Hepatitis B: Lessening its grip?

Thanks in large part to vaccination of children and adolescents, the number of new cases of hepatitis B in the United States has declined over the past decade or so. However, the hepatitis B virus (HBV) is still a problem. The Centers for Disease Control & Prevention estimates that about 1.25 million people have been infected with HBV, and about 5,000 Americans die each year from complications of the disease. Worldwide, hepatitis B is one of the top 10 causes of death, and two billion people have been infected with HBV, according to the World Health Organization. Up to one-third of patients infected will eventually develop liver scarring, liver failure, or liver cancer.

HBV is most commonly transmitted through sexual and blood-to-blood contact. It can also be passed from pregnant mothers to their infants.

Hepatitis B occurs in two forms: HBeAg-positive and HBeAg-negative. The latter is more difficult to treat. Hepatitis B e-antigen (HBeAg) is an antigen that correlates with early and active hepatitis B infection. "HBeAg positivity suggests that very active viral replication is taking place," said Joseph Guglielmo, Pharm.D., a University of California at San Francisco School of Pharmacy professor and clinical pharmacist specializing in medications to treat infectious diseases. "A patient who is HBeAg-negative is still infectious and infected, but the HBV is in a less active viral replication state."

Prevention and education

Vaccination with hepatitis B vaccine can provide immunity against HBV. According to CDC, children and adolescents should be vaccinated, as should adults who are at risk for acquiring HBV. About half of all people exposed to HBV will develop chronic hepatitis B. Because hepatitis B may be asymptomatic in early stages, people infected with the virus may be unaware they have it. Raising awareness of the disease and urging people to get tested are key issues in the fight against hepatitis B.

"Too often, people are ashamed to be tested because of past drug habits or sexual activities," said James L. Boyer, M.D. "But shame is a terrible reason to die an unnecessary and painful death." Boyer, who is the director of the Liver Center at Yale University, is also chairman of the board of directors of the American Liver Foundation. "Testing can allow for early diagnosis and treatment, preventing the virus from developing into cirrhosis of the liver or cancer."

Several programs were instituted this year to increase awareness and testing for hepatitis B. Gilead Sciences launched Stop Hep B ( http://www.StopHepB.com/), an educational and physician referral program. Two other programs target Asian-Americans, in whom the infection rate is highest: Awareness, Involvement, and Mobilization for Chronic Hepatitis B (AIM for the B) and The Hepatitis Information you Need to Know (THINK). It should be noted that the higher incidence has nothing to do with race or genetics, said Guglielmo. "It is because they originated from regions of high endemicity."

Current treatment options

When it's too late for prevention, then diagnosis, monitoring, and treatment of hepatitis B are paramount. The American Association for the Study of Liver Diseases (AASLD) has created treatment guidelines based on clinical information. The guidelines are summarized in Table 1.