“HBV Free LV” Campaign Increasing Hepatitis B (HBV) awareness in the Asian and Pacific Islander Communities in Las Vegas.

WHO? WHAT? WHY? HOW?

One in ten Asians and Pacific Islanders are infected with HBV. Majority of these infections are acquired from the mother during childbirth. There is a one in four chance that those infected will die prematurely from cirrhosis or liver cancer. HBV is not curable, however it is suppressible and controllable. The initial step in achieving this is determining who is chronically infected with HBV. Recent CDC guidelines recommend screening of ALL individuals who are Asians or Pacific Islanders. This handbook aims to provide an overview on current screening and therapeutic guidelines for HBV.

STEP 1: Screening

• Patients from Asia, Pacific Islands, Middle East, Eastern Europe and Russia, Sub-Sahara Africa, Amazon Basin, Caribbean and indigenous populations of Alaska and Canada
• Household members or sexual partners of known HBV carriers
• Patients infected with HCV or HIV
• Injection drug users (current or previous)
• All Pregnant women
• Men who have sex with men

What tests should be ordered? HBsAg and anti-HBs

How should test be interpreted?

-HBsAg -anti-HBs		VACCINATE (no immunity)
-HBsAg +anti-HBs		IMMUNE (to HBV)
+HBsAg -anti-HBs		CHRONIC HBV – go to Step 2

STEP 2: Chronic HBV (+HBsAg)

What tests should be ordered?

• HBV DNA Quant: determines activity and long term risk for HCC and cirrhosis
• Anti-HAV: vaccinate if negative
• Anti-HBc IgM/IgG, HBeAg, anti-HBe, HDV Ag/Ab
• Anti-HCV and HIV: determine co-infection

What should you counsel patients on?

• Having family members and sexual partners tested
• Advise on not sharing razors or toothbrushes
• Counsel on alcohol use
• Importance of medical follow up
• Liver cancer surveillance every 6-12 months

Consider referral to specialist for further management and therapy.

STEP 3: Guide on interpreting results

-HBV DNA		INACTIVE or CARRIER
+HBV DNA+anti-HBc IgM		ACUTE INFECTION
++HBV DNA+anti-HBc IgM		CHRONIC INFECTION
+HBV DNA+HBeAg		HIGHLY INFECTIVE
+HBV DNA-HBeAg		PRE-CORE MUTANT, MAY STILL BE INFECTIVE, STILL HAS ADVANCING DISEASE

The level of HBV DNA is important:

• To determine inactive vs. active disease
• To determine patient’s long term risk for developing cirrhosis and hepatocellular carcinoma
• To allocate patient to proper treatment

Treatment Guidelines

HEPATITIS B IS NOT CURABLE.

HEPATITIS B IS SUPPRESSIBLE AND CONTROLLABLE.

Rationale for treatment:

• Reduce the risk of progressive chronic liver disease
• Reduce the risk of transmission to others

Therapy recommended for:

• HBV DNA >2,000 IU/mL
• Elevated ALT
• Any DNA level in patients with cirrhosis
• Any DNA level in patients with family history of hepatocellular carcinoma
• Reduce the risk of hepatocellular carcinoma

The goals of HBV therapy are:

• Suppression of HBV DNA levels to undetectable amounts on blood tests
• Normalization of liver enzymes
• Improvement in liver histology
• HBsAg seroconversion
• In +HBeAg: seroconversion
• In -HBeAg: no clear endpoint of therapy; relapse common
• First line therapy: Entecavir, Tenofovir