Vibrant Episode 3 - National Hepatitis Testing Day with Dr. Ben Sokoloff.
On our third episode of Vibrant, we are diving into the topic of Hepatitis with one of our Prism Health primary care providers, Dr. Ben Sokoloff. May 19th marks National Hepatitis Testing Day, so Dr. Sokoloff is bringing all the hepatitis knowledge to share with you all to make sure you can take charge of your health and be your most vibrant self! Check out the full episode, including transcript, below.
Episode Transcript
Intro: Welcome to Vibrant, an affirming healthcare podcast from Cap, our House and Prism Health. I'm your host, Dustin Vance. And I'll be here sitting down with folks across our agency to get the inside scoop on the work they do to provide compassionate, affirming care to all those in our community. Let's get the show started!
Disclaimer: Hi, folks. Before we get started, I did want to provide a quick disclaimer for the episode ahead. Today's episode features a discussion around hepatitis, and there will be some mildly graphic descriptions of its symptoms as well as modes of transmission, including various sexual activities. Listener discretion is advised.
Dustin: And with that said, today we are talking hepatitis. May 19 is National Hepatitis Testing Day, and I have the pleasure of sitting down with Dr. Ben Sokoloff, one of our incredible primary care providers at Prism Health, to talk about the importance of hepatitis testing, treatment and prevention. Welcome to the show, Dr. Sokoloff.
Dr. Sokoloff: Hey, thanks for having me here.
Dustin: We're really excited to get into today's topic. But before we get started, do you mind introducing yourself and telling us a little more about your professional background in medicine?
Dr. Sokoloff: Sure. Yeah. So I grew up in Michigan, suburbs of Detroit, came out to my parents as gay at Michigan State University. I then got my degree from medical school in Florida at Nova Southeastern University, and subsequently did my internal medicine training in Portland, Oregon, and subsequent HIV and hepatitis fellowship through the University of Massachusetts.
Well, it sounds like your studies have taken you all over the country, so we're really happy to have you back in Portland with us. For those who aren't very familiar with or perhaps don't fully understand hepatitis, could you give us an overview of hepatitis and the types of viruses that cause it and their impacts on the body?
Dr. Sokoloff: Sure. Well, I'll back up for a sec and just say that hepatitis itself really just refers to any kind of inflammation of the liver. It can be caused by a very wide differential of causes, one of which does include viruses. And there are four common viruses that we will often refer to that infect the liver. And they each have their own unique traits. So there's A, B, C, and E. There is also a fifth one which is referred to as Delta, but which is not one that we generally test for, nor one that generally affects the common general population. Hepatitis A virus acts similarly to hepatitis E, and we can, in a sense, group those two together. Both of them really cause just acute or short-term liver inflammation. Neither one of them live in the body throughout your life or even long term. And both of them are transmitted through what we call fecal-to-oral transmission. And that means these viruses are transmitted through the GI tract, and any consumption of anything that might have some fecal contamination is a risk factor for transmission. And so when we think about that, we think about poor hygiene, not hand washing after using the restroom, perhaps other poor hygiene methods. Hepatitis B and C, in a sense, are also similar, and those are both chronic viruses. They have the potential to both live inside the body long term and life-long. Hepatitis B and C are also transmitted very similarly, so they can be transmitted through sexual activity, although more commonly they'll be transmitted through intravenous drug use or sharing of intravenous equipment such as syringes or needles. So hepatitis A and E, because those are acute viruses, those can present with nausea, vomiting, diarrhea, abdominal pain, or abdominal upset. People can be really sick, even requiring admission to an ICU. Or it could be more of a mild infection, and anywhere somewhere in between is a possibility as well. But most folks will recover from those viruses without specific directed treatment at those viruses.
Dustin: Got you. So when should someone seek out testing for hepatitis or how often should someone be tested for hepatitis?
