Baby Boomers Are Especially Vulnerable
“The hepatitis C virus didn’t have a name or a screening test until in 1989,” Reau says. “That means people born between 1945 and 1965, the group referred to as ‘baby boomers,’ are at highest risk of infection. They grew up before health care facilities started taking standard precautions, like not sharing vials of medicine among patients and requiring staff to wear gloves.”
The CDC reports that baby boomers are five times more likely to have Hepatitis C than other adults, accounting for 75% of those living with the disease.
These are some other reasons you may be at risk:
- You have engaged in high-risk behaviors like IV drug use or unprotected sex
- Your biological mother has/had hepatitis C
- You received blood transfusions, an organ transplant or dialysis before 1989
- You were or are currently incarcerated
Treatment For Chronic Hbv Infection
For chronic HBV infection, antiviral medications are available.
This is not a cure for chronic HBV. However, it can stop the virus from replicating and prevent its progression into advanced liver disease.
A person with a chronic HBV infection can develop cirrhosis or liver cancer rapidly and without warning. If a person does not have access to adequate treatment or facilities, liver cancer can be fatal within months of diagnosis.
People with a chronic HBV infection require ongoing medical evaluation and an ultrasound of the liver
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What A Hepatitis C Cure Means
Scientists have a very specific definition of what it means to be cured of hepatitis C. In order to be considered cured, patients must have undetectable HCV RNA on an HCV test 12 or 24 weeks after completing a course of therapy. The lack of detectable HCV is what is known as a sustained virological response .
At first, scientists were reluctant to consider an SVR an actual cure. However, research has shown that when HCV RNA is undetectable in both the blood and the liver, the virus has been cured. In theory, this means it may be possible to eliminate all hepatitis C.
More than 95 percent of hepatitis C patients are theoretically curable by an eight- to 12-week treatment regimen with DAAs.
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How Is Hepatitis B Treated
Your healthcare provider will treat you based on what type of hepatitis B you have, acute or chronic.
Acute hepatitis B infections
If you develop an acute form of the condition, you probably wont need medical treatment. Instead, your doctor will likely suggest that you get plenty of rest, drink lots of fluids and maintain a healthy diet to support your body as it fights off the infection.
Chronic hepatitis B infections
If you have chronic hepatitis B, you might be a candidate for drug therapy. Usually, drug therapy is used only if you have active liver disease. There are seven drugs that are approved by the U.S. Food and Drug Administration to treat hepatitis B. Two are injectable forms of interferon, while the five other antivirals are tablets.
You will need to take these medications every day. They help by slowing the viruss ability to multiply in your system. This helps reduce swelling and liver damage. Youll need to be regularly monitored for early signs of liver damage and liver cancer. Your healthcare provider will want to see you once or twice a year.
How Is Hepatitis A Spread
Hepatitis A virus is found in the stool of infected people. It can spread directly from person to person or in food or water that has been contaminated with stool that has the virus. To prevent this, be sure that everyone in your house always washes their hands with soap and water after every diaper change or after using the toilet, and before preparing or eating food.
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Barriers To A Cure For Hepatitis C
While a potential cure for hepatitis C exists, it doesn’t mean that the cure is accessible for most people carrying the virus. A number of factors have historically limited access to even the newly improved HCV treatments. One of the biggest is that screening for hepatitis C isn’t universal. Many people don’t know they’re infected. Therefore, they can’t be treated.
Another factor is that it’s really important for people to adhere to their treatment regimen and follow-up plan. If someone’s virus is resistant to a treatment, other options are available. However, healthcare providers don’t want more resistant viruses to develop, and thus they may be reluctant to prescribe these drugs to patients who are unlikely to take them reliably. There are also concerns that high-risk hepatitis C patients, such as those who inject drugs, may be at risk of re-infection.
That said, cost-effectiveness research suggests that hepatitis C treatments are a good deal in the long term. That’s true even when they’re given to people with early, “silent” HCV or those who are at high risk for reinfection. Furthermore, the CDC now recommends all adults born between 1945 and 1965 receive one-time testing for the virus.
Is Svr Considered A Cure
The oral DAA treatments are capable of causing a sustained virologic response , which means that the hepatitis C virus is not detected in the blood 12 weeks or more after completing treatment. Your doctor will monitor your virologic response with blood tests. Most people are considered cured when the virus is no longer present after 12 weeks.
Two or more oral antiviral drugs are typically used together to help prevent resistance in patients treated for HCV. Sometimes these treatments still need to be used with older medications such as ribavirin if you have advanced liver disease. Your chances for a cure may be better if you do not have advanced liver disease and have never received HCV treatment before.
Once you reach an SVR, it is highly unlikely for the hepatitis C virus to be detected again unless you are reinfected. Studies have shown this type of relapse occurs in less than 1% of patients who complete treatment. Also, when the virus is cleared from your blood you can no longer transmit the virus to others. However, you should still take precautions to help prevent catching and spreading HCV.
Any liver damage you have won’t be reverse after you reach SVR, but further damage may be minimized with treatment.
