 Photo by Anh Nguyen on Unsplash First published on Hepatitis Australia's website in May 2020 People with chronic hepatitis B have higher rates of depression and anxiety than the general population [1]. Let’s have a look at why this happens, and what we can do about it. Reacting to your diagnosis Adjustment to having a chronic (lifelong) disease may mean having to [2]:
Research [3] has found that many people worry about getting liver cancer or infecting others, and that these concerns could increase the risk of mental health problems, particularly depression. Not understanding enough about hepatitis B or having no one to confide in can also cause social isolation and affect mental health [4]. Hepatitis B treatment There is no cure yet for chronic hepatitis B, but there are medications which can control the virus and reduce the risk of serious complications from the condition. However, like all medications, the treatment for hepatitis B can cause side-effects for some people, including affecting your mental health. This is something you should discuss with your doctor, as well as whether you’d like any additional support during your treatment. There are two main options for treatment [5]. Usually, the preferred option is nucleoside analogues (NAs), such as tenofovir and entecavir. These have fewer side effects than interferon, but often need to be taken for a long time, or even for life. Pegylated interferon (PEG-IFN) is an alternative and is usually given over 48 weeks. Researchers [6] reviewed studies of people on interferon, and found:
It is also possible that a history of depression, anxiety, bipolar disorder or post-traumatic stress disorder (PTSD), combined with interferon may cause worsening symptoms, or relapse [2]. Now let’s look at how to get help. Learn and connect Learning about hepatitis B is a good way of combatting misconceptions. Great resources include the Hepatitis Australia website and the National Hepatitis Infoline (1800 437 222), which directs you to the community-based hepatitis organisation in your state or territory who provide friendly and confidential help. In addition you can look at the Hep B Help website which has links to hepatitis B organisations plus multilingual factsheets, audio and video resources too. You could also contact the hepatitis organisation in your state or territory and perhaps link up with people who have similar experiences. Alternatively, you could join an online forum like Hep Forums. Talk to your partner, friends and family. By sharing your knowledge, you can reduce stigma - which might otherwise isolate you or interfere with you receiving treatment - while getting the support you need. You can read these tips on telling others you have hepatitis. Get healthy Eat a healthy, balanced diet and maintain a healthy weight. Avoid alcohol and smoking. You should talk to your doctor before using any non-prescription drugs or supplements. Try to keep to a regular sleep pattern and regular exercise. For general support for mental health you can check out Head To Health as well as Lifeline and Beyond Blue. If you need more support, don’t forget you can speak with your GP, specialist or ask for a referral to a psychologist or psychiatrist. Medications and talking therapy When mental health issues arise, many people find it helps see a psychologist for one‑to‑one, confidential talking therapy. Sessions usually include learning about the mental health condition, why it has happened and why it has persisted. The psychologist can work with you to use tools like relaxation, mindfulness and cognitive behavioural therapy (CBT) as a way of coping with difficult emotions [7,8]. It is also thought that antidepressants and anti-anxiety medications can work well for interferon-related depression and anxiety [9,10]. Pre-existing psychiatric medication may need to be changed or adjusted during antiviral treatment, for example to one less toxic to the liver. Psychiatric medications and support might need to continue for at least 6 to 12 weeks after finishing antiviral treatment [10]. For people at higher risk for depression, such as those with a history of depression or alcohol overuse, pre-emptive treatment with antidepressants can be started before beginning antiviral therapy [10]. References
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 Photo by Shelby Deeter on Unsplash First published on Hepatitis Australia's website in March 2020 "Having HBV is only a small facet of who you are, and not a reason to give up on a loving relationship. A partner who accepts you as you are and wants the best for you is someone who will not see HBV as a barrier to getting to know you.” Although most people get hepatitis B at birth, it can be transmitted in other ways including sex. This article contains information about how it is spreads, and how you can keep your partner safe. How Hepatitis B is spread through sexHepatitis B contained in blood, semen or other fluids can be spread through unprotected vaginal, anal or oral sex. As it is very infectious, it transmits easily through breaks in the skin or mucous membranes (the lining of the nose, mouth, eyes and