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May is Hepatitis Awareness Month!
In recognition of May as Hepatitis Awareness Month, Liver Cancer Connect reviews some important facts and dangerous fiction about chronic hepatitis B and C- the world’s leading causes of liver cancer. Continue reading
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If you have recently been diagnosed with chronic hepatitis B, your liver specialist is running a series of tests over time to determine if you are a good candidate for treatment. Remember, not everyone benefits from treatments currently available to chronic HBV patients.
Since you are chronically infected, you know your hepatitis B panel most likely shows that you are:
HBsAg positive/reactive,
HBcAb positive/reactive
HBsAb negative/non-reactive
The last entry in this series looked at the HBeAg (HBe-antigen) and HBeAb (or anti-HBe antibody) tests, and what they mean if they are positive or negative, giving you a good indication of the replication activity of the virus and how infectious you are. The HBV DNA test or viral load test takes this a step further by quantifying the amount of HBV DNA you have at the time of the blood draw.
Simply put, the HBV DNA test indicates how much of the HBV virus is circulating in your blood. This test, over time, can give a good idea of the hepatitis B replicative activity in your liver. The virus is released into your blood, which can then drawn and analyzed by the HBV DNA viral test.
These viral load test results may be used to help determine whether or not treatment is recommended. If you are HBeAg negative, and your viral load is above 2,000 IU/mL, treatment may be recommended. If you are HBeAg positive, treatment may be recommended if your viral load is above 20,000 IU/mL. Please note that these are guidelines. There are other factors that come into play when recommending treatment, such as ALT and other liver function tests, liver diagnostic information, age, family history, and more. It can be complicated, so the importance of a liver specialist cannot be underestimated.
The viral load test results may also be monitored to determine treatment response. This is particularly true with the use of antivirals. Antivirals work by stopping replication of the virus. If your viral load decreases significantly or becomes undetectable, then you are having a favorable response. If your viral load goes down and eventually begins to elevate again, then it may indicate that you have developed a resistance to the antiviral you are taking.
The HBV DNA test is performed using a Polymerase Chain Reaction (PCR), a technique used for rapidly generating DNA fragments so your HBV DNA can be analyzed. It’s a sophisticated, but common test, and it’s a complicated if you don’t work in the lab. There are different techniques, so you will likely see reference to the method used for your test such as “real time” (RT) PCR or TAQMAN. This shouldn’t really matter unless you are in a clinical trial, where consistency is very important when analyzing results.
What does matter for comparative purposes are the units of measurement. The viral load test is typically measured in the units IU/mL or international units per milliliter. Previously it was measured in copies per milliliter, and sometimes those units are still used. When comparing, it is important to be sure the units are consistent from one test to the other. In case they differ, there are about 5 to 6 HBV DNA copies per international unit, so you can do a basic conversion and compare your results over time. Remember to keep copies of your lab information on file so you can track your status. An Excel spreadsheet works great.
The sensitivity of the HBV DNA test may vary with the lab, but the low end of the range is typically 300 IU/mL or less. Below the threshold of the test, the viral load is considered “undetectable” – something everyone with chronic hepatitis B wants to hear.
How the results of the test are displayed mathematically on your lab results can be confusing. Because the amount of virus in the blood may be very high – in the millions or billions, the result they may be displayed as an exponent or a log, rather than a whole number. If this is confusing to you, please take a look at this explanation on the math.
The range of the viral load numbers vary greatly from person to person, and over time the viral load will likely vary with each individual. Young children may have viral loads in the hundreds of million or even billions. It sounds scary, but that is not unusual, and kids have different treatment guidelines. The viral load may remain very high for decades depending on how your body is responding to the virus. This varies with the person and the genotype.
It is important to remember that the viral load test provides you with important information, but it must be read in relation to your other HBV and liver function test results in order to determine if treatment is a good option, or if you are responding favorably to current treatment. Although an undetectable or low viral load is considered favorable, it does not necessarily guarantee that you have not, or are not experiencing liver damage. Hepatitis B is a tricky virus. Talk to your liver specialist with your HBV specific questions.