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Symptoms Of Hepatitis A
You can become ill any time between 2 and 4 weeks after coming into contact with the hepatitis A virus.
The average incubation period for the virus is 28 days.
Many infected people, particularly children less than 5 years old, show few or no symptoms.
For older children and adults, the symptoms of hepatitis A include:
- yellow skin and eyes .
Symptoms may last for several weeks. Most people fully recover from hepatitis A infection.
A single infection of hepatitis A leads to lifelong immunity. Prior infection with hepatitis B or hepatitis C does not offer immunity for hepatitis A.
How Is It Tested For And Diagnosed
After you discuss your symptoms with your doctor, they may order a blood test to check for the presence of a viral or bacterial infection. A blood test will reveal the presence of the hepatitis A virus.
Some people have only a few symptoms and no signs of jaundice. Without visible signs of jaundice, its hard to diagnose any form of hepatitis through a physical examination. When symptoms are minimal, hepatitis A can remain undiagnosed. Complications due to a lack of diagnosis are rare.
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Pregnancy And Hepatitis A Immunisation
Hepatitis A immunisation is not usually recommended for women who are pregnant although vaccination might be recommended in some situations.
Speak with your doctor if you are not immune to hepatitis A and you are at increased risk of infection or if you have a pre-existing medical condition such as liver disease.
Is There A Vaccine
In Canada, there are several hepatitis A vaccines available for children 1 year of age or older and adults who are at risk of getting hepatitis A or to prevent infection after being exposed. Speak to your doctor about the vaccine that is best for you. If necessary, hepatitis A vaccine may be given to babies as young as 6 months.
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Nucleocapsid Assembly And Pgrna Packaging
Nucleocapsid formation and packaging of the pgRNA are critical steps of the viral life cycle. Therefore, developing inhibitors or modulators of this process is an attractive therapeutic approach. The HBV core protein is involved in many aspects of the viral life cycle including transport of viral genome to the nucleus, uncoating to release relaxed circular DNA in the nucleus, packaging of polymerase protein and pgRNA, capsid assembly, modulation of reverse transcription, and interaction with envelope proteins for virus assembly. It may have additional functions including modulation of cccDNA chromatin and stability, nuclear export of viral RNAs, and modulation of innate immunity.
The HBV precore/core protein has recently emerged as a promising direct antiviral target. With the knowledge of the three-dimensional structure of the core protein, several classes of non-nucleoside small molecules called core protein assembly modulators have been developed, including phenylpropenamide and heteroaryldihydropyrimidine derivatives. These molecules can strengthen proteinâprotein interaction, inhibit pgRNA encapsidation, and block plus strand DNA synthesis., Results of the first dose-ranging phase 1b study of NVR3-778 showed a decline in serum HBV DNA, HBV RNA, and HBsAg, with more pronounced effect when combined with pegylated IFN.
The Hepatitis B Vaccine
The hepatitis B vaccine is one of the most effective ways to prevent hepatitis B. Its usually divided into three doses, which are given over the course of six months. In many countries, infants receive their first dose of the vaccine at birth.
The Centers for Disease Control recommends that all children under the age of 19 be vaccinated if they havent already received the vaccination. Adults can also get the hepatitis B vaccine, and its generally recommended if you have an increased risk of infection due to:
- traveling to or living in a region where hepatitis B is common
- being sexually active with more than one partner
- working in a medical setting
- using intravenous drugs
If youve been exposed to the hepatitis B virus and havent been vaccinated, try to see a doctor right away. They can administer the first dose of the vaccine, though youll need to follow up to receive the remaining doses over the next few months.
They can also prescribe a medication called
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What Should You Know About Pregnancy And Hepatitis B
A pregnant woman who has hepatitis B can pass the infection to her baby at delivery. This is true for both vaginal and cesarean deliveries.
You should ask your healthcare provider to test you for hepatitis B when you find out you are pregnant. However, while it is important for you and your healthcare provider to know if you do have hepatitis B, the condition should not affect the way that your pregnancy progresses.
If you do test positive, your provider may suggest that you contact another healthcare provider, a liver doctor, who is skilled in managing people with hepatitis B infections. You may have a high viral load and may need treatment during the last 3 months of your pregnancy. A viral load is the term for how much of the infection you have inside of you.
You can prevent your infant from getting hepatitis B infection by making sure that your baby gets the hepatitis B vaccine in the hours after they are born along with the hepatitis B immunoglobulin. These two shots are given in two different locations on the baby. They are the first shots needed.
Depending on the type of vaccine used, two or three more doses must be given, usually when the baby is 1 month old and then 6 months old, with the last by the time the baby is 1 year old. It is critical that all newborns get the hepatitis B vaccination, but even more important if you have hepatitis B yourself.
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Managing Injection Site Discomfort
Many vaccine injections may result in soreness, redness, itching, swelling or burning at the injection site for one to 2 days. Paracetamol might be required to ease the discomfort. Sometimes a small, hard lump at the injection site may persist for some weeks or months. This should not be of concern and requires no treatment.