Dr. Sokoloff: Yeah, that's a good question, too. So generally speaking, we don't test or screen for hepatitis A or for hepatitis E. We do screening for hepatitis B and C. For hepatitis C, it is recommended that folks be screened at least once in their lifetime between the ages of 18 and 65. And depending on which guidelines, those age ranges are very slightly different. It might be warranted to continue ongoing screening intermittently if there are ongoing risk factors for hepatitis B. We don't always do universal screening. That means we don't screen every single person for hepatitis B. Many folks in the US will have had vaccinations at a very young age for hepatitis B. And we may want to do a test for an antibody for hepatitis B. And some folks, if there's any question if they haven't been vaccinated, we might want to do screening, more so in folks who have many sexual partners who might be at higher risk through sexual transmission or for folks who are migrating here from other countries, or if they've migrated away in the past and haven't been tested since they've moved here, we might want to do that as well, because we do see it at a higher rate in other countries.
Dustin: And is it possible to treat any of the types of hepatitis you've mentioned?
Dr. Sokoloff: Unlike hepatitis A and E, we do have treatments for hepatitis B and C that are directed specifically at those viruses. Hepatitis C, we can, in fact, even cure. So it's a chronic, life-long infection, but we can cure that infection with the medications that we have nowadays and with a very high cure rate as well. Hepatitis B, we don't have the means to cure at this point, but we can very easily treat it long-term with the medications that we do have.
Dustin: And what might put someone at an elevated risk of contracting any of the types of hepatitis you've mentioned so far?
Dr. Sokoloff: Yeah. And that goes back to what are the risk factors for these viruses. For hepatitis A and B, it's a matter of hygiene. So folks who may not be able to maintain good hygiene. So we're thinking folks who might be homeless, unhoused, not have ready access to a shower or a sink. Those folks are at high risk for hepatitis A. The other group who are at higher risk for hepatitis A infection are folks who might participate in rimming or otherwise might have their mouth come in contact either with the anus rectum or through finger play that might involve the anus or rectum. And we can easily forget that we touch our face or mouth very commonly. So that is another method of transmission. And so we might focus our vaccinations on groups who are, of course, homeless, groups who may involve in any kind of sexual activities involving the anus or rectum. But of course, we try to vaccinate everyone. So that includes hepatitis A. We said that hepatitis A and E are similar. We don't have a vaccine for hepatitis E, but it's a similar method of transmission, and so the same risk factors apply. There's an additional risk factor for hepatitis E that is unique to hepatitis E, and it might be more aggressive in folks who are pregnant. And that's one of its common associations. Thankfully, we don't see hepatitis E nearly as much as the other viruses for hepatitis B and C. Again, going back to those risk factors, mainly are sexual and intravenous drug use and sharing of needles. It used to be once upon a time that another risk factor was transfusions, and that was prior to national screenings at blood banks. And we're thinking back to prior to ‘92, at least for hepatitis C. And so folks who have more sexual partners or perhaps frequent sexual partners or perhaps might be under sexual duress, perhaps, or having non consensual sex, those folks might be at higher risk for both hepatitis B and hepatitis C. There is one other risk factor for hepatitis C, which is less common, but it is associated with cocaine use as well. It's not something that we really see in our community here in Portland, but it is one possible other means of transmission.
Dustin: Well, now that we kind of have a better understanding of how hepatitis is transmitted, what are some ways that people can lower or eliminate their risk of contracting hepatitis? You mentioned the vaccines for hepatitis A and B, but what other preventative tools do folks have at their disposal?
