Hepatitis B Awareness

By Dr. Katherine Kingsley
Interviewed by Rasa Fournier
Wednesday - October 12, 2011
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Dr. Katherine Kingsley
Internist at Kaiser Permanente Hawaii

Where did you receive your schooling and training?

I attended medical school at Cornell University Medical College and completed my Internal Medicine residency at the Hospital of the University of Pennsylvania.

How long have you been practicing?

I finished my residency in 1998, and have been practicing since then in internal medicine and as a hospitalist. I have been working with hepatitis B patients in Kaiser Permanente Hawaii’s Viral Hepatitis Clinic since 2007.

How is hepatitis C different from B?

Hepatitis B and C are both viruses that can live chronically in the liver and may cause liver damage. Liver damage isn’t inevitable when you have either virus, per se, but it does occur in many individuals and it can be quite serious.

The manner in which each virus is acquired is one differentiating factor. I would say that in Hawaii most patients with hepatitis C likely were exposed to the virus as an adult, while most of the hepatitis B that we see likely resulted from being exposed to the virus as a child. The treatment for each condition is also dramatically different. Hepatitis C can often be cured with six to 12 months of intensive treatment, with many side effects. Hepatitis B treatment is easier to go through, but is focused on controlling the virus rather than curing it.

How do you get hepatitis B?

In our clinic, the majority of adults with hepatitis B are of Asian or Pacific Islander extraction and likely were exposed to the virus at a young age. For example, a patient’s mother may have had hepatitis B and exposed her child during childbirth or shortly thereafter. When we study risk factors and try to predict who’s at greatest risk for having hepatitis B infection, one of the most important risk factors is one’s place of birth anyone who was born or whose parents were born in Asia, Southeast Asia or the Pacific Islands are at greater risk for being infected and should be tested.

Gloria Duarte, Dr. Katie Kingsley, Shelley Miyashiro and Carmen Alimoot. Nathalie Walker photos .(JavaScript must be enabled to view this email address)

Does hepatitis B spread through sexual activity?

This is very important. Yes, the virus can be transmitted sexually, but sexual exposure isn’t the reason most people have chronic hepatitis B in Hawaii. The same thing can be said about hepatitis B and drug use yes, it can be transmitted during intravenous drug use, but that isn’t how most of our population was infected. What’s unique about hepatitis B is that the age at which you’re exposed to the virus largely determines if it stays in your body or if you resolve the infection on your own. The younger you are when you’re exposed to the virus, the more likely it is to persist as an active infection. When an adult is exposed to hepatitis B, their immune system resolves the infection 90-95 percent of the time. Thus, it’s unlikely a person would become chronically infected with hepatitis B from adult exposure. The more important point is that there is a very safe vaccine to prevent hepatitis B infection no matter the age or mode of exposure.

Since it’s a virus, how curable is it?

Technically, hepatitis B isn’t really curable at least, not in the way we typically use that word. I tell patients it’s like having asthma: We can’t cure asthma, but there is a lot we can do to keep it from becoming an active problem in your health. The same concept applies to hepatitis B infection.

How common is liver damage?

Liver disease can be seen in 15-40 percent of patients who have hepatitis B. The virus doesn’t hurt the liver directly, it is just using the liver as a place to make more viruses. The liver damage that happens when you have hepatitis B comes from your own immune system’s reaction to the virus. When it tries to attack the virus to get rid of it, that interaction can result in collateral damage to the liver. We have very good medications to help stop liver damage related to hepatitis B infection.

Are there symptoms?

For the most part, there are no symptoms. Hepatitis B and liver disease are both silent processes. Patients don’t come to us knowing they have this condition. Providers need to be screening for it, so patients can be identified and cared for.

What does screening consist of?

Screening for hepatitis B is via a simple blood test.

Can you say something more about the hepatitis B vaccine?

The vaccine is very effective and safe. All children are routinely vaccinated for hepatitis B, and any adult living with (or sexually active with) someone that has hepatitis B should be vaccinated. There are many other groups which also should be vaccinated because they are at higher risk of being exposed to hepatitis B. It’s also worth pointing out that anyone who would like to be vaccinated for hepatitis B can receive the vaccine. And for parents who forego childhood vaccinations, hepatitis B exposure is real in Hawaii and they should understand that.

Any final recommendations about hepatitis B?

Awareness of hepatitis B is crucial for both health care providers and the general population. Because the hepatitis B virus has the potential to cause liver cancer, knowing you have hepatitis B is critical to getting the right preventive care. Hawaii has the highest rate of liver cancer in the country, which is in large part because of the high prevalence of hepatitis B in our state.

It’s a very rewarding experience caring for my patients and helping them understand these issues. It’s something that I feel very privileged to be able to do.

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