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WHD 2012 Cairns: Hep Day Out friends - Yvonne, Rhondda, Murph & Allana
A personal reflection on WHD events from Guest Blogger Yvonne Drazic
WHD was again promoted and celebrated in style in Cairns with lots of dedicated people making it a great success. The key organizers were Rhondda, the Viral Hepatitis Health Practitioner from the Cairns Sexual Health Service, and Alanna and Julie from the Queensland Injectors’ Health Network (QuIHN). At present, the bulk of hepatitis B health promotion and patient support is done through these organizations as part of hepatitis C and HIV services because sufficient separate government funding for hepatitis B is not yet forthcoming.
Last year, Rhondda organized a fabulous free lecture about hepatitis B which, while aimed at health care professionals and medical staff, was open to the public and especially to people affected by or living with hepatitis B. The speaker was Dr. Benjamin Cowie, an infectious diseases physician from Melbourne with a special interest in hepatitis B. His passionate and compelling presentation evoked great feedback from the audience, many stating it was a real eye-opener. This year’s lecture was presented by Dr. Joshua Davis who spoke equally engaging about his efforts to address hepatitis B in Indigenous communities in the Northern Territory. The talk attracted an audience of more than 100 people. As an add-on to the lecture, Aboriginal and Torres Straits Islander health workers could move on to an event/workshop called Yarnin up HepB where they were able to discuss anything hepB – and get expert advice – from Dr. Davis. This was very well received although many participants were quite disturbed about the statistics of hep B in Aboriginal and Torres Strait Islander people.
This year the open day at Cairns Sexual Health Service was called “Hep Day Out”. It was designed to be fun with funky, colourful posters (created by the talented Murph) and a music jam session. Like last year, the day featured tours of the premises with screening opportunities, as well as the famous QuIHN van offering information, a scrumptious lunch and fun activities. Every visitor who took the tour and completed a short quiz received a cool t-shirt courtesy of Hepatitis Queensland (see photos) and a health pack. In addition, the resident psychologist was on site for people who wanted a chat and I was available for brain-picking for everyone who wanted to know more about hepatitis B. Invitations were distributed to migrant services and communities but unfortunately did not attract any visitors from these groups. Possibly the time was unsuitable due to work commitments but it could also be due to fear of stigmatization which may be increased in these populations. I am currently conducting research to explore barriers and other issues that may keep people from engaging in health-protective actions such as screening and monitoring. It will also help to find more effective ways of engaging with migrant communities and get a better turnout for next year’s WHD.
Overall, plenty of awareness was raised, many people were educated about viral hepatitis, and a fun time was had by all.
Posted in Hep B Awareness, Public Health, World Hepatitis Day
Tagged Australia, Cairns, HBV, hep B, Hep Day Out, Hepatitis B, WHD
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Whether you have hepatitis B or not, you will want to follow some simple clean-up rules now that you are living in a more public environment and away from home. (Take a look at the previous blog – Off to College with HBV.) Regardless of your living arrangements – dorm room, quad, or apartment, you will want to set a couple of ground rules, and be prepared for maintenance, and possible emergency spot cleaning.
Bathrooms are a breeding ground for a plethora of bacteria and viruses. They are the site of all kinds of planned and unplanned, natural and unnatural biological and human functions that produce blood, bodily fluids, and all kinds of other body by-products. They are shared spaces where very private things occur. They are shared spaces where there’s a whole other microbial world living off of all the human activities that occur in the bathroom. That is why bathrooms should be cleaned properly and regularly. It’s good practice and keeps everyone healthy.
