Hepatitis B: the advice of a specialist

Interview with a specialist doctor, Professor Thierry Poynard, head of the hepatogastroenterology department, hospital group Pitié-Salpêtrière, Paris.

We remember the debate in France about vaccination against hepatitis B. What is your point of view?

What do I think of it ? You must be vaccinated as soon as possible! The simplest is to integrate vaccination against hepatitis B into the vaccination schedule. Among the population who did not have early vaccination, it is necessary to vaccinate pre-adolescents as long as they accept it ... It is necessary to vaccinate when one is single: it is a sexually transmitted disease . Knowing that the disease takes time to develop, if you are over 80, you can abstain. Otherwise, get vaccinated!

Is the hepatitis B vaccine at risk?

The vaccine was questioned a few years ago, it's true. He was suspected of causing relapses in multiple sclerosis. Obviously, I will not tell you that there is no risk. All medicines or vaccines can cause side effects. All the numerous studies carried out since then have not shown a scientifically established risk, even if a very very low risk can not be definitively ruled out.

Many arguments are in favor of the vaccine ...

In France, we have reflexes of rich countries. We challenge vaccines because we forget the risks of the disease. We think, wrongly, that diseases can be treated when they are diagnosed. This is not the case for hepatitis B. There is still no definitive cure, and cirrhosis and liver cancer can be formed without any symptoms. The treatment will often come too late.

The only way to avoid the disease is to get vaccinated. It is also, globally, the only way to eradicate this epidemic. It should not be forgotten that in France 1, 000 people die each year of the proven consequences of hepatitis B. It is estimated that for a generation of unvaccinated French, at least 40 serious complications of hepatitis B can occur while less a multiple sclerosis outbreak could be caused if these 800, 000 people were vaccinated ...

The treatments are hard to bear, which treatment do you prefer?

Personally, I always start a treatment with the prescription of tenofovir or entecavir molecules. These treatments are better supported, they do not require work stoppages and they provide a good quality of life for patients. Very quickly, we know if it works or not. After four years of treatment, almost half of the patients treated do not have a short-term recurrence.

Interferon treatments are hard to bear?

They cause significant disorders of mood, depressions, phases of great excitement too. They can make hair fall and are very painful for a relative benefit. While their duration of action is longer after the initial one-year treatment, if one calculates all the discomfort associated with the treatment, it is not sure that the benefits are greater with interferon.

How to do, when a patient develops another disease, in addition to hepatitis and must, for example, undergo chemotherapy?

This is a problem that can arise. It can happen that a woman, for example, with hepatitis B previously inactive, also develops breast cancer. In this case, it has been noticed that the time of the chemotherapy, the viral load B increases, without symptoms. This is because chemotherapy lowers the patient's immune defenses.

The hepatitis B virus is less controlled by the defense systems, the time of chemotherapy. On the other hand, when the chemotherapy is stopped, the immune reaction is brutal and this can cause disasters in the liver. There is a high risk of progression to very severe hepatitis and cirrhosis.

To avoid this, when the case presents itself, one must simply prescribe a preventive antiviral, before the implementation of chemotherapy. It works in two or three weeks and therefore does not delay much the start of chemotherapy. But you always have to think about it before, to avoid problems.

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