Dr. Sokoloff: Yeah. So for hepatitis A and B, that's pretty easy. Vaccination is the best means of protection for hepatitis A. We have a vaccine that's been around for a long time, and same with hepatitis B. Hepatitis A only recently has the CDC suggested more universal vaccination for that. Prior to more recently, it was advocated in folks who were at higher risk or in areas where there were outbreaks of hepatitis A. But we've kind of moved past. That’s because we do see that the prevalence of outbreaks is increasing throughout the US. And so we are moving towards doing more universal vaccinations for hepatitis A. And we can also test for an antibody to see if perhaps someone has been vaccinated in the past and still has immunity for hepatitis B. Like I said, there's also been vaccination for a long time. Usually vaccination is universal. That means we vaccinate everyone starting at a young age. And of course, there are people who don't have that vaccination early on. Perhaps they slip through the cracks or perhaps had parents who were averse to vaccination at that age. And so we can definitely do catch up vaccinations for anyone who hasn't had that vaccine at an early age. And in some cases, some people won't respond to the hepatitis B vaccine series. And so we might repeat the vaccine or perhaps use a different form of the vaccine. For hepatitis A and E, just keeping good hygiene practices. If bottoming for sexual partners, just using good hygiene measures, showering, perhaps even douching might provide some reduced risk. But I don't think we have enough evidence to provide that. For hepatitis B and C, using safe sexual measures can reduce that risk. Condom usage certainly can reduce that risk for penetrative sex. If there's any blood play in your sexual activities, that could be a risk factor for transmission for both of those. And one means of perhaps reducing that risk would just be avoiding sharing of blood, any means of passing blood from one exposed cut to someone else's exposed cut, not consuming any blood from other persons. Those might reduce the risk for transmission. And we can think of this, too, as also perhaps reducing risk for HIV transmission as well. And then for those who may use injection drugs, having a sterile needle exchange program is a great means of reducing risk. And in Portland, we do have access to syringe services programs. That may not be the case everywhere, but I would definitely encourage discussing that with your doctor if you might be using intravenous drugs and might be at higher risk for acquisition of either hepatitis B or C.
Dustin: Well, it sounds like folks have a lot of prevention tools at their disposal when it comes to hepatitis, so thanks for walking us through all of those. I guess as we get ready to close out, what message do you feel is important to leave our listeners with on National Hepatitis Testing Day?
Dr. Sokoloff: Yeah. So I would say that hepatitis C, if I'm going to pick up one virus of them all, is prevalent in the US. It is one that we can test for. We can't vaccinate for it yet, but we can certainly cure it. And we can certainly prevent both liver cancer, liver disease, even death from hepatitis C by simply testing and treating. And we can definitely prevent infection with hepatitis A and B with vaccinations. And I would encourage everyone to obtain those vaccinations for themselves.
Dustin: Well, I just want to say thank you so much for spending today with us and sharing with us why it's just so critically important to understand hepatitis and how it impacts our community. For our listeners. To find out if more regular testing vaccination or treatment for hepatitis is right for you, we highly suggest talking to your primary care provider. You can also learn more about our care team at Prism health and if it could be a good fit for you by giving us a call at 503-445-7699 or online at www.prismhealth.org.
Outro: Well, that's our show for today, folks. Thanks so much for tuning in for another episode and we can't wait to share a new one with you really soon. In the meantime, if you have questions or comments, feel free to reach out to us at Comsat capnw.org. Until then, stay vibrant!
About Cascade AIDS Project
CAP is a non-profit organization that was founded in 1985 as a grassroots response to the AIDS crisis. As the oldest and largest community-based HIV services provider in Oregon and southwest Washington, we seek to support and empower all people with or affected by HIV, reduce stigma, and provide the LGBTQ+ community with compassionate healthcare. We do so by helping to ensure the health and well-being of our program participants each year through health, housing, and other social services. When the need for affordable, accessible, and culturally affirming primary care services was identified as a community need, we responded by opening Prism Health in 2017. More information can be found at www.capnw.org.
About Prism Health
Prism Health provides high quality, affordable, and accessible health care for all, with a focus on serving individuals who identify as lesbian, gay, bisexual, transgender, queer, plus all other gender and sexual minorities (LGBTQ+). All of Prism services aim to reach the most vulnerable – those living below the poverty line, communities of color, homeless or unstably housed individuals, and people experiencing mental health and/or addiction issues.
