Silent but serious: Why more Canadians should be screened for Hepatitis B

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When Biniam Soquar came to Canada as a refugee 15 years ago, he had no idea he had chronic Hepatitis B (CHB).

Mr. Soquar, now 55, was asymptomatic when he immigrated from Eritrea, and only received the diagnosis after some routine blood work upon his arrival in Canada. It was a shock to receive the news from a physician at the health clinic, he says.

“I was scared. I didn’t know much about Hepatitis B,” says Mr. Soquar, who currently works as a refugee coordinator for a Calgary-based refugee clinic. “I thought it could be cancer, for example.”

Mr. Soquar’s story is a common one, says Dr. Scott Fung, a hepatologist with Toronto General Hospital. Hepatitis B, a liver infection caused by the Hepatitis B virus, can be either acute or chronic in patients. About 90 to 95 per cent of healthy adults who contract the virus clear it on their own within six months of infection. But if the illness does not resolve, it becomes chronic, and the patient must be monitored by a health care professional, says Dr. Fung.

“I think that’s what makes it somewhat difficult to diagnose and care for Hepatitis B patients – when they’re chronic, they [often] have no symptoms,” he says. “And if they do have symptoms, they are usually non-specific, like fatigue, or abdominal pain where the liver is, under the right [side of the] rib cage.”

Because many people with CHB do not have symptoms, they may remain undiagnosed until severe complications arise, he adds.

Untreated CHB can damage the liver, leading to cirrhosis, which is scarring of the liver that can progress to liver failure. According to Dr. Fung, approximately 2-5 per cent of patients with Hepatitis B-induced cirrhosis eventually develop liver cancer every year, a disease that ranks as the third leading cause of cancer-related deaths globally.

Managing and treating CHB

In Canada, CHB is most often found in people who have immigrated from regions where the disease is endemic, says Dr. Fung – places such as Central, Southeast and East Asia and sub-Saharan Africa. He adds that the most common source of Hepatitis B infection worldwide is from mother to child during childbirth.

CHB affects over 262,000 people across Canada. However, with a diagnosis rate of just 58 per cent, a significant proportion of individuals may be unaware that they are living with the condition.

Once diagnosed with CHB, patients should be monitored through regular blood tests and liver ultrasounds, says Dr. Fung. These tools allow physicians to track the progression of the disease and determine whether any treatment is necessary.

“We are very lucky – we’ve had oral antiviral pills since the late 90s for treatment of Hepatitis B which have progressively gotten better and better with almost no risk of antiviral resistance and very few side effects,” he says. This year, the Canadian Association for the Study of the Liver (CASL) and the Association of Medical Microbiology and Infectious Diseases (AMMI) released updated guidelines for the management of CHB, expanding eligibility criteria and allowing more patients to benefit from these treatments.

Building on this progress, Dr. Fung underscores the importance of ongoing research in understanding CHB and enhancing patient care. “The focus is on finding ways to improve disease management and ultimately reduce the burden of living with chronic Hepatitis B,” he says.

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In Canada, screening for the Hepatitis B virus is currently limited to individuals identified as high-risk, which may result in missed opportunities to detect cases in the broader population.

In response to this challenge, the updated guidelines have expanded screening recommendations aimed at promoting earlier detection and intervention for CHB. Supporting this approach, Dr. Fung emphasizes the need for universal screening to ensure timely diagnosis of cases and prevent complications.

“Universal one-time screening of all adults is a proactive approach that could significantly improve diagnosis rates and allow for earlier treatment,” adds Dr. Fung.

Since his diagnosis, Mr. Soquar has been vigilant about getting blood tests and ultrasounds every six months. For a long time, he didn’t require any treatment, but a few years ago, his physician called: his test results revealed complications.

“My doctor noticed scarring on my liver and said I must start taking medication,” Mr. Soquar says. “That was a very scary moment for me. I thought my liver was gone.”

Mr. Soquar now needs to take antiviral treatments in the form of a daily pill to manage the risk of cirrhosis and to reduce, though not fully prevent, the chance of developing cancer. “I’m scared about what might happen if I don’t stay on top of my treatment,” he adds.

In addition to his regular monitoring, quantitative Hepatitis B surface antigen testing is also recommended as a tool to monitor treatment response and disease progression, according to the CASL/AMMI guidelines.

However, access to this essential diagnostic test remains uneven across Canada, posing challenges to optimal care for CHB patients. Dr. Fung emphasizes the importance of collaboration among policymakers, diagnostic laboratories and health care systems to enhance nationwide access to quantitative Hepatitis B surface testing. “Such efforts would enable better monitoring of treatment response and address patients’ needs more effectively,” he says.

Lifting stigma

In his work at the refugee clinic, Mr. Soquar draws on his experiences with CHB to educate and support others facing similar challenges. “Looking after my health has been a journey, but it’s helped me live my life. I hope others can see that it’s possible to take control and move forward,” he says.

Dr. Fung supports this proactive approach, saying that individuals with CHB can lead normal lives and maintain close relationships with friends, family and employers. He also notes that some patients have expressed concerns about the illness, particularly feelings of fear or anxiety.

“Some patients feel worried about how their diagnosis might affect their daily lives,” he says. “They may feel uncertain about managing work commitments or sharing details about their condition with employers. However, it’s important to understand that with proper care and treatment, CHB is a manageable condition.”

Dr. Fung encourages individuals to get tested if they believe they may be at risk, as early detection opens the door to effective treatment options and long-term health management.

“The more patients seek care and engage with their healthcare providers, the better equipped they are to protect their health and make informed decisions.”

Stigma may also prevent people from getting tested, Dr. Fung adds, but that could have life-threatening consequences.

“Really, the outlook is very good if we detect [CHB] early,” he says. But the most important thing is screening and getting care.

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