July 28, 2025 • 30 mins
In this episode of The Paid Leave Podcast, I speak with a liver specialist from the Yale School of Medicine. World Hepatitis Day is observed each year on July 28th to raise awareness of viral hepatitis. The theme for 2025 is: "Hepatitis, Let’s Break it Down." It calls for urgent action to dismantle the financial, social and systemic barriers including stigma that stand in the way of hepatitis elimination and liver cancer prevention. I spoke with Yale's Dr. Bubu Banini, who is an assistant professor of medicine at the Yale School of Medicine, and works at the Yale Liver Center and volunteers on a regular basis with the American Liver Foundation. Dr. Banini goes on to explain the importance of the liver and the various types of viral hepatitis (A, B, C, D, E, G). She highlights the social barriers and is hoping to negate the stigma associated with liver diseases. Dr. Banini also discusses the effectiveness of vaccinations and treatments for chronic viral hepatitis, such as hepatitis C, and the importance of mental health support for patients. Dr. Banini emphasizes the benefits of the Connecticut Paid Leave program for caregivers and patients dealing with chronic liver diseases.
For more information about the American Liver Foundation please go to their website at: Liver - American Liver Foundation
For more information about the Yale Liver center: Yale Liver Center < Liver Center
To get in touch with Dr. Bubu Banini please go to: Bubu Banini, MD, PhD < Yale School of Medicine
For more information or to apply for benefits please go to: CT Paid Leave
https://ctpaidleave.org/s/?language=en_US
https://www.facebook.com/CTPaidLeave
https://www.instagram.com/ctpaidleave/
https://twitter.com/CTPaidLeave
https://www.youtube.com/results?search_query=ct+paid+leave
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Nancy Barrow (00:01):
Hello Connecticut, give you information you should
know about Connecticut PaidLeave and maybe just a little
(00:29):
World Hepatitis Day is observedeach year on July 28, to raise
awareness of viral hepatitis aninflammation of the liver. The
theme for 2025 is "Hepatitis.
Let's break it down." It callsfor urgent action to dismantle
the financial, the social andsystemic barriers, including
stigma, that stand in the way ofhepatitis elimination and liver
cancer prevention. Millions ofAmericans from all walks of life
(00:52):
are living with viral hepatitis,and most don't know they even
have the virus. More than halfof the people living with
hepatitis don't know they haveit and are unknowingly
transmitting the virus toothers. Here to talk more about
hepatitis, is Dr Bubu Banini. DrBubu Banini is an assistant
professor at the Yale School ofMedicine, where she also serves
(01:14):
as the Translational ResearchDirector of the metabolic health
and weight management program.
She also serves as the AssociateDirector of the clinical and
translational core of the Yaleliver Center. Dr Banini has
board certifications ingastroenterology, transplant
hepatology and obesity medicine.
Her clinical and researchinterests are in chronic liver
(01:36):
diseases, specifically metabolicdysfunction associated sciatic
liver disease. Dr Baninirecently co chaired the fatty
liver disease working groupestablished by the Connecticut
State General Assembly toprovide recommendations to the
state on how to increaseawareness and to improve care
for people living with liverdisease. She serves on various
(01:57):
boards and committees, includingstudy sections of the National
Institutes of Health committeesbit more. Connecticut Paid Leave
brings peace of mind to yourfor the American Association for
the Study of Liver Diseases andthe American Gastroenterology
Association and on the NationalMedical Visionary Advisory Board
for the American Liverhome, family and workplace.
Welcome to The Paid LeaveFoundation. Welcome to The Paid
Leave podcast Dr. Banini.
(02:18):
Podcast!
Dr. Banini (02:19):
Thank you so very much. Nancy, it's a pleasure to
be here today.
Nancy Barrow (05:52):
Since we're here to talk about World Hepatitis
Day, yes. What is hepatitis?
Dr. Banini (05:57):
Yes so when we say hepatitis, it really is a term
that refers to inflammation ofthe liver. And in that word, it
doesn't really tell you what iscausing the inflammation. So
essentially, you know, layman'sterms is just hepatitis means
inflammation. And so we are ableto further characterize what the
(06:23):
inflammation is related to bysaying viral hepatitis, or
alcohol, as you should say,hepatitis. So the World
Hepatitis Day, as you mentioned,is coming up on the 28th of
July, and that the focus of thatis on viral hepatitis. This is
(06:43):
in recognition of the fact thatthere are various viruses that
can lead to inflammation of theliver, hepatitis, as I
mentioned, and over time, someforms of those hepatitis
infections can cause long termdamage that can cause chronic
liver disease, that can then putthe individual at risk for end
(07:07):
stage liver disease and cancer.