Standard or universal precautions are prevention methods that should be integrated into everyone’s life. The whole goal is to prevent contact with an infectious agent such as HIV, HCV and HBV, assuming all possible blood or bodily fluids may be contaminated. They remind you to provide a barrier between you and any potentially contaminated blood or body fluid, whether it is in an emergency situation with a bleeding person, or the cleanup of blood or bodily fluids. It’s yet another reminder to “wash your hands”, and basically use common sense. In the case of HBV or other infectious diseases (HCV, HIV), blood in particular may contain high concentrations of virus which could be transmitted to others through mucous membranes, orifices, or microscopic cuts in the skin. HBV is a tenacious virus and can live outside the body for seven days. Fortunately, HBV is vaccine preventable.
If you live in a dorm, with shared, floor bathrooms, they should be cleaned and maintained by the janitorial staff. However, it’s good to be prepared for an emergency spill in your room, or the bathroom at odd hours. If you live in a quad or apartment with others, you’ll want to be sure to set up a chore chart so that common areas like bathrooms and kitchens are properly cleaned, and that trash is regularly disposed. If you don’t set the ground rules from the start there are bound to be hard feelings among your roommates.
Weekly bathroom maintenance should include the disinfection of surfaces on toilets, sinks and showers. The general rule is clean first and then disinfect. This does take some time since the bathroom cleaner is first sprayed and allowed to sit for at least 30 seconds (times will vary with the disinfectant or depending on your source), and then cleaned with towels, (to be disposed, or laundered separately in hot water with detergent and a little bleach) and then disinfected with the same cleaner and allowed to sit for at least five minutes, and then finally wiped down again with clean towels. Don’t know how many housekeepers follow this rule of thumb, but use common sense and think about how you use your towels as you clean from surface to surface. In between cleanings, use disposable bleach wipes to wipe the toilet and sink, and don’t be stingy with them.
Keep the container of bleach wipes in plain sight so visitors have the option to wipe the toilet, sink, or clean up after an accident – hopefully not with the same wipe. (You may find it interesting to note that the sink is often the greatest source of bacteria…a moist environment with plenty of microbial snacks including skin flakes and other organic fodder) Don’t forget to put out a container of liquid soap to encourage hand washing, and if you are a female at college, be sure that all used feminine hygiene products are carefully disposed of in plastic bags.
When it comes to cleaning up a blood or body fluid spill, it is essential to follow the rules. All blood should be considered contaminated with an infectious agent such as HCV, HIV or HBV. If you are assisting your friend or roommate in the case of an emergency, be sure you have a barrier between you and your bleeding friend – of course this is after you have called 911 if this is a true emergency.. Disposable gloves are perfect, but in a pinch, put plastic bags on your hands, or use a clean sanitary pad, or bunch of towels (paper or cloth) to staunch the flow of blood. When you are finished with the emergency, dispose of contaminated articles and thoroughly wash your hands with soap and warm water before progressing to the cleanup. Hopefully your roommate will be able to clean up his own spill, but it’s possible he’ll need some help.
Bleach is a wonderful disinfectant, and effectively kills HBV, and other pathogens. Don your disposable gloves, and prepare a fresh bleach solution for the cleanup that is one part bleach to nine parts cool water. Use a fresh solution as the potency of the solution quickly diminishes, and do not use hot water. Remember the proper order – clean, then disinfect. When cleaning a surface that is known to contain a potential contaminant (blood or bodily fluid), spray it with the bleach solution and let it sit for a few minutes. While wearing gloves, cleanup the spill with disposable rags or paper towels. Dispose of the contaminated towels, and gloves. Don a new pair of gloves and once again spray the area. Let is sit and disinfect for at least 10 minutes and wipe again with clean towels. Dispose of contaminated towels and gloves in a seal-able plastic bag.
If you are in a dorm shared-bathroom, it’s possible to walk into a mess you choose not to clean up, but be sure to alert floor mates of the contaminated area with a sign so others are not accidentally exposed to the potential contaminant, and to alert the janitorial staff of the spill. It’s a courtesy, but it also keeps everyone safe.
There are also EPA registered disinfectants that are premixed and kill infectious diseases, but be sure that HBV is specifically listed as it is a more difficult virus to kill. The times to soak and disinfect vary with each product, and the times I found for basic disinfection varied in my research, so when you’re making the effort, be sure to take the extra time to ensure you have killed all possible contaminants. These pre-mixed disinfectants are more convenient, but they are also more expensive, and you need to check the dates to ensure they remain effective and have not expired.
