Hepatitis: Is Your Doctor in the Dark?
June 7, 2010
There was good news and bad news after 25-year-old Carlos Xavier's (name changed) recent STD screening at a Chicago public health clinic. "I don't have HIV," the college student says, "but I have hepatitis B -- which I never heard of before.
Hepatitis is an infectious, blood-borne virus that inflames the liver. Hepatitis A is often transmitted through foods tainted with microscopic amounts of fecal matter, particularly during overseas travel. It is also transferred through contaminated blood and stool. Hepatitis B (HBV) and hepatitis C (HCV) are often passed through infected blood as a result of a variety of behaviors.
How to Reduce Your Risk
Having unprotected sex, multiple sexual partners, more than one sexual partner during any six-month period or concurrent relationships -- including "friends with benefits" -- increases your chances of developing hepatitis. Men who have sex with men (MSM) should be particularly careful, as should the HIV-positive: Unprotected sex and drug use -- even of non-injection drugs -- increase a person's chances of exposure, and compromised immune systems are particularly susceptible to the virus.
Inmates, people on dialysis and those living with someone who has chronic hepatitis also have higher odds. You should never share another person's razor blade or toothbrush; nor is it safe to engage in oral or anal contact. And, as always, it's vital to wash your hands carefully after you use the bathroom and before eating. Blacks are more than three times as likely as Whites to be diagnosed, reports the U.S. Department of Health and Human Services.
A series of shots can prevent both hepatitis A and B, but no vaccine exists for hepatitis C. Once a person becomes infected, the body may fight off hepatitis on its own, as it always does hepatitis A. Hepatitis B and C, however, can become chronic and may lead to loss of liver function, liver cancer and a liver transplant. Unfortunately, few or no symptoms appear until significant liver damage has already occurred. When signs do exist, hepatitis often mimics the flu's sore throat, nausea and vomiting. Chronic infection is often marked by telltale jaundice and dark-colored urine.
"On a day-to-day basis, you can practice safer sex with condoms," says Michael Kharfen, who is with the HIV/AIDS, Hepatitis, STD, and TB Administration of the District of Columbia Department of Health, "and dental dams for oral sex."
Patients and Physicians Need to Be Educated
"Apparently I've had hepatitis B for a few years but did not know," says Carlos, who is Black, Puerto Rican and bisexual, a combination of factors that increases his risk even more than race and sexual orientation would individually. "Why did they never test for this before?"
Primary care physicians should screen for hepatitis but often don't. A recent Institute of Medicine (IOM) report surprisingly singled out primary care and social service providers -- including those helping people with IV-drug-abuse problems -- as having "generally poor" knowledge of chronic HBV and HCV.
In addition to improving public awareness, the IOM assessment calls for more frequent use of the hepatitis B vaccination, which has been widely available since 1982 and is so effective that the FDA has described it as the first "anticancer vaccine." Less than 55 percent of adults have been vaccinated for hepatitis B. Even among health-care workers, a group at higher risk of infection, "only 75 percent had received the three-dose vaccine series," the American Academy of Family Physicians reports.
Blacks Need Better Treatment Options
There is no cure if the body does not clear the virus on its own. In the case of hepatitis B, doctors monitor blood levels and suppress the virus.
Hepatitis B is treated by up to seven oral antiviral drugs, most notably interferon and tenofovir, an antiretroviral used as an HIV prophylactic. HCV is also treated with antivirals: interferon, ribavirin or a combination therapy.
"Unfortunately, treatment does not always work as well in persons living with HIV," Kharfen says. Black and Latino HCV patients respond poorly to interferon-based therapy, reports hivandhepatitis.com. But not everyone with HCV experiences debilitating outcomes.
"For many people living with hepatitis C," Kharfen says, "the goal is to maintain a healthy liver." Knowledge is "empowerment," he adds. So eat a nutritious diet; talk to your doctor before taking any vitamins, nutritional supplements or prescription medications; avoid illegal drugs as well as alcohol, which harms the liver; and get vaccinated for hepatitis A and B.
"When my doctor told me about my hepatitis, at first I was angry," Carlos says. "Now I'm happy to take care of myself and eat better. I'm getting tested every few weeks and even stopped drinking. Who would have guessed that?"
Rod McCullom has written and produced for ABC News and NBC, and his reporting and analysis have appeared in Ebony, The Advocate, ColorLines and other media.
This article was provided by The Black AIDS Institute. It is a part of the publication Black AIDS Weekly. Visit Black AIDS Institute's website to find out more about their activities and publications.
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