So these can really be veryserious.
Nancy Barrow (07:14):
How do they usually get diagnosed? And it is
ike a simple blood test thatlet's you know you have
heapatitis or is there moretesting that needs to get done?
Dr. Banini (07:23):
Yeah, that's a good question. That's a great
question. A lot of times, thepatient may present with what we
call jaundice, so yellowing oftheir eyes and skin, and that
really is a signal that there'ssomething severely wrong with
the liver. And as you mentioned,typically, the diagnosis is
(07:45):
blood based. And so thedifferent types of hepatitis
that one can get our viralhepatitis A, or have a, for
short, we can also have viralhepatitis B, hepatitis C,
hepatitis D and hepatitis E, aswell as the newest form of viral
(08:09):
hepatitis, which is hepatitis G.
You know, viral hepatitis G wasidentified in 1995 so about 30
years ago, and so we do not knowmuch about it in comparison with
other hepatitis that have beenaround for for much longer. And
so some people refer to viralhepatitis G as human Peggy virus
(08:30):
one. So HP, HPG, v1, that isanother name for that.
Nancy Barrow (08:41):
Interesting. So what are the differences with A,
B, C, D and E? And how do theyaffect you differently?
Dr. Banini (08:49):
So viral hepatitis A typically causes acute
hepatitis. It is a highlycontagious, usually short term
form of viral hepatitisinfection, and that can spread
quickly from person to personwhen they consume contaminated
(09:10):
foods or drinks. Oh, wow. It cancause severe inflammation to the
liver, and it is typicallyprevented by vaccination. So a
lot of times, individuals mayget a vaccine which combines
viral hepatitis A and B, andwith that series of
(09:34):
vaccinations, it protects themfrom contracting the infection
when they are exposed. Sodespite that, unfortunately,
some individuals still succumbto viral hepatitis A in the
(09:54):
setting of not having beenvaccinated. So usually we. Have
about 100 deaths a year in theUS related to viral hepatitis.
You We also mentioned the othertypes of viral hepatitis, B and
C are the most common forms ofchronic viral hepatitis that we
(10:19):
encounter. There is a largepercentage of patients who will
clear the infection shortlyafter they contract it. However,
a percentage of individuals whocontracted go on to develop a
chronic infection from hepatitisB or C. We also have viral
(10:42):
hepatitis D, which a lot oftimes we see it piggybacking on
viral hepatitis B, so those whohave viral hepatitis B have a
more higher risk of alsocontracting hepatitis D, and
that can also lead to severeliver injury, especially in the
(11:03):
setting of having both viralhepatitis B and D and then E. I
mentioned as well. That can alsobe found in contaminated foods,
so typically a shed through thestool of infected individuals,
and we see that causing disease,and typically in young children
(11:29):
and in pregnant individuals. Itouch briefly on hepatitis G as
well, and then HumanImmunodeficiency Virus or HIV
can also cause severe liverdisease, and we see that
sometimes occurring togetherwith chronic viral hepatitis C.
(11:50):
So an individual may have coinfection, which means there's
both HIV and chronic hepatitis Caffecting the liver.
Nancy Barrow (12:01):
Are they all contagious?
Dr. Banini (12:04):
So they are so contagious in terms of the fact
that, yes, they can be spreadfrom one person to the other
through different ways. As Imentioned, the subtypes of viral
hepatitis A and E can be foundspread through contaminated
foods, contaminated drinks,viral hepatitis B and C
(12:28):
typically spread through cominginto contact with infected body
fluids. So that could be usingthe same household items that
exposes one person's blood tothe other, or through sexual
contact or using needles, forinstance, that are infected,
(12:49):
whether it is through IV druguse, or sometimes in healthcare
workers, where they happen tohave a needle prick from a
patient who may have had chronicviral hepatitis B or C that can
be spread to them through thatmeans.
Nancy Barrow (13:07):
Boy, that's that's a little bit scary. What are
some of the treatments for thedifferent forms of hepatitis?
Are there treatments that thatwork, and can they be cured?