other soft tissues) [2]. We also need to remember that hepatitis B infection can occur through non-sexual contact such as sharing toothbrushes, razors or contact with an infected open wound. However, it is not spread through normal hugging or kissing, or sharing meals, showers or toilets with someone who has hepatitis B [3]. How can we prevent the spread of hepatitis B?The best way to prevent hepatitis B infection, is to get vaccinated. Given hepatitis B can be spread in many different ways, it is strongly advised that all household contacts and sexual partners should be vaccinated, as well as using condoms with sexual partners [4]. By the way, vaccination is usually free for the above groups [5]. If you are concerned you may have been put at risk of hepatitis B, or that you may have put someone else at risk, contact your GP or local sexual health clinic straight away. Your doctor can also contact a sexual partner for you, without including your details if you wish to stay anonymous. Telling others about your diagnosisAfter you have had time to come to terms with your diagnosis [6], you may wish to start thinking about disclosing your condition to others.There are many possible reasons for disclosure, such as:
Knowing when and how to disclose can be difficult. Some people may be supportive, whereas others may withdraw or even be angry. Often this is due to their lack of knowledge about the condition. Be prepared that a relationship may change or even end. Here are some tips that may help with the process [7]:
Finally, you may find these insights help you to negotiate your own relationships and communicate your diagnosis. “My personal philosophy and method is to be selective about the people I choose to date. To me, it is important if the potential date has common sense and good character. Once I feel this person is worthy of my time and attention, I have the talk about my hepatitis B, and that HBV is vaccine preventable. If they are interested in continuing a romantic relationship with me, they need to be vaccinated to protect against HBV. Some may have already been vaccinated, and if so, HBV is no longer an issue.” “You need to approach dating, not as who will ‘accept’ you, but rather who ‘deserves’ you. Perspective is everything. If you see a health issue like HBV as a unique barrier to intimacy others will not understand and might reject you for, you will create self-defeating thoughts that not only limit your happiness, but are inaccurate. Everyone has issues. Whether it is health, mental, social or financial, we all feel alone at times and want a connection with another soul.” If you think this article might help someone else too, please like and share References
First published on Hepatitis Australia's website in January 2020  Image by marker_photography from Pixabay “Detox diets”, supplements and Traditional Chinese Medicine are marketed as beneficial for the liver, but do they work? First let’s look at where the liver is and what it does. Liver anatomyIts functions include:
Detox dietsAlso known as a liver cleanse or flush, some people believe a detox diet helps remove excess waste after too much alcohol, unhealthy foods, or just for daily liver health. The first days may begin with fasting or drinking fluids only. Most detox diets take out processed food from your diet and may include commercial products, such as herbal supplements. Some people feel better on these diets, often simply due to eating more healthily. This might cause them to believe that the liver cleanse works, but it’s important to consider the following:
For most people following a healthy lifestyle, the liver is well equipped to remove day-to-day toxins and you don’t need to do a detox. SupplementsSome studies in animals show milk thistle decreases liver inflammation, and turmeric protects against liver injury. However, there haven’t been enough studies done on humans to recommend their use in prevention of liver disease [4]. The US National Center for Complementary and Integrative Health (NCCIH) advises that milk thistle can cause allergic reactions in some people or low blood sugar in people living with diabetes [5]. We should also remember that detox products and liver supplements may not be standardised. Products could have different strengths and be of varying quality. Some may interact with medication or have side effects including causing liver damage. Traditional Chinese MedicineTraditional Chinese Medicine (TCM) views the liver in terms of vital energy (qi) and the storage of blood (xue). Together with the scheme of Yin Yang, TCM practitioners may diagnose liver disorders, and offer treatments like acupuncture or herbs [6]. There is no evidence that acupuncture helps people with liver conditions. However, it is relatively safe if performed correctly [7]. Because there have been very few good quality studies, we have no strong proof that Chinese herbal products work for liver health. Some products have also been found to have been contaminated with plant or animal material, drugs like the blood-thinner warfarin, and heavy metals like arsenic. Some products can even contain the wrong herbs, which may damage the liver [8]. Therefore, it is very important that you are confident of what is in the Chinese herbs you buy. If you decide to use Chinese herbs or other supplements, it is advisable that you talk to your doctor, especially if you have hepatitis B or C, or other chronic diseases. Finally, the best way to look after your liver is maintain a healthy weight, follow a balanced diet, exercise regularly, minimise alcohol intake, and avoid smoking. If you think this article might help someone else too, please like and share. References
