Health Insight
Jennifer Nebesky
CEO, Liver Canada
Dr. Scott Fung
Hepatologist, Toronto General Hospital and
Associate Professor of Medicine, University of Toronto
An estimated quarter million Canadians have chronic hepatitis B, yet many gaps in its diagnosis and care remain.
Chronic hepatitis B (CHB) is a long-term viral infection that affects the liver. It can lead to serious consequences, including cirrhosis and liver cancer, especially if left undiagnosed or poorly monitored. CHB is often silent, with many patients living with the virus for years without experiencing symptoms.
“It’s estimated that around 250,000 Canadians are living with CHB,” says Dr. Scott Fung, a hepatologist at Toronto General Hospital and Associate Professor of Medicine at the University of Toronto.
“Hepatitis B is one of over 100 forms of liver disease affecting Canadians,” says Jennifer Nebesky, CEO at Liver Canada. “Liver disease as a whole is on the rise in Canada. Today, one in four Canadians is affected, compared with one in ten just a decade ago.”
CHB is manageable and treatable, making early diagnosis and connection to care essential priorities. And yet, it often goes unnoticed.
The silent burden of hepatitis B
Because it’s so often asymptomatic, CHB can go undetected for years.
“The early stages of disease have really no symptoms, or very non-specific manifestations,” says Dr. Fung. “Most patients feel very well.”
“Symptoms are not always obvious in the beginning and can be easily confused with other health issues,” adds Nebesky. “These symptoms can include fatigue, abdominal pain, loss of appetite, and vomiting.”
Because of its silent nature, CHB often goes undiagnosed. “It’s estimated that 40 per cent of people with hepatitis B may still be undiagnosed and unaware they have a chronic infection,” says Dr. Fung.
Greater awareness is needed to diagnose CHB earlier and to ensure patients receive appropriate monitoring and care. With early intervention and ongoing assessment, many CHB patients can escape the disease’s serious complications.
“Viral hepatitis infections impact the liver and can lead to liver damage, cirrhosis, liver cancer, and even death,” says Nebesky. “The biggest gaps are tied to education and lack of awareness, stigma associated with blood-transmitted diseases like hepatitis, and barriers to care.”
“Viral hepatitis infections impact the liver and can lead to liver damage, cirrhosis, liver cancer, and even death.”
Closing gaps in diagnosis and care
In Canada, CHB disproportionately affects newcomers from endemic regions.
“Hepatitis B tends to disproportionately affect people born outside Canada, especially from endemic areas such as East Asia, Southeast Asia, and sub-Saharan Africa,” says Dr. Fung.
“Many newcomers come from regions where hepatitis B is more common and is often acquired at birth or in early childhood, but routine screening and public education may be limited in their countries of origin,” says Nebesky.
Barriers to diagnosis and care include lack of awareness but also language barriers, financial constraints, stigma, and challenges navigating the health care system.
“Language is a barrier for many of our patients,” says Dr. Fung. “English may not be their first language. There’s also significant stigma attached to many liver diseases, which can prevent timely screening for CHB.”
“The first step is to increase screening, all Canadians should be screened for CHB at least once in their lifetime” Dr. Fung adds. This recommendation is reflected in the updated CHB management guidelines from the Canadian Association for the Study of the Liver and the Association of Medical Microbiology and Infectious Diseases Canada.
“Without universal screening, there’s a missed opportunity for early diagnosis and voluntary engagement in care and treatment,” adds Nebesky.
Improving care pathways
“Once a patient is known to be chronically infected with hepatitis B, then linkage to care is extremely important,” says Dr. Fung. Post-diagnosis, regular follow-ups are needed: blood work at least once or twice annually with abdominal ultrasound every six months for men aged 40 years and older and women aged 50 years and older, according to the guidelines. “In many cases, we can’t tell whether the disease is progressing without regular monitoring,” says Dr. Fung.
Some people living with CHB are eligible for anti-viral treatments. The updated guidelines have also expanded treatment recommendations for patients that were previously considered ineligible.
Quantitative hepatitis B surface antigen (HBsAg) testing is another important tool in CHB management. The test measures the exact amount of hepatitis B surface antigen protein in the blood, which helps doctors and nurses to better understand the infection. “Quantitative HBsAg testing gives us a whole new level of information,” says Dr. Fung. “It has very important prognostic implications. Unfortunately, we don’t have uniform access to this test across most of Canada.”
Currently, only Alberta, British Columbia, and Quebec have defined pathways for patients to access this test; Ontario and several other provinces do not. This creates barriers to optimal care and highlights gaps in CHB diagnosis and treatment.
Equitable care is critical, and it starts with awareness.
Learn more at liver.ca.
This article was made possible with support from GSK.