Today’s morning lecture at MGH by Dr. Arthur Kim was about HBV/HCV. A few take-home points:
- Hepatitis B’s geographic distribution is important. The highest prevalence settings include Asia and Sub-Saharan Africa, even though quality of surveillance data is often an issue.
- Vaccination, vaccination, vaccination for HBV!
- Normal ALT does not mean there is no liver disease.
- Entecavir (HBV treatment) has anti-HIV activity and can lead to M184V
- For HBV and HCV, treatment is prevention, just like with HIV.
- Hepatitis C is a much more diverse virus than HBV or HIV (via sequence diversity, phylogenetic trees) and the epidemiology is worth knowing.
- Genotype 3 progresses faster.
- The epidemiology of hepatitis C genotypes is important.
- HCV survives very well in syringes and medical equipment, leading to transmission (examples include IVDU in southern China vs Amsterdam, hemodialysis, Egypt schistosomiasis campaign, etc).
- Indiana HIV/HCV outbreak should be a wake up call for the “time bomb” that is IVDU in America.
- Massachusetts is trying to ban oxymorphone (“Opana”) due to its addictive potential.
- Harm reduction is effective.
- IVDU is frighteningly common in Massachusetts high school students. MA has a good integrated disease surveillance system at the DPH.
- HCV treatment is important because untreated HCV leads to 20 years of lost life on average.
Thanks to Mark Siedner as well for one of the links above.
Thanks so much for reading! Reading/writing blog posts does take significant time and we all know that time is in short supply. You and I will both get much more out of my blog posts if they lead to discussion/dialogue. If you found this post useful and wouldn’t mind leaving a brief comment/sharing on social media, that would be great. Thank so much! Best regards, Phil