 Image by Mabel Amber, still incognito... from Pixabay First published on Hepatitis Australia's website in December 2019. If you’ve been told that you are “just a healthy carrier”, read on for a myth-busting update. Acute versus chronicWhen a person is first infected with the hepatitis B virus, it’s called an acute infection. If that person cannot get rid of the infection after six months, then this becomes a chronic infection, which is lifelong [1]. In the past, people who seemed well despite chronic infection were labelled “healthy carriers”. However, this term is inaccurate as people with chronic hepatitis B: • risk transmitting hepatitis B to others such as close contacts, sexual partners and unborn babies. • have nearly a one in four risk of dying from cirrhosis, liver cancer or liver failure [2]. Where did the term “healthy carrier” come from?The term “carriers” was initially used to identify people found to have the hepatitis B virus in their bloodstream for six months. However, these “carriers” varied widely. Some were highly contagious, some had no symptoms, and some had significant liver disease. In simple terms, we didn’t understand the hepatitis B virus very well. This led to many people being told by doctors that they were “just healthy carriers” and that they needed no follow up. Others were told their infection had “resolved” or was “inactive”, without being warned that it may reactivate, even without symptoms [3]. Why we should stop using the term “healthy carrier"Some people still use this term even though it is unhelpful. Here are some possible consequences: • People may miss out on receiving proper healthcare if they hold a false belief that they are healthy. • People who describe themselves as healthy carriers may feel they are less likely to experience stigma and discrimination [4] than those who say they have chronic hepatitis B virus. Unfortunately, this can actually increase stigma surrounding the condition by making it more hidden. You may like to read more about your rights and responsibilities on this page, or by phoning the Hepatitis Infoline. • Using the term “healthy carriers” might falsely imply that there are additional ways of passing on the virus as well as the usual transmission routes, or that healthy carriers are unlikely to transmit the infection to others. What we know nowThe reason people with chronic hepatitis B vary widely is that hepatitis B has four identifiable phases [5]: • Silent (Immune tolerance - phase 1): Hepatitis B virus is replicating but there is no active liver damage. • Damage (Immune clearance – phase 2): Hepatitis B virus is attacking the immune system and the immune system is fighting back. Liver is getting damaged. • Control (immune control – phase 3): Immune system has virus under control and there is no further liver damage. • Escape (immune escape – phase 4): Virus is active again and liver is being damaged. Your doctor can order tests* to see which phase your hepatitis B is in, and therefore what screening and/or treatment would be best. You should visit your doctor for liver check-ups every six months longterm to reduce the risk of liver damage. Screening may comprise blood tests, or scans such as liver ultrasound and ultrasound elastography (commonly known as Fibroscan®). Treatment may be anti-viral replication medication, or interferons to stimulate immune control [7] – as well as other actions like having a healthy lifestyle . Living with hepatitisThe goal of screening and treatment is to prevent, stop or even reverse the effects of hepatitis B on your liver [7]. Screening is important for those felt to be at higher risk groups, such as Asian men over 40, Asian women over 50, and Aboriginal and Torres Straits Islanders over 50. One study found that more than one-third of people with chronic hepatitis B lived much longer if they had six-monthly screening, compared to no screening [6]. In general, treatment is recommended to people whose hepatitis B is in the Damage (phase 2) and Escape (phase 4) phases, and all those with cirrhosis which is a severe form of liver scarring [7]. International research shows that appropriate treatment for chronic hepatitis B can reduce the risk of liver cancer by up to 75%, or three-quarters [8]. Treatment also reduces risk of transmission to others, and most importantly, gives you the best chance to live a long and healthy life. You can find out more about testing, monitoring and treatment here. If you think this article might help someone else too, please like and share References1. Hepatitis B Foundation. 