Which Is Worse, Hepatitis B or Hepatitis C?

Chronic hepatitis B and chronic hepatitis C, while caused by different viruses are clinically indistinguishable. Both affect the liver and both are potentially fatal.  Over years or decades, chronic HBV and HCV infection can progress to severe liver diseases including cirrhosis, liver cancer, and ultimately end-stage liver failure.

However, until now, few head-to-head comparisons of clinical outcomes have been attempted.

So, we were really interested to read a new study published in the Journal of Clinical Infectious Diseases.  This study is the first in which the effects of hepatitis B and hepatitis C virus infections were compared in a relatively homogeneous population.

Researchers from Johns Hopkins, led by Oluwaseun Falade-Nwulia, studied almost 7,000 American men included in the large Multicenter AIDS Cohort Study (MACS) prospective database of men who have sex with men.

Approximately 5% of participants entered the study with each type of chronic hepatitis.  At the end of an 8 year follow-up, all-cause mortality was similar in both groups, but liver-related mortality was significantly higher for those with chronic hepatitis B infections. This finding held true for both HIV-negative and HIV-positive participants, including those who were severely immune-compromised.

Excluding the few men in the study who underwent treatment for hepatitis C, infection did not change the pattern. However, liver-related deaths among participants who were co-infected with hepatitis B and HIV and who were enrolled after 2002 were markedly lower than among those who were enrolled earlier, possibly reflecting use of newer antiviral drugs that are active against both HIV and hepatitis B virus.

These results are worth noting for a number of reasons.  First, they underscore the need for expansion of HBV screening and vaccination to protect against HBV infection. Second, they suggest individuals co-infected with HIV/HBV should be treated with dually active drugs.

And lastly, despite the recent surge of public health advertisements that have brought hepatitis C screening and treatment into the public eye, clinicians should remember that hepatitis B is still out there, and that effective oral treatment can save lives.

Breaking Cancer News– 122 years later!

On December 3, 1890 William Russell, a pathologist in the School of Medicine at the Royal Infirmary in Edinburgh, gave an address to the Pathological Society of London.  In it he outlined his findings of “a characteristic organism of cancer” that he had observed microscopically in all forms of cancer that he examined, as well as in certain cases of tuberculosis, syphilis and skin infection.

On May 8, 2012, Catherine de Martel and Martyn Plummer from the International Agency for Research on Cancer in France announced: “Infections with certain viruses, bacteria, and parasites are one of the biggest and preventable causes of cancer worldwide.”

In case you haven’t already done the math, that means it’s taken 122 years for someone to take notice.

A hundred and twenty two years ago!  That’s the year Eiffel Tower was completed, it’s around the time that  serial killer Jack the Ripper was terrorizing London, the same year Thomas Edison used electric Christmas lights for the first time and the year Vincent Van Gogh, the Dutch painter, committed suicide.

How, you might ask, have scientists put men on the moon, developed the internet, flying cars and metal-free underwear bombs, but yet remain so ignorant about cancer and its origin?

How can the infectious causes of tuberculosis, leprosy, syphilis, smallpox, polio, malaria, and other viral and bacterial and parasitic diseases be so well understood, but the cause of cancer be unknown?

The fact that all cancers could conceivably be caused by an infectious agent now seems a distinct possibility. That, until now,  this has been overlooked, ignored, or unrecognized by twentieth century doctors is simply incredible.

According to de Martel and Plummer, one in six cancers, accounting for around two million cases a year, are caused by preventable infections. They claim “application of existing public-health methods for infection prevention, such as vaccination, safer injection practice, or antimicrobial treatments, could have a substantial effect on future burden of cancer worldwide.”

The percentage of cancers related to infection is about three times higher in developing than in developed countries. For example the fraction of infection-related cancers is around 3.3%in Australia and New Zealand to 32.7% in sub-Saharan Africa.

Many infection-related cancers are preventable, particularly those associated with human papillomaviruses (HPV), Helicobacter pylori (H. pylori), hepatitis B (HBV) and C viruses (HCV).

Of these infection-related cancers, cervical cancer accounts for around half of the cancer in women. In men, liver and gastric cancers accounted for more than 80%.

Dr. de Martel says: “Although cancer is considered a major non-communicable disease, a sizable proportion of its causation is infectious and simple non-communicable disease paradigms will not be sufficient.”

Clearly we need to start making up for 122 years of lost time and directing further research and treatment efforts into these preventable causes of cancer.  Since vaccines for HPV and HBV are available, and increasing their availability, and lowering the cost should be a priority for governments and health systems around the world.

Manicure and pedicure – $100… avoiding hepatitis – priceless.

Having survived the ghostly ghoulishness of Halloween, those of us living in Virginia thought we could rest easy for the next year.  Not so.  According to a new report, a mani-pedi could result in way more than beautiful nails.

The study by the Virginia Department of Health entitled, “Assessment of the Risk of Bloodborne Pathogen Transmission in Nail Salons and Barber Shops and Regulatory Requirements in Virginia” concluded that the risk of disease transmission cannot be excluded.

And although the current Virginia regulations (dated September 1, 2011), are sufficient to preventing bloodborne pathogens transmission, there is little evidence to show that they are being followed.  David A. Johnson, M.D., FACG of Eastern Virginia Medical School who analyzed the report said “The risk of transmission of infectious disease, particularly hepatitis B and C, in personal care settings is significantly understudied in the United States.”

Repeat use instruments such as nail files, finger bowls, foot basins, buffers, clippers, and scissors all constitute a threat if they are not fully cleaned and disinfected.

A recent case of acute hepatitis C (HCV), a disease that can result in liver chirrosis, liver cancer and even death, was “clearly related to a manicure/pedicure treatment” said Johnson.  This case prompted the evaluation of the current safety regulations in Virginia and compared them with those in 13 other states and the District of Columbia.  This review of the published literature identified eighteen papers, including nine case-control studies, three case-series studies, and six population-based surveys, that assessed manicure, pedicure, or barbering as potential risk factors for hepatitis B (HBV) and/or HCV infection. Of the nine case-control studies, five evaluated HBV and/or HCV in nail salon settings and three of the five showed association with HBV and one of the five showed association with HCV.

Uggggh!   Nevertheless, caution is required in interpreting these findings because of the substantial heterogeneities in the population studied, sample size, case and control selection, analytic method, and control of confounding variables across studies. Furthermore, none of the nine case-control studies was conducted in the United States.

The federal Occupational Safety and Health Administration (OSHA) does not have specific guidelines for the prevention of HBV or HCV infection in nail salons and neither the current CDC case report form for HBV or HCV nor the National Electronic Disease Surveillance System captures manicures or pedicures as risk factors for transmission of hepatitis.

“The true magnitude of this risk has yet to be defined and clearly needs further study,” commented Dr. Johnson.

In the meantime, he urged nail salon customers to be aware of the potential risks for hepatitis transmission, and to take precautions including asking questions to determine whether or not the establishment is properly cleaning and disinfecting their equipment. “No one should accept on blind trust that a business is taking the necessary steps to prevent transmission of bloodborne infections such as hepatitis,” said Johnson.

SRxA’s Word on Health won’t be giving up our well earned trips to the salon just yet…but we will probably starting bringing our own clippers, and nail files with us .