other efforts to eliminate HIV and other BBV transmission.

  • Download our submission>>> CLICK HERE
  • Read other submissions – NSW Parliament site>>> CLICK HERE

For more information, please contact:

Hepatitis NSW
Steven Drew, CEO
[email protected]
0402 518 285

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What you need to know about hep B | part 3

What you need to know about hep B | part 3

This article – part 3 of 8 – was written by Dr Alice Lee , Gastroenterologist and Hepatologist, Concord Repatriation General Hospital.

Hepatitis B treatment under other circumstances

There are special groups of patients for whom treatment is needed outside of the standard setting. This includes patients who need to undergo significant immune suppressive therapy; women who are pregnant and at risk of transmitting the virus to their unborn baby; and patients with co-infections such as HIV, hepatitis C or other significant chronic health conditions that place them at increased risk of complications. Family history of complications of liver disease such as liver cirrhosis and cancer are also considered as risk factors.

Our immune system causes liver scarring

The hepatitis B virus itself does not cause direct damage to the liver. Such damage is due to our immune systems response to the virus which causes the liver to become inflamed. Over time, this inflammation can lead to scarring. However, in certain clinical situations, when a person’s immune system is altered by medical treatment, hepatitis B can become “reactivated”. For instance, someone who is having cancer chemotherapy will have medicines to suppress their immune system. When the treatment is finished, their immune system becomes active again and this activity can lead to a flare of hepatitis. This is referred to as immune reactivation. Reactivation can be mild, and seen on routine bloods; but, in rare cases, this can be so severe that it can lead to liver failure. Having prophylaxis with antiviral therapy for hepatitis B can save the patient’s life.

There are non-cancer medicines that are also used to suppress the immune system for a variety of immune related disorders. These can also cause immune reactivation. Hepatitis B treatment is therefore given whilst on immunosuppressive therapy, and after stopping, for about six months. The doctor will test for hepatitis B and will advise what may be needed.

Hep B test for all pregnant women

Pregnant women are the other group of hepatitis B affected people where hep B treatment may be considered as a preventative measure. All pregnant women are screened for hepatitis B. In some cases, it may be the first time they find out they are hepatitis B positive. It is important that you receive lots of counselling about this condition and be assessed to determine whether you should have treatment or not. If you do not need treatment, a special blood test to measure the amount of virus in your blood will be done during pregnancy. This is to see whether there is an increased risk of transmitting the virus to the baby at birth.

Hep B vaccine for all newborn babies

In Australia, all babies (irrespective of their mother’s hepatitis B status) are given a hepatitis B vaccine at birth. For babies born to hep B positive mothers, an additional injection of an immune globulin is also given. Despite this, there is still a risk of the baby acquiring hepatitis B if there is a lot of the virus in the mother’s blood at birth. Hence, viral load during her pregnancy helps to determine whether additional medicines can be given to reduce this further. Tenofovir is the usual drug offered and is given around week 28 of pregnancy and stopped at some time after delivery. An obstetrician will work closely with the liver specialist in making sure the mother and her unborn baby are protected.

In addition to having treatment with regular monitoring, a mum to be needs to ensure that she takes good care of her health. General wellbeing including regular exercise, a well-balanced diet with high fibre, plenty of vegetables and protein is important. Avoiding excessive weight gain will also ensure other health benefits.

Next: In Part 4, to be published next week, Dr Lee will write about liver cancer.

Published 28 January, 2021

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What you need to know about hep B | part 2

What you need to know about hep B | part 2

This article – part 2 of 8 – was written by Dr. Alice Lee , Gastroenterologist and Hepatologist, Concord Repatriation General Hospital.

Diagnosing And Treating Hepatitis B

Once a diagnosis of chronic hepatitis B is confirmed through blood tests, an assessment is made. The assessment will be based on health history (including family history of liver cancer), a physical examination, further blood tests, ultrasound or CT and special imaging called Fibroscan. These are needed to determine whether treatment for hepatitis B is required, or if someone only needs to be monitored for now.

A careful assessment is needed to ensure that someone will benefit from hepatitis B treatment. There are two main reasons for this. Firstly, a person can have a chronic infection without it progressing to complications such as cirrhosis or liver cancer. Secondly, hepatitis B treatment (unlike hep C treatment) is not curative and is, in most cases, long term or lifelong once commenced.

What Is Cirrhosis And Can It Be Treated?

When the liver cells are damaged they become inflamed or swollen – this is called liver fibrosis. Over time this can build up and lead to cirrhosis of the liver – which is actual scar tissue in the liver. The scar tissue reduces blood flow through the liver. The liver then can’t do its work as well as it should.

All patients with cirrhosis should have treatment. Diagnosis of cirrhosis can be simple, but in some cases may require a combination of blood test, scans and a fibroscan that measure liver scarring. A fibroscan is a special type of non-invasive scan, like an ultrasound.

In people without cirrhosis, high liver function (ALT) readings associated with high virus count are indications for hepatitis B treatment. Even where an ALT reads normal, indicating no need for treatment, it can still go up without the person being aware. Hence, the need for regular check-ups – usually every six to twelve months.

Other considerations for treatment are older age, and a family history of liver cancer.

How To Treat Hepatitis?

Treatment for hepatitis B, if required, is very simple. It is one pill per day. There are one of two medicines that are used – entecavir or tenofovir. The medication is best taken at the same time each day (entecavir away from food; tenofovir is not affected by eating). Neither drug is associated with significant side effects but, as with all medicines, side effects are possible.

