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 this 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 it?
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. This often leads to misunderstandings about the status of a person. Blood tests check someone has the virus (hepatitis B surface antigen), or whether they have had the virus (hepatitis B core antibody) and, finally, whether they have protection against infection (hepatitis B surface antibody).
In addition to this, if someone has the virus (hepatitis B surface antigen), they then need to have further tests to see if they need to have treatment. This is done through more blood tests and liver scans. It can be very complex and confusing to patients but please continue to check in with your doctors as it can save your life.
Even if a person 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 okay and do not need to have check-ups. This can be very dangerous as if they leave it until they feel sick, then it may be too late.
Who needs to be monitored?
Hepatitis B can cause liver cirrhosis and liver cancer. Most people with the virus can live a normal, healthy life and not have any complications. However, identifying who is at risk of liver disease, and who is not, requires monitoring.
Some key risks include:
- those who have a family history of liver cancer;
- those who have 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; and
- those with high levels of virus.
Any of these factors are taken into consideration, over time, to decide whether or not, and when, treatment is needed.
How is it monitored?
Liver cancer is the most common cause of death from hepatitis B. It too is asymptomatic until very late, and the best way to check for it is with regular ultrasounds and blood tests. If there are concerns about spots on their liver the doctor may advise to have additional tests such as CT or MRI . All patients with a family history of liver cancer, and all with cirrhosis, should have, at the very least, six monthly check-ups.
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