Why Hepatitis B Demands More Attention

August 18, 2021

By Robert Gish, MD

Most people are aware of hepatitis C, but other types of viral hepatitis and liver disease often get overlooked. As a result, Americans suffer.

Just consider that up to 2.4 million people in the United States have hepatitis B, and most are unaware of their infection.

Similar to other forms of the disease, hepatitis B is a serious liver infection. Symptoms of acute disease or late stages of disease may include yellowing of the eyes, abdominal pain and dark urine. In chronic cases, liver failure, cancer or scarring can occur. The disease is most commonly spread by exposure to infected blood and body fluids.

But while disease progression can be dangerous, symptoms are often invisible. Many people don’t realize they are positive for hepatitis B because they experience only mild, if any, symptoms. Increased testing could offer patients life-saving information, while also providing much-needed data on the number of infected Americans.

After all, thanks to science and innovation, hepatitis B is fully preventable with a vaccine. But we can’t vaccinate people without first knowing their status. Someone who is already infected with hepatitis B, for example, is not a candidate for vaccination. The virus can, however, be controlled, there is not yet a cure.

Yet risk-based testing, the current model of testing only those who are deemed likely to have hepatitis B, is not effective. In fact, data indicates the opposite is true. Studies show that risk-based testing misses many people who have the disease but never had the occasion to be tested. Testing everyone regardless of their level of risk would be a more effective approach.

As with hepatitis C, hepatitis B can impart a stigma upon those who have it. Society frequently blames the person infected for contracting the disease in the first place. This often leads to self-blame and shame. As a country, however, we need to reduce stigmatizing and hurtful behaviors and instead focus on enhancing preventive measures.

Some states are already taking measures to expand testing and increase referrals to treatment. In California, for example, a bill moving through the legislature would require health facilities to offer voluntary hepatitis B and C testing. If the bill passes, California would be the first state to have such a provision as law.

The bill encourages primary health care providers to offer testing during routine appointments and that, no doubt, will expand the number of people tested. Ideally, testing will entail a triple panel, which tells the health care provider whether the patient is susceptible or immune and shows whether a patient’s infection is acute or chronic. Patients with an antigen called HBsAg+ should also be screened for a coinfection known as Delta hepatitis.

Hepatitis B testing will link those who are infected with access to curative treatment. It will also reduce disparities in health care and ultimately save lives. In short, hepatitis B testing should be standard of care. That’s why I encourage policymakers across the country to take a close look at California’s proposed approach. Why not ensure that hepatitis B patients who need testing, support and treatment can access them? If the whole country can move toward this new approach, it will lead to improved public health for all.

Robert Gish, MD, is the medical director of the Hepatitis B Foundation and a member of the Alliance for Patient Access’ Hepatitis Therapy Access Physicians Working Group.

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