Approximately two billion people around the world have been infected with viral Hepatitis B (HBV) in their lifetime. Despite this large number of infected people worldwide, it’s estimated that only 0.3% to 0.5% of U.S born residents will be infected due to the universal vaccination against the virus that is practiced in the U.S. However, those who immigrate to the U.S., particularly those born in Southeast Asia and Africa, are disproportionately affected by HBV. In the majority of cases, it starts at birth, transferring from the mother to her children, and then again between those children and members of their community. 

This knowledge is one of the reasons why Mohamed Hassan, MD, FAASLD, a professor in the University of Minnesota Medical School’s Department of Medicine, continues to dedicate his career to the study of hepatology. For the last 35 years, Dr. Hassan has been researching viral hepatitis strains and their resulting diseases worldwide. His most recent research, conducted as part of the Hepatitis B Research Network (HBRN) and published in the American Journal of Epidemiology, found significant differences in the rate of HBV infection between American and foreign-born Black people, highlighting the need for tailored strategies for prevention and management of chronic HBV infection for African Americans. 

Why HBV is Dangerous

HBV differs from its sister-virus, Hepatitis C, because it can cause both acute and chronic liver disease within the infected subject. And, although it is most prevalent in foreign-born residents and geographical areas with large immigrant populations, U.S. born citizens can contract HBV through an infected individual’s blood or bodily fluids if they are not vaccinated.

Unlike Hepatitis C, Hepatitis B does not have a cure. However, there are medications to suppress HBV progression and even reverse the damage. In order to be eligible for medication, the infected patient has to be experiencing active disease. The wording is key, says Dr. Hassan, because many people infected with HBV are inactive carriers and don’t experience liver injury. 

These carriers are at even greater risk, however. According to Dr. Hassan, another virus called Hepatitis D has the potential to “superinfect” people who are carriers of the HBV virus. This creates acute liver infection and can lead to chronic liver dysfunction.

Serving HBV Patients in the Twin Cities

Dr. Hassan remembers a time—shortly after he helped establish the viral hepatitis center at the U of M—when Hepatitis C was the leading cause of liver transplantation in the U.S. “The clinic was very busy,” he said. But now, the majority of patients he sees are immigrants with Hepatitis B seeking better healthcare. 

He said, “In the Twin Cities we have a considerably large foreign-born immigrant population who have a high prevalence of Hepatitis B, so we have the patients. We also have the doctors who deal with the liver because there are very few hepatologists who are practicing outside the University of Minnesota.”

The Medical School has some of the only hepatologists in the Twin Cities. And, although the creation of curative medications for Hepatitis C has decreased the prevalence of hepatitis in the U.S., the large immigrant population in the Twin Cities and asymptomatic carrier possibilities ensure many still need access to a hepatology clinic and specialty clinicians. 

On the need for hepatologists, Dr. Hassan said, “Hepatitis does not only involve a large portion of the world’s population—wherever they are—it is one of the leading causes of chronic liver disease and liver cancer, and that is a big deal because if we don’t catch it early, you will lose the patient.”