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If You Notice Symptoms See A Doctor Right Away
Symptoms of hepatitis C include the following:
- Jaundice a yellowish tone to the eyes and skin
- Mild, chronic right belly pain
- Nausea
- Loss of appetite
- Fatigue
If you believe you have been exposed to hepatitis C or notice any symptoms, visit your primary care doctor as soon as possible. If you test positive for the virus, your doctor can refer you to a hepatologist to discuss your options.
“I strongly encourage all baby boomers and others who are at high risk to get tested, even if you don’t look or feel sick,” Reau says. “If you do have hepatitis C, the earlier we discover it, the more likely we can prevent it from progressing and causing more serious damage.”
What Are The Symptoms
Most infants and young children infected with hepatitis A have no symptoms or mild symptoms. Most of the time, no one knows that they even had hepatitis A. Older children, teens and adults are much more likely to become sick when infected with hepatitis A.
Symptoms can include:
- abdominal pain,
- yellowing of the skin and whites of the eyes .
Rarely, hepatitis A infection causes such severe disease that the liver stops working and the person can die. In other cases, a liver transplant may be needed.
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How Is Hepatitis A Infection Prevented
Vaccination
- The hepatitis A vaccine offers excellent protection against HAV. The vaccine is safe and highly effective. Vaccination consists of 2 doses of vaccine spaced 6-12 months apart. Protection starts 1-2 weeks after the first dose of vaccine, and lasts for 20 years to life after 2 doses.
- The American Academy of Pediatrics recommends that all children should receive hepatitis A vaccine starting at 1 year of age .
- The CDC recommends hepatitis A vaccine for all persons traveling to countries where HAV is common . For infants that will be traveling internationally, an early dose of Hepatitis A vaccine can be given at age 6-11 months.
Natural Immunity
- People who have hepatitis A infection become immune to HAV for the rest of their lives once they recover. They cannot get hepatitis A twice.
- The blood test for immunity to hepatitis A is called the Hepatitis A Total Antibody test. People who have had hepatitis A and those who have received hepatitis A vaccine show positive antibodies to hepatitis A on this test for the rest of their life.
Healthy Habits
- Good personal hygiene and proper sanitation help prevent the spread of the HAV virus. Always wash your hands with soap and water after using the bathroom, changing a diaper, and before preparing, serving, or eating food.
- Alcohol-based hand sanitizers do not kill the hepatitis A virus
After Exposure to HAV
Aiming For Functional Cure With Established And Novel Therapies For Chronic Hepatitis B
Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
ADDRESS CORRESPONDENCE AND REPRINT REQUESTS TO:
Norah Terrault, M.D., M.P.H.
Keck School of Medicine, University of Southern California
1450 San Pablo Avenue
Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
ADDRESS CORRESPONDENCE AND REPRINT REQUESTS TO:
Norah Terrault, M.D., M.P.H.
Keck School of Medicine, University of Southern California
1450 San Pablo Avenue
Potential conflict of interest: Dr. Terrault consults and received grants from Gilead, Roche-Genentech, GlaxoSmithKline, and consulting from EXIGO, ENYO, and Moderna. Dr. Janssen consults and received grants from Gilead, GlaxoSmithKline, Janssen, Roche, and Vir. He consults for Aligos, Antios, Arbutus, Eiger, VBI Vaccines, and Viroclinics. He received grants from AbbVie.
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What Causes Hepatitis A
Hepatitis A is caused by infection with the hepatitis A virus. You get the virus when you unknowingly eat a small amount of infected feces. This can happen through person-to-person contact, or through eating or drinking contaminated food or water.
A person can have and spread hepatitis A, even if that person does not have any symptoms. You are most likely to get hepatitis A from another person when:
- A person who has the virus does not wash their hands properly after going to the bathroom
- A parent does not wash their hands properly after changing the diaper of an infected child
- A caregiver does not wash their hands properly after cleaning up the stool of an infected person
- A person has sex with a person who has the virus
You can also get infected with hepatitis A by eating contaminated food or drinking contaminated water. Contaminated food and water are more common in developing countries. When traveling in areas where hepatitis A is common, avoid eating raw fruits and vegetables, shellfish, ice, and untreated water.
Contaminated Food And Water
Hepatitis A is most commonly passed on by eating food prepared by someone with the virus whose hands have not been washed properly. You can also get it by drinking dirty water and by eating raw or undercooked shellfish from dirty water.
You can protect yourself by:
- Washing your hands each time you go to the toilet, before you prepare or eat food, after coughing or sneezing, or handling rubbish or other dirty items.
- Peeling and washing all your fresh fruit and vegetables avoiding raw or undercooked meat and fish avoiding all drinks if youre not sure if theyre safe with or without ice.
- If tap water isnt safe and bottled water isn’t available, boil tap water before drinking it.
- People living in places with poor sanitation and hygiene are at a greater risk of hepatitis A infection. You may also be exposed to hepatitis A through your work, for example, sewage workers, staff in institutions where levels of personal hygiene may be poor , people working with animals that may be infected with hepatitis A and daycare centres.
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