Here are list of supplies to have on hand for your room or apartment that specifically relate to blood and body fluid cleanups:
You’ll need a whole list of other supplies if you want to keep that bathroom relatively germ free. Don’t forget the liquid soap and the bleach wipes!
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Are you ready to head off to college? Are you concerned about your HBV status? Here are a few things to consider…
If you live in the U.S. your roomate(s) will most likely be vaccinated for hepatitis B, so you shouldn’t need to worry about disclosure. Later on in your relationship you can decide whether or not you want to disclose your HBV status to your roommate, other friends, or SOs. For now it’s probably best to keep it to yourself. Once the info is out, you cannot take it back.
If you are sexually active you will want to consider how you will handle these relationships. HBV is spread through vaginal or anal sex so you want to be sure to practice safe sex for the benefit of both you and your partner. Please use a condom to ensure there is no transmission of STDs and other infectious diseases. There is a vaccine for hepatitis B, but not for HCV and HIV. If you are living with HBV, you are well aware that you do not want an HBV coinfection with either HCV or HIV. Coinfections are more complicated and more difficult to treat and manage. Play it safe and use a condom.
It’s great to be on your own at college. Days and nights learning, studying and preparing for a bright future, branching out on your own… away from mom and dad. Quite often it’s time for a little experimentation, a little craziness, or just plain fun.
It’s a time to interact with lots of different kinds of people. Sometimes you have control over these interactions and sometimes you don’t. You can’t control all of these things, but you can control parts of your own little environment.
Get yourself a bag for your personal toiletries. Whether you’re using bathroom and shower facilities on the dorm floor, living in a quad, or sharing an apartment with roommates, you’ll want to be sure to keep your personal items in a separate bag and out of sight of floor mates, roommates and visitors.
We all know that HBV and other infectious agents are transmitted via contaminated bodily fluids – especially blood, semen and vaginal fluids. Store your razor inside your bag, and be sure you do NOT leave it in the shower stall. Razors are an effective transmission vehicle for infectious disease like HBV or even HCV and HIV. If you leave your razor in the shower, you cannot assume that someone else has not used it. Throw it away and start fresh.
This goes for nail accessories like clippers, cuticle cutters or even files. Keep them in your bag and keep them out of sight from roommates and other visitors. Few people think twice about picking up a pair of nail clippers or a nail file.
Communal items such as soap should be liquid soap and not bar soap. Don’t share any body jewelry including pierced earrings.
Don’t forget about your toothbrush. I can still remember a friend mentioning that he had borrowed my toothbrush, after visiting. Unfortunately he mentioned it after I had already brushed my teeth. Disgusting! Do you really want anyone using your toothbrush?? After the fact, it’s too late to do anything about it. You need to be proactive to make sure these little mishaps don’t occur. Put your personal items away and out of sight.
Then there are the visitors… Most likely you won’t have control of everyone in and out of your room or apartment. My college roommate and her boyfriend loved that I was organized and prepared for all scenarios. They were constantly “borrowing” my things. I wish I had the courage to tell my roommate’s boyfriend that I would prefer he wash my pillowcase after he borrowed my pillow, along with all of the other things he helped himself to without asking. Keep your personal items separate, and let your roommate know that your boundaries are to be respected. Establish these boundaries up front!
Perhaps you’re worried about what others might think of your toiletries bag, or that you like your personal things respected. Don’t tell them you’ve got HBV. Just laugh and tell them you’re a “germaphobe”. By keeping personal items out of view and sequestered in your own bag, everyone is protected.
Be sure to read the follow-on blog: Cleaning up and Staying Safe at College.
Posted in General Hep B info, HBV Awareness, Hep B Awareness, Hep B Prevention, Hep B Treatment, Living with Hep B
Tagged college, HBV, hep B, Hepatitis B, roommates