About 50 persons attended the Seminar on Hepatitis B organized by the Asian Pacific Health Center (APHC) under the sponsorship of Gilead Sciences on May 31, 2006 at Jasmine Restaurant.

At 7:15 PM, Dr Ton Tran, APHC Medical Director, welcomed the audience and introduced the main speaker: Dr. Tuan Nguyen, gastro-enterologist in practice in San Diego. Dr Nguyen presented an “Update on Hepatitis B” with slides in English. In the lively Questions and Answers section, Dr. Tran gave the answers in Vietnamese, and Dr. Charles Liu answered in Chinese.

Following are the questions and answers:
1. The affected patient has no symptoms, although carrying the virus in the body. Does the virus still damage the cells?
Answer: Hepatitis B virus has been associated with liver cancer. Although there are cases where the virus coexists with minimal damage to the liver, they can become active at any time. Therefore, we need to monitor regularly the infected patients with liver tests: alpha-feto-protein, and ultrasound.

2. How do we know which medication is available for the disease on hand?
Answer: The treatment of chronic active hepatitis B is evolving. It would be best that patient seek help from a specialist. Each therapy has its own advantages and disadvantages. The choice of therapy will depend on patient characteristics, life style, duration of disease, and laboratory data. For example, to a young non-Asian woman who has a low viral count, genotype A and would like to have a family in the near future, then Interferon may be an option. The disadvantages of Interferon are its side effects and it is an injection.

3. A patient had three shots of vaccine in Hong Kong. How long before he needs to be checked for immunity?
Answer: There are rare cases of non-responders or response below the threshold of labs detection. These patients may benefit from a repeat of another series of vaccination.

4. A patient has been screened by checking the viral load (number of virus). At which level of virus load do we need to take medications?
Answer: It depends on the case. The recommendation is at about 104 to 105 in patients documented to have significant liver disease.

Along with the treatment, the patient should:
- Get vaccination against Hepatitis A
- Get flu immunization
- Do physical exercise
- Avoid drinking alcohol, to prevent further damage to the liver
- Avoid medications which have side-effects on the liver

5. How are patients monitored while under treatment?
Answer: We usually monitor the labs tests including liver test, viral count every three months. The viral load will reduce with effective therapy. We may need to perform the Genotype and resistance profile of the virus if there is a rise in the viral count while the patient is on therapy (assuming that compliance is not an issue). The majority of patient will need long term therapy.

6. Does the medication have side-effects?
Answer: Interferon can give flu-like reactions, thrombocytopenia. Oral meds have less side-effects, however viral resistant can be a problem with long term therapy.

7. Which types of food or medications are harmful to the liver?
Answer: The list of potential hepatotoxic medications is long. However, the common medications are Tylenol at high doses, chemotherapy meds, and cholesterol lowering agents. Among the latter products, the newer water soluble agents can be less hepatotoxic, for example Zocor, Pravachol. It is recommended that the doctor follow the liver tests while the patient is on these medications.

8. I have a low income, how can I afford the cost of medications?
There are programs to enroll the patients for free medications. Some companies have a limit of $25,000 – 30,000 yearly income above which no assistance is available, whereas others have a higher limit.
To start enrollment and get free funding for Hepsera:
- Call the Asian Pacific Health Center at 619-582-2360.
- Specify the low income status.
- Only a mailing address is needed to document the eligibility of the patient. The social security number is not required.
- If the patient has some type of insurance that does not cover for the medication, the pharmaceutical company will try to enroll in a better insurance program.

9. What is the role of herbal medications?
Answer: There are no well controlled studies that I am aware of, showing that herbal medications are effective in the treatment of chronic hepatitis B. Some products may normalize the liver tests, but have no effect on the hepatitis B virus.

Dinner was served during the meeting.
We thank Greg Nolan, Therapeutic Specialist, and Michael Roy, Community National Account Manager from Gilead for the generous support of the meeting. Cadence Hsiao, coordinator of the past Hepatitis B Prevention Project, compiled the list and invitation of the attendees.


Reported by Binh N. Tran, Pharm.D.
Asian Pacific Health Center
www.aphcenter.org
June 1, 2006