In South Australia, recent mathematical modeling would suggest we've got about
14 and a half thousand people with chronic hepatitis B infection.
Of those, only probably less than half have been identified as having infection,
and of those, only a very small number have regular
monitoring and accessing therapy.
The health outcomes of people with chronic hepatitis B infection vary,
even the healthy carriers, so called, in the past have a risk of reactivation
and therefore developing the complications, which occur in the rest of the population
with hepatitis B infection.
And that includes progressive scarring of the liver,
decompensation of the liver that is failure of the liver.
In a number of those people, even without scarring,
may develop hepatocellular carcinoma, or liver cancer.
Hepatitis B is a very chronic process
which happens over a lifetime,
but only at certain stages
of people's lives is when hepatitis B are the most problematic.
In certain cases, even though hepatitis B
remains inactive from an inflammation point of view where their liver function tests are normal,
but they may have a significantly higher risk of hepatocellular cancer, or liver cancer
based on their family history.
And in those patients, they need to be aggressively screened
for early onset of hepatocellular cancer,
which can be as early as in people's 20s and 30s in certain circumstances.
The most critical thing to see from a referral
from a GP is to know where patients are at in terms of their chronic hepatitis B infection.
Obviously a liver function test in particular, knowing what their ALT is at that time will
dictate whether they have active inflammation or not.
Concurrently obviously a positive surface antigen will imply they've got chronic infection.
And subsequently knowing their
E-antigen and E-antibody status will also know in what phase of their chronic hepatitis
B infection to see whether they have gone through what we call “immune clearance”
where significant scarring could have happened during that period of time.
And most finally a Hepatitis B DNA PCR, what we call a viral load, of hepatitis B will dictate how much
infection they have in their bloodstream at that point in time.
All those information will help us piece together exactly where they're at
in terms of the chronic hepatitis B infection.
So as GP's, when we get our hepatitis B serology results back
they can often be quite confusing to interpret.
So if you're not sure exactly what it means,
a very good point of reference is the hepBhelp.org.au site
which provides a very simple, easy to use tool.
Another point or place that I use is the ashm.org.au site, which has the decision making tools.
So it's ‘Decision-Making in Hep B’, which is also freely available online.
And even then, if they’re still too confusing, a very good point of reference is to call the Viral Hepatitis Nurse.
We usually talk to the GP, if they've done the relevant blood tests required and an ultrasound,
we ask them to either fax them through to us so we can look at them.
And if they're just a little bit unsure, the GP or myself, that we're unsure
of the patient's condition, we will then show these results to one of our specialists.
We as our liaison will then ring the GP and say the specialist feels that this patient should
be monitored in the community with you, if you are happy to,
this patient will need a) b) and c) done six monthly or twelve monthly
or alternatively the specialist might say
this patient seems complex and could you please refer them in and I will manage them in the clinic.
One of the things we can do for the patient when they come to clinic is do a Fibroscan.
We're really looking at the severity of liver damage, the liver scarring.
It's used in conjunction with blood tests and not as a standalone test.
It takes 10 minutes, noninvasive, simple, easy test and it's available for all patients in the clinic.
So many of these people we're testing are unaware
that they're either at risk for hepatitis B or actually unaware that they have hepatitis B.
These people are often unaware because they've acquired the infection at birth or in early childhood.
Obviously chronic hepatitis B infection
affects people from certain areas, which are endemic with a virus.
It's not uncommon that the virus affects multiple family members within a certain family tree.
And as a result of that, those who are at risk of the virus within the family
I would strongly urge my patient to inform their family members of the potential risk
and then be screened for the virus as well.
And those whom are not infected and potentially at risk of infection in the future,
vaccination is an excellent option to prevent any potential risk of future infection.
For a GP, in terms of monitoring their patients,
they should be having regular liver function tests on a six to 12 monthly basis
to ensure their liver function tests remain within normal limits.
And those whom are at risk of hepatocellular cancer may need to have regular surveillance
with liver ultrasound, which is guided by their specialist in terms of their likely risk
on a six monthly basis or so.
Well the risk overall of people with hepatitis B infection
is about one in five people developing some clinical or illness associated with Hepatitis B.
There are going to be highly complex cases which will need to be seen in tertiary centres.
But in a shared care model with general practitioners.
But the vast majority of people with Hepatitis B infection
can be managed at the primary practice level.
We strongly would encourage general practitioners who have their interest in viral hepatitis
to be involved with co-sharing, co-managing these patients with specialists like ourselves
so we can certainly manage those lower risk patients in the community.