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Commentary: Older Adults and HBV
What It Means to Be an Adult Living and Aging With Chronic Hepatitis B

Released: June 28, 2023

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Key Takeaways
  • Education is key to reducing barriers to HBV treatment that may change as a person living with chronic hepatitis B ages.
  • Early screening and diagnosis are key to identifying people with HBV so that they can be linked to care in a timely fashion and live normal, healthy lives.

My HBV Diagnosis

I was born in Taiwan and immigrated to the United States in the mid-1980s. Being from a highly hepatitis B virus (HBV)‒endemic region at a time when the virus was spreading, the natural inclination for my parents when we settled in the United States was to get our family vaccinated. Thus, when I was 12 or 13 years old, my parents took me to a local family doctor for the 3-shot series of HBV vaccines. When my HBV vaccination series was complete, we naturally assumed that I would be immune to HBV infection for life.

However, when I donated blood to the American Red Cross for the first time during a high school blood drive, I was informed that my blood could not be accepted because it contained HBV—and I was not eligible to donate blood ever again. This was the moment I first paid attention to what HBV really is.

A few lab visits and multiple liver function tests later, it was confirmed that I was hepatitis B surface antigen positive and had not experienced hepatitis B surface antibody seroconversion following my vaccine series. At that time, because my family knew many Asian adults who had been HBV carriers for years and still managed to live normal, healthy lives, we simply accepted the situation and took no further action.

Seeking a Greater Understanding of HBV With Age

It was not until my early 20s—when I started my first adult job and had my own health insurance—that I felt compelled to seek greater understanding and targeted care for my HBV. Upon meeting me and discovering that I may have had lifelong chronic hepatitis B (CHB), the first hepatologists I sought care from at a large metropolitan teaching hospital immediately recommended blood work, HBV quantitative testing, x-rays, and abdominal ultrasounds. Despite my asymptomatic presentation, tests that revealed no elevated alanine aminotransferase or HBV viral loads, and no physical abnormalities on ultrasound, the hepatology team pushed me to get a liver biopsy. Not realizing that I was serving as more of a case study, I consented.

During the liver biopsy, I experienced excruciating pain from the sample extraction, and some of my internal organs went into shock, leaving me bedridden in the hospital for 5 days with a major bowel obstruction. The biopsy ultimately revealed that my liver was perfectly healthy. Needless to say, after this traumatic ordeal, I began searching for alternative hepatology care.

Fortunately, not long after the biopsy, the ensuing hospital stay, and a series of outpatient follow-up tests to rule out other comorbid gastrointestinal conditions, I found a new hepatologist who viewed and treated me like a normal, healthy patient who just needed to be monitored more closely and better informed on what HBV is. From the outset, she explained how we could work together using existing and forthcoming medical technology to stay ahead of the HBV in my body and address any developments with existing and investigational drugs to improve my chances of living a long, normal life. Now, 20+ years and a 1700-mile move across the country later, thanks to telehealth I’m still under the care of this same hepatologist who put me at ease from the beginning.

Evolution of My HBV Treatment Plan Over Time

My hepatologist remained empathetic and sensitive to my early traumatic experiences with hepatology care. She has cared for me through many stages, from simple and easy semiannual and annual monitoring during the early years with my CHB, to advising my wife and me on how to prevent perinatal HBV transmission to our 2 children at birth, and eventually to starting active treatment with a perfectly suited (ie, relatively hassle-free and, luckily for me, adverse event‒free) oral antiviral drug when I entered my 30s and my viral loads began to spike. Over these 20+ years, she has continually shared with and educated me on new technologies that could serve as alternatives to a liver biopsy. Furthermore, she keeps me up to date with alternative and pipeline drug options in case my HBV ever develops resistance to my current antiviral agent.

A Path Forward as I Age

Given my experience, I truly believe that living a long, normal, healthy life with CHB  is entirely possible, especially with proper HBV awareness, screening, and care by trusted healthcare professionals. When detected early (prior to one’s 30s or 40s), much can be done in collaboration with a hepatologist to stay ahead of the long-term negative effects and complications associated with HBV, such as cirrhosis or liver cancer.

All liver specialists should be capable of providing multiple treatment options and adjusting to life-stage objectives for each patient beginning in their late teens and early 20s. I will always encourage people to request that their primary care physician order a hepatitis B panel of blood tests along with their annual labs at least once in their lifetime. Following HBV testing, it is relatively straightforward to determine the next course(s) of action, which are either: (1) do nothing if HBV immunity is already present, (2) get vaccinated against HBV immediately if neither HBV immunity nor infection are present, or (3) seek out a reputable hepatologist for further investigation and/or care for HBV infection.

The worst predicament would be for an individual to discover that they have HBV later in life only after being diagnosed with advanced-stage cirrhosis or late-stage liver cancer. I want people to understand the importance of getting screened early so that, if diagnosed with HBV, it’s in time for the virus to be controlled and its long-term effects prevented. Ironically, at least 2 of the previously mentioned “healthy” Asian adults in my family whom I knew to be long-term HBV carriers (as of the time I discovered my own diagnosis 30 years ago) passed away in their early 60s from liver cancer. My hope is that early detection will prevent this outcome in others. 

Your Thoughts?

How do you approach treating and monitoring adults with CHB as they age? Join the conversation by leaving a comment below.