2019. Acute vs. Chronic Infection. [ONLINE] Available at: https://www.hepb.org/what-is-hepatitis-b/what-is-hepb/acute-vs-chronic. [Accessed 3 October 2019]. 2. Australasian Society for HIV Medicine. 2019. Prevalence and epidemiology of hepatitis B. [ONLINE] Available at: http://54.66.239.154/prevalence-and-epidemiology-of-hepatitis-b/. [Accessed 3 October 2019]. 3. Hoofnagle, J., 1987. Chronic Type B Hepatitis and the “Healthy” HBsAg Carrier State. Hepatology, [Online]. 7/4, 758-763. Available at: https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.1840070424 [Accessed 3 October 2019]. 4. Ellard, J., 2013. Stigma, Discrimination and Hepatitis B - A review of current research. Australian Research Centre in Sex, Health & Society (ARCSHS), [Online]. Available at: https://siren.org.au/wp-content/uploads/2016/08/Stigma-Discrimination-and-Hepatitis-B-A-review-of-current-research.pdf [Accessed 18 November 2019]. 5. Hepatitis QLD. 2021. Hepatitis B | Hepatitis QLD. [ONLINE] Available at: https://www.hepqld.asn.au/hepatitis-b/. [Accessed 23 February 2021] 6. Zhang, B., 2004. Randomized controlled trial of screening for hepatocellular carcinoma. Journal of Cancer Research and Clinical Oncology, [Online]. 130(7), 417-22. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15042359 [Accessed 21 November 2019]. 7. Australasian Society for HIV Medicine. 2018. Treatment of chronic hepatitis B virus infection. [ONLINE] Available at: http://54.66.239.154/treatment-of-chronic-hepatitis-b-virus-infection/. [Accessed 3 October 2019]. 8. Cancer Council Victoria. N.D. Hepatitis and liver cancer. [ONLINE] Available at: https://www.cancervic.org.au/for-health-professionals/community-health-professionals/hepatitis-b-and-liver-cancer. [Accessed 3 October 2019]. * As the range of HBV tests can be confusing, your GP may appreciate being pointed to this handy decision-making aid.
 Image by Waltteri Paulaharju from Pixabay First published on Hepatitis Australia's website in September 2019. If you’ve just been diagnosed with hepatitis B, it might help to know you’re not alone. In 2018 there were 226,612 people in Australia (257 million people worldwide) living with hepatitis B. Emotional reactionsAfter being diagnosed with hepatitis, people can experience a range of reactions including shock and uncertainty, even if they had been expecting a positive test result. It’s not uncommon to feel depressed, anxious, fearful, or worry about possible stigma. In addition, there may also be self-blame, guilt, or embarrassment. Take your time working through difficult thoughts and emotions. Try to be patient and have self-compassion. Sometimes talking things through with your doctor or a counsellor can help. StigmaStigma can arise in society or even within yourself. It can isolate you or interfere with you receiving treatment. For instance, a person may feel apprehensive about being seen attending an infectious diseases clinic if they are worried about what others might think. A great way of reducing stigma is by learning more about hepatitis B. This will empower you to manage your condition together with your doctor, plus it’s helpful if you want to educate others. The learning processBe open to learning about hepatitis B at your own pace. Feel free to explore the huge range of resources available such as via Hepatitis Australia. Information is available in other languages, audio/video formats including podcasts. There are also personal stories here and here about real people living with hepatitis B. SupportHaving the right support is invaluable. Who you share your diagnosis with is a very personal decision. No matter who your trusted person(s) is; you should reflect on the pros and cons of disclosure to each one. You can also join a support group through your local hepatitis organisation or online forums like Hep Forums. Do keep in mind that forums may include people from other countries who have differing access to healthcare and medications, and that any health information should be discussed with your doctor. Finally, these tips might be useful when you see your doctor. Come prepared Being prepared will help you get the most out of your appointment. Having a set of questions ready is a great way for you to get the information you need. Don’t be afraid to ask questions Here are some common questions others ask:
Make notes for later Research shows that people who are anxious or stressed are more likely to forget or incorrectly recall information later. So, it’s good to make notes during the appointment. Alternatively, ask your doctor for a written list of what you will both do after the appointment. The right doctor for you Because hepatitis B can be a lifelong condition, it’s ideal if you have a good and honest relationship with your doctor. Consider the following:
If you answered no to a few of these questions, then seeking a second opinion might be reasonable. If you need help to find a doctor with experience treating hepatitis B, you can call the National Hepatitis Infoline on 1800 437 222. If you think this article might help someone else too, please like and share References
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