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.

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 .