Tenofovir has been associated with renal issues and a doctor will need to regularly monitor kidney function. Both medicines need to be reduced to a lower dose if the person has reduced kidney function and this needs to be discussed with the doctor.

Once treatment is underway, it is really important that the medicines are taken regularly as resistance can occur, and there is also a risk of worsening liver disease, such as a flare, after stopping the medicine. These tablets are generally prescribed by specialists, but some GPs can also prescribe these medicines.

Regular monitoring whilst on treatment, usually six-monthly, is also critical with blood tests and ultrasound. The medicine is taken to control the amount of hepatitis B virus in the blood, which then leads to decrease in liver damage.

These hep B treatments have been available for decades and have been shown to be lifesaving, preventing and, potentially, reversing liver damage.

Can Hepatitis B Be Cured?

There are currently no cures for hepatitis B.

Liver cancer risks are lowered with treatment, but there is still a need for ongoing screening as the risks are not completely averted. The goals of treatment are initially to improve the liver tests (to get an ALT normalisation) and to stop the virus from replicating . In the long term, some patients have what is referred to as a “functional cure”, where the hep B surface antigen becomes negative.

For the small percentage of people who achieve this, usually after many years of treatment, their treatment can sometimes be stopped. Even after stopping treatment, they will still require ongoing monitoring. Regardless, where cirrhosis is present, lifelong treatment is still recommended.

For those who do not have cirrhosis, it remains critical that they discuss any interruption or cessation of medicines with their doctors.

What Is The New Medicine For Hepatitis B?

Treatments that have been available in the past include medicines such as lamivudine and interferon. There are limited roles for these medicines for special circumstances. New drugs are constantly under development in order to improve outcomes.

A newer version of tenofovir is available (tenofovir alafenamide) which is associated with fewer kidney issues. It is currently not widely available and not government funded.

Other drugs are being studied as ongoing efforts are being made to find a cure for hepatitis B.

Next: In Part 3, to be published next week, Dr. Lee looks at  other issues and circumstances around treatment.

Published 19 January, 2021

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What you need to know about hep B | part 1

What you need to know about hep B - part 1

This article – part 1 of 8 – was written by Dr. Alice Lee , Gastroenterologist and Hepatologist, Concord Repatriation General Hospital.

Referred to as the ‘silent killer, hepatitis B lives up to its name. Despite great efforts around the world to increase awareness of this virus, and to improve prevention, testing and treatment, there has sadly been no decline in global mortality rates. Nearly one million people die from hepatitis B, and its complications, every year.

What makes hepatitis B such a difficult and lethal virus?

Hepatitis B is a highly infectious virus, more so than hepatitis C and even HIV. In some parts of the world, the prevalence rates are very high – up to 20%. For Korean people, the prevalence rates have been markedly reduced by nationwide vaccination programs, but those who already have the infection remain at risk.

Even with vaccination, there are instances where, for those at high risk – such as babies born to mothers who have hepatitis B – vaccination may not be enough to prevent infection. Also, in some cases, one course of hepatitis B vaccine might not be adequate and further vaccination courses may be needed. It is safest for people to have a doctor check their blood tests – looking for protective antibody levels – to ensure that they are not in this group.

How do we test for hepatitis B?

Testing for hepatitis B is done by blood tests, but the levels of bloods tests can change over time whether you have treatment or not. Blood tests detect whether a person has:

  • the virus (hepatitis B surface antigen),
  • had the virus (hepatitis B core antibody) and/or
  • protection against infection (hepatitis B surface antibody).

Anyone living with the virus (hepatitis B surface antigen),will need to have further tests to see if they need to have treatment. The results of the tests can change over time, which can lead to misunderstanding about a person’s status.

Further testing is done through more blood tests and scans. It can be very complex and confusing to patients, but they should continue to check in with their doctors as it can save their life. Even if someone does not need treatment now, they may need to have treatment at a later date. Most people who need treatment are asymptomatic and may feel that they are alright and do not need to have checkups. This can be very dangerous because, if someone leaves it until they feel sick, then it may be too late.

How is hepatitis B monitored?

Hepatitis B can cause liver cirrhosis and liver cancer. While most people will live a normal healthy life with hepatitis B and not have any complications, identifying who is at risk, and who is not, is not so easy. Some key risks includes those who have a family history of liver cancer, other conditions that can increase risk of hepatitis B complications – such as other viruses or those who drink excessively – older patients, patients who have severe scarring of the liver(cirrhosis), have high liver enzymes (ALT) and those with high levels of virus (Hepatitis B DNA). All these factors are taken into consideration over time to decide whether treatment is required, or not, at a particular time.

Liver cancer is the most common cause of death from hepatitis B. It is also asymptomatic until very advanced and the best way to check for it is with regular ultrasounds and blood tests. If there are concerns about spots on your liver, a doctor may advise to have additional tests such as CT or MRI scans. All patients with a family history of liver cancer and all with cirrhosis should have checkups at least every six months.

Whether a person with hepatitis B is receiving treatment or not, screening can save their life. Ultrasounds are safe, there is no radiation, and they do not hurt. Anyone can have an ultrasound, as many times as needed. CT scans require radiation and hence should only be done when advised from a doctor. MRI is also available and accessible through a doctor. The benefits of an MRI is that there is no radiation, but it requires contrast (that is, requires the injection of a dye) and so is indicated for some patients only. People should ask their doctor about this if they have any concerns.

Next: In Part 2, to be published next week, Dr. Lee looks at  treatment options for Hepatitis B.

Published 12 January, 2021

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