Dr. Banini (13:17):
Yes, yes. So absolutely. The good news is
that we do have treatments,especially for the chronic viral
hepatitis subtypes, so chronicviral hepatitis C can be cured
with almost close to 100% curerate. And that really was not
(13:38):
the case, you know, a couple ofdecades ago, or actually even
less than that time, in a matterof few months, they would have
close 100% cure, if they areconsistent with taking it as
prescribed. So that is really agreat success that we're able to
offer that.
Nancy Barrow (13:58):
Yeah and how about a and b and and and D. Are they
more difficult to treat?
Dr. Banini (14:03):
Yeah so, viral hepatitis A, typically, we are
able to support patients throughthe acute infection supportive
care, being able to, you know,give them things like Tylenol
and fluids and helping withwhether other symptoms that they
(14:27):
contract. And a lot of times,they're able to get through that
acute viral hepatitis Ainfection. Again, the goal is to
prevent getting it in the firstplace. So if
Nancy Barrow (14:41):
How do you prevent it? That's, that's a great
segueway, like, how do youprevent it, though?
Dr. Banini (14:46):
Key I think is having access or getting that
vaccine, if you are able to, Imentioned that we have
vaccinations that are availablefor very. Viral hepatitis A and
viral hepatitis B, hepatitis Cdoes not have a vaccine, but we
(15:06):
do have it for hepatitis A and Band so typically, with the
series of vaccinations. So forviral hepatitis A is two
vaccinations done at, you know,baseline and then after six
months. And for hepatitis B, isthree vaccinations, then at
baseline, at one month, and thenat six months. And that really
(15:30):
gives you protection from fromcontracting it. If one has not
had the vaccination forprotection, then you really want
to be careful in terms of whatyou're eating, what you're
drinking, and that's in the caseof viral hepatitis A, because,
like I mentioned, it can becontracted through exposure to
(15:52):
dirty foods and drinks, and forviral hepatitis B and C, making
sure that you really arevigilant with contacts, in terms
of sexual contacts, in terms ofin the healthcare field, being
careful not to expose yourselfto contaminated needles that may
(16:15):
cause that. Another way throughwhich people can contract
chronic viral hepatitis B and Cis through tattoos. So now, now,
methods for tattoos are a lotmore sanitary than several years
ago, where people would sort ofhave tattoos done by their
friends and their garage or andunfortunately, sometimes the
(16:40):
needles that I use for thosetattoos are not properly
standardized, and so if thatneedle was used in an individual
who had chronic viral hepatitisand then used on the next
person, there was the chancethat it could get transmitted to
them. And then something elsethat I wanted to mention is the
(17:00):
opioid epidemic. Unfortunately,we've heard about that ravaging
our communities in the pastseveral years, and that was
another way through whichchronic viral hepatitis could be
transmitted from one personusing a needle to inject opioids
and then the next person usingthe same needle. So there was a
(17:23):
period of time where we wereseeing an uptick, especially in
chronic viral hepatitis Crelated to the opioid epidemic,
and thankfully, over the lastyear, so it seems to be going
down. So that that really issomething for people to be aware
of.
Nancy Barrow (17:41):
Do some forms of hepatitis cause liver failure or
liver cancer?
Dr. Banini (17:46):
Yes, really, any kind of acute viral hepatitis
infection can increase the riskof liver failure, and this
occurs when the infection is sosevere that it really overwhelms
(18:07):
the body and starts to shutdown. The liver is function. And
as I mentioned, we work with anumber of other specialists as
because we know that the liveris very interconnected with
other organs. And so really, intrue sense of the word failure,
(18:28):
liver failure means the liverreally cannot sustain its
multiple functions. I mentionedthat there are over 500
different functions that theliver can do. And so in that
setting, then we start to lookinto the possibility of the
individual getting a livertransplant, because that
(18:50):
sometimes is the only waythrough which the person can be
saved. So that happens typicallyin the setting of acute viral
hepatitis infection. I do wantto note that sometimes when
individuals have chronic viralhepatitis infection, they can be
a reactivation of flare of thatchronic viral hepatitis so we
(19:16):
see that sometimes in those whohave chronic viral hepatitis B,
that the disease has been underfairly good control for several
years, and then you may have aflare, which then puts them into
acute liver injury, and that canlead to failure. And then, in
(19:36):
terms of chronic viral hepatitisinfection, any kind of
hepatitis. And going back to thebeginning of the program, I
mentioned that hepatitis reallyrefers to inflammation of the
liver. And so any thing thatcontinuously makes the liver
inflamed, this doesn't go away.
It keeps on causinginflammation. And day in, day
(19:59):
out, continuously, can put theliver at risk for scarring. And
in the medical terms, we referto scarring of fibrosis, and it
is an attempt by the liver toregenerate and recover from that
chronic insult that it keepsseeing, and as it keeps on
(20:22):
trying to regenerate, it getsmore cells, and some of them
really put the liver at risk forhaving that scar tissue, and
also put the liver at risk forbecoming cancerous. So we do see
individuals with chronic liverdisease developing cancer when
(20:44):
persons have the most advancedform of scarring. So typically
when you develop scarring, itstarts mild, and then they it
can advance. And advancedscarring, which we call
(21:05):
fibrosis, stage four orcirrhosis, increases the risk
for liver cancer. And so we arevery vigilant in those
individuals that have advancedscarring or advanced fibrosis,
we need to image their liverevery six months so that, God
(21:26):
forbid, they ever get livercancer. We can't catch the
cancer early, because sooner wecatch the liver cancer, the more
options available to offer thepatient, as opposed to when the
liver cancer is caught too late,at that time, we don't have good
options for cure.
Nancy Barrow (21:49):
Well, this year's theme is hepatitis. Let's break
it down, and it calls for actionto dismantle the financial,
social and systemic barriers,including stigma. Let's talk
about this. Why is there such astigma attached to hepatitis?
Dr. Banini (22:02):
I think it is due to a number of factors. So when we
think about chronic viralhepatitis, hepatitis B,
hepatitis C, a number of waysthat people contracted, as I
mentioned, is through contactwith others body fluids that
(22:24):
have already been infected. Sowhether it's through IV needle
use, IV drug use, or throughsexual contact, and I think
there is a stigma in thatsetting, that when someone sees
that they have hepatitis theneverybody, everybody may be
looking at them as havingengaged in one of those
(22:47):
practices, whether it's throughdrug use or having had
unprotected sex with someone whohad the disease. And so there's
stigma in that way. There's alsostigma in other forms of chronic
liver disease, for instance,alcohol related liver disease.
So in that setting, typically,we find that alcohol liver
(23:11):
disease affects those who usemoderate to high amounts of
alcohol, and so the individualmay not be willing to share that
they have alcohol dependence,because of the stigma that comes
from society in sort of lookingat that person and judging them
as having engaged in thosehabits. And so in recognition of
(23:34):
that stigma, actually the the NI triple A, which is the
national association that looksat alcohol abuse disorders has
recommended using terminologythat is non stigmatizing, so
that instead of sayingalcoholic, we are encouraged to
(23:59):
Say alcohol associated, so thatpeople are getting away from
using alcoholic liver disease tosaying alcohol associated liver
disease, instead of seeingalcohol addiction or someone has
engaged in alcoholism, we wouldsay alcohol use disorder again,
To take away that stigma ofputting almost the blame on the
(24:23):
person and recognizing that is adisorder that resulted in that,
just as any other disorder canreally result in disease.
Nancy Barrow (24:34):
Connecticut Paid Leave helps offer up to 12 weeks
of income replacement while youtake time away from work to tend
to your own serious healthcondition or that of a loved
one. So you can take time awayfrom work and get income
replacement to diagnose or treathepatitis and if it's a chronic
health condition, like you hadmentioned, you can take those 12
weeks year after year if thereare flare ups. How does a
(24:57):
program like Connecticut paidleave help your patients and
their caregivers?
Dr. Banini (25:02):
Yeah. I mean, it is very challenging at times to
take care of someone who has achronic liver disease when the
disease is in advanced stages orwhen it's very severe and
individuals need to get a livertransplant. For instance, it
would require the primarycaregiver to take time off to
(25:25):
care for their loved ones,because really they need almost
20 or seven care and attentionin that setting. So that
Connecticut paid leave wouldgive patients and also their
caregivers the peace of mindthat they can take the time off
that is necessary to care fortheir loved ones, but still be
(25:47):
able to pay their bills evenwhile they do that.
Nancy Barrow (25:53):
Yeah, I know I stress during that time is not
good for you either. So, so Ithink connected leave is sort of
like a stress reliever in thefact that you don't have to
worry about paying your bills.
Dr. Banini (26:02):
Absolutely that really, I mean, with everything
that's going through, takingaway that stress that comes with
financial strain is a big help.
Nancy Barrow (26:17):
Do you encourage people to seek mental health
care when they have a diagnosisof hepatitis?
Dr. Banini (26:22):
Yes, I think it can be very mentally and
psychologically challenging. Noteverybody, necessarily may need
mental health support, but thereare some individuals, especially
those that may have had thedisease for several years and
ended up having complicationsfrom those conditions. Might be
(26:49):
my benefit from speaking to amental health provider to get
the support that is necessary. Iencourage my patients that as
much as they are providers thatare trained to care for their
body. They are also providersare trained to care for their
mind, and so patients should alltheir caregivers should not have
(27:11):
hesitation about asking forsupport for for their mind,
because we know that the mindreally works very closely with
the body, and supporting both ofthose components is essential.
Nancy Barrow (27:22):
What would you like to see happen duringWorld
Hepatitis Day on July 28th?
Dr. Banini (27:27):
I think this is a great avenue for people to learn
about hepatitis, learn aboutviral hepatitis, learn about
other types of chronic liverdiseases and build awareness. We
know that more than half ofpeople who have chronic liver
(27:50):
disease, including hepatitis, donot know, and that's why the
transmission rate can also behigh, because without knowing,
they don't take the necessaryprecaution to prevent
transmitting it to other people.
And so I think this is really agreat avenue for education for
all parties involved, to try andmove forward knowledge about the
(28:14):
liver, and also try and moveforward knowledge about how to
care for those with chronicliver disease, I do want to put
a plug in that, as much as weare celebrating World Hepatitis
Day on July 28 the state ofConnecticut also in recognition
especially of the fact thatmetabolic dysfunction associated
(28:35):
liver disease is causing a highprevalence of chronic liver
disease in Connecticut and otherparts of the US came up, put
together a working group forwhich I was fortunate to co
chair last year and earlier thisyear, and we put forward a set
(28:58):
of 20 recommendations to thestate as to how we can increase
awareness of chronic liverdisease. And Connecticut is
going to have its firstConnecticut liver health day
next April. April 19, 2026, soI'm excited about that. So I
(29:18):
think these really are avenuesto increase awareness about
chronic liver disease.
Nancy Barrow (29:25):
I want to thank my incredible guest and brilliant
guest, Dr Bubu Banini from theYale School of Medicine, for
joining me on the paid leavepodcast. Thank you so much for
taking time out of your verybusy schedule to join us. I know
you're really busy!
Dr. Banini (29:39):
Thank you so very much. Nancy, it's been a
pleasure!
Nancy Barrow (29:42):
For more information or to apply for
benefits, please go toctpaidleave.org. This has been
another edition of The PaidLeave Podcast. Please like and
subscribe, so you'll be notifiedabout new podcasts that become
available. Connecticut PaidLeave is a public act with a
personal purpose. I'm NancyBarrow, and thanks for
(30:03):
listening.
Hello Connecticut, give you information you should
know about Connecticut PaidLeave and maybe just a little
(00:29):
World Hepatitis Day is observedeach year on July 28, to raise
awareness of viral hepatitis aninflammation of the liver. The
theme for 2025 is "Hepatitis.
Let's break it down." It callsfor urgent action to dismantle
the financial, the social andsystemic barriers, including
stigma, that stand in the way ofhepatitis elimination and liver
cancer prevention. Millions ofAmericans from all walks of life
(00:52):
are living with viral hepatitis,and most don't know they even
have the virus. More than halfof the people living with
hepatitis don't know they haveit and are unknowingly
transmitting the virus toothers. Here to talk more about
hepatitis, is Dr Bubu Banini. DrBubu Banini is an assistant
professor at the Yale School ofMedicine, where she also serves
(01:14):
as the Translational ResearchDirector of the metabolic health
and weight management program.
She also serves as the AssociateDirector of the clinical and
translational core of the Yaleliver Center. Dr Banini has
board certifications ingastroenterology, transplant
hepatology and obesity medicine.
Her clinical and researchinterests are in chronic liver
(01:36):
diseases, specifically metabolicdysfunction associated sciatic
liver disease. Dr Baninirecently co chaired the fatty
liver disease working groupestablished by the Connecticut
State General Assembly toprovide recommendations to the
state on how to increaseawareness and to improve care
for people living with liverdisease. She serves on various
(01:57):
boards and committees, includingstudy sections of the National
Institutes of Health committeesbit more. Connecticut Paid Leave
brings peace of mind to yourfor the American Association for
the Study of Liver Diseases andthe American Gastroenterology
Association and on the NationalMedical Visionary Advisory Board
for the American Liverhome, family and workplace.
Welcome to The Paid LeaveFoundation. Welcome to The Paid
Leave podcast Dr. Banini.
(02:18):
Podcast!
Dr. Banini (02:19):
Thank you so very much. Nancy, it's a pleasure to
be here today.
Nancy Barrow (05:52):
Since we're here to talk about World Hepatitis
Day, yes. What is hepatitis?
Dr. Banini (05:57):
Yes so when we say hepatitis, it really is a term
that refers to inflammation ofthe liver. And in that word, it
doesn't really tell you what iscausing the inflammation. So
essentially, you know, layman'sterms is just hepatitis means
inflammation. And so we are ableto further characterize what the
(06:23):
inflammation is related to bysaying viral hepatitis, or
alcohol, as you should say,hepatitis. So the World
Hepatitis Day, as you mentioned,is coming up on the 28th of
July, and that the focus of thatis on viral hepatitis. This is
(06:43):
in recognition of the fact thatthere are various viruses that
can lead to inflammation of theliver, hepatitis, as I
mentioned, and over time, someforms of those hepatitis
infections can cause long termdamage that can cause chronic
liver disease, that can then putthe individual at risk for end
(07:07):
stage liver disease and cancer.
So these can really be veryserious.
Nancy Barrow (07:14):
How do they usually get diagnosed? And it is
ike a simple blood test thatlet's you know you have
heapatitis or is there moretesting that needs to get done?
Dr. Banini (07:23):
Yeah, that's a good question. That's a great
question. A lot of times, thepatient may present with what we
call jaundice, so yellowing oftheir eyes and skin, and that
really is a signal that there'ssomething severely wrong with
the liver. And as you mentioned,typically, the diagnosis is
(07:45):
blood based. And so thedifferent types of hepatitis
that one can get our viralhepatitis A, or have a, for
short, we can also have viralhepatitis B, hepatitis C,
hepatitis D and hepatitis E, aswell as the newest form of viral
(08:09):
hepatitis, which is hepatitis G.
You know, viral hepatitis G wasidentified in 1995 so about 30
years ago, and so we do not knowmuch about it in comparison with
other hepatitis that have beenaround for for much longer. And
so some people refer to viralhepatitis G as human Peggy virus
(08:30):
one. So HP, HPG, v1, that isanother name for that.
Nancy Barrow (08:41):
Interesting. So what are the differences with A,
B, C, D and E? And how do theyaffect you differently?
Dr. Banini (08:49):
So viral hepatitis A typically causes acute
hepatitis. It is a highlycontagious, usually short term
form of viral hepatitisinfection, and that can spread
quickly from person to personwhen they consume contaminated
(09:10):
foods or drinks. Oh, wow. It cancause severe inflammation to the
liver, and it is typicallyprevented by vaccination. So a
lot of times, individuals mayget a vaccine which combines
viral hepatitis A and B, andwith that series of
(09:34):
vaccinations, it protects themfrom contracting the infection
when they are exposed. Sodespite that, unfortunately,
some individuals still succumbto viral hepatitis A in the
(09:54):
setting of not having beenvaccinated. So usually we. Have
about 100 deaths a year in theUS related to viral hepatitis.
You We also mentioned the othertypes of viral hepatitis, B and
C are the most common forms ofchronic viral hepatitis that we
(10:19):
encounter. There is a largepercentage of patients who will
clear the infection shortlyafter they contract it. However,
a percentage of individuals whocontracted go on to develop a
chronic infection from hepatitisB or C. We also have viral
(10:42):
hepatitis D, which a lot oftimes we see it piggybacking on
viral hepatitis B, so those whohave viral hepatitis B have a
more higher risk of alsocontracting hepatitis D, and
that can also lead to severeliver injury, especially in the
(11:03):
setting of having both viralhepatitis B and D and then E. I
mentioned as well. That can alsobe found in contaminated foods,
so typically a shed through thestool of infected individuals,
and we see that causing disease,and typically in young children
(11:29):
and in pregnant individuals. Itouch briefly on hepatitis G as
well, and then HumanImmunodeficiency Virus or HIV
can also cause severe liverdisease, and we see that
sometimes occurring togetherwith chronic viral hepatitis C.
(11:50):
So an individual may have coinfection, which means there's
both HIV and chronic hepatitis Caffecting the liver.
Nancy Barrow (12:01):
Are they all contagious?
Dr. Banini (12:04):
So they are so contagious in terms of the fact
that, yes, they can be spreadfrom one person to the other
through different ways. As Imentioned, the subtypes of viral
hepatitis A and E can be foundspread through contaminated
foods, contaminated drinks,viral hepatitis B and C
(12:28):
typically spread through cominginto contact with infected body
fluids. So that could be usingthe same household items that
exposes one person's blood tothe other, or through sexual
contact or using needles, forinstance, that are infected,
(12:49):
whether it is through IV druguse, or sometimes in healthcare
workers, where they happen tohave a needle prick from a
patient who may have had chronicviral hepatitis B or C that can
be spread to them through thatmeans.
Nancy Barrow (13:07):
Boy, that's that's a little bit scary. What are
some of the treatments for thedifferent forms of hepatitis?
Are there treatments that thatwork, and can they be cured?
Dr. Banini (13:17):
Yes, yes. So absolutely. The good news is
that we do have treatments,especially for the chronic viral
hepatitis subtypes, so chronicviral hepatitis C can be cured
with almost close to 100% curerate. And that really was not
(13:38):
the case, you know, a couple ofdecades ago, or actually even
less than that time, in a matterof few months, they would have
close 100% cure, if they areconsistent with taking it as
prescribed. So that is really agreat success that we're able to
offer that.
Nancy Barrow (13:58):
Yeah and how about a and b and and and D. Are they
more difficult to treat?
Dr. Banini (14:03):
Yeah so, viral hepatitis A, typically, we are
able to support patients throughthe acute infection supportive
care, being able to, you know,give them things like Tylenol
and fluids and helping withwhether other symptoms that they
(14:27):
contract. And a lot of times,they're able to get through that
acute viral hepatitis Ainfection. Again, the goal is to
prevent getting it in the firstplace. So if
Nancy Barrow (14:41):
How do you prevent it? That's, that's a great
segueway, like, how do youprevent it, though?
Dr. Banini (14:46):
Key I think is having access or getting that
vaccine, if you are able to, Imentioned that we have
vaccinations that are availablefor very. Viral hepatitis A and
viral hepatitis B, hepatitis Cdoes not have a vaccine, but we
(15:06):
do have it for hepatitis A and Band so typically, with the
series of vaccinations. So forviral hepatitis A is two
vaccinations done at, you know,baseline and then after six
months. And for hepatitis B, isthree vaccinations, then at
baseline, at one month, and thenat six months. And that really
(15:30):
gives you protection from fromcontracting it. If one has not
had the vaccination forprotection, then you really want
to be careful in terms of whatyou're eating, what you're
drinking, and that's in the caseof viral hepatitis A, because,
like I mentioned, it can becontracted through exposure to
(15:52):
dirty foods and drinks, and forviral hepatitis B and C, making
sure that you really arevigilant with contacts, in terms
of sexual contacts, in terms ofin the healthcare field, being
careful not to expose yourselfto contaminated needles that may
(16:15):
cause that. Another way throughwhich people can contract
chronic viral hepatitis B and Cis through tattoos. So now, now,
methods for tattoos are a lotmore sanitary than several years
ago, where people would sort ofhave tattoos done by their
friends and their garage or andunfortunately, sometimes the
(16:40):
needles that I use for thosetattoos are not properly
standardized, and so if thatneedle was used in an individual
who had chronic viral hepatitisand then used on the next
person, there was the chancethat it could get transmitted to
them. And then something elsethat I wanted to mention is the
(17:00):
opioid epidemic. Unfortunately,we've heard about that ravaging
our communities in the pastseveral years, and that was
another way through whichchronic viral hepatitis could be
transmitted from one personusing a needle to inject opioids
and then the next person usingthe same needle. So there was a
(17:23):
period of time where we wereseeing an uptick, especially in
chronic viral hepatitis Crelated to the opioid epidemic,
and thankfully, over the lastyear, so it seems to be going
down. So that that really issomething for people to be aware
of.
Nancy Barrow (17:41):
Do some forms of hepatitis cause liver failure or
liver cancer?
Dr. Banini (17:46):
Yes, really, any kind of acute viral hepatitis
infection can increase the riskof liver failure, and this
occurs when the infection is sosevere that it really overwhelms
(18:07):
the body and starts to shutdown. The liver is function. And
as I mentioned, we work with anumber of other specialists as
because we know that the liveris very interconnected with
other organs. And so really, intrue sense of the word failure,
(18:28):
liver failure means the liverreally cannot sustain its
multiple functions. I mentionedthat there are over 500
different functions that theliver can do. And so in that
setting, then we start to lookinto the possibility of the
individual getting a livertransplant, because that
(18:50):
sometimes is the only waythrough which the person can be
saved. So that happens typicallyin the setting of acute viral
hepatitis infection. I do wantto note that sometimes when
individuals have chronic viralhepatitis infection, they can be
a reactivation of flare of thatchronic viral hepatitis so we
(19:16):
see that sometimes in those whohave chronic viral hepatitis B,
that the disease has been underfairly good control for several
years, and then you may have aflare, which then puts them into
acute liver injury, and that canlead to failure. And then, in
(19:36):
terms of chronic viral hepatitisinfection, any kind of
hepatitis. And going back to thebeginning of the program, I
mentioned that hepatitis reallyrefers to inflammation of the
liver. And so any thing thatcontinuously makes the liver
inflamed, this doesn't go away.
It keeps on causinginflammation. And day in, day
(19:59):
out, continuously, can put theliver at risk for scarring. And
in the medical terms, we referto scarring of fibrosis, and it
is an attempt by the liver toregenerate and recover from that
chronic insult that it keepsseeing, and as it keeps on
(20:22):
trying to regenerate, it getsmore cells, and some of them
really put the liver at risk forhaving that scar tissue, and
also put the liver at risk forbecoming cancerous. So we do see
individuals with chronic liverdisease developing cancer when
(20:44):
persons have the most advancedform of scarring. So typically
when you develop scarring, itstarts mild, and then they it
can advance. And advancedscarring, which we call
(21:05):
fibrosis, stage four orcirrhosis, increases the risk
for liver cancer. And so we arevery vigilant in those
individuals that have advancedscarring or advanced fibrosis,
we need to image their liverevery six months so that, God
(21:26):
forbid, they ever get livercancer. We can't catch the
cancer early, because sooner wecatch the liver cancer, the more
options available to offer thepatient, as opposed to when the
liver cancer is caught too late,at that time, we don't have good
options for cure.
Nancy Barrow (21:49):
Well, this year's theme is hepatitis. Let's break
it down, and it calls for actionto dismantle the financial,
social and systemic barriers,including stigma. Let's talk
about this. Why is there such astigma attached to hepatitis?
Dr. Banini (22:02):
I think it is due to a number of factors. So when we
think about chronic viralhepatitis, hepatitis B,
hepatitis C, a number of waysthat people contracted, as I
mentioned, is through contactwith others body fluids that
(22:24):
have already been infected. Sowhether it's through IV needle
use, IV drug use, or throughsexual contact, and I think
there is a stigma in thatsetting, that when someone sees
that they have hepatitis theneverybody, everybody may be
looking at them as havingengaged in one of those
(22:47):
practices, whether it's throughdrug use or having had
unprotected sex with someone whohad the disease. And so there's
stigma in that way. There's alsostigma in other forms of chronic
liver disease, for instance,alcohol related liver disease.
So in that setting, typically,we find that alcohol liver
(23:11):
disease affects those who usemoderate to high amounts of
alcohol, and so the individualmay not be willing to share that
they have alcohol dependence,because of the stigma that comes
from society in sort of lookingat that person and judging them
as having engaged in thosehabits. And so in recognition of
(23:34):
that stigma, actually the the NI triple A, which is the
national association that looksat alcohol abuse disorders has
recommended using terminologythat is non stigmatizing, so
that instead of sayingalcoholic, we are encouraged to
(23:59):
Say alcohol associated, so thatpeople are getting away from
using alcoholic liver disease tosaying alcohol associated liver
disease, instead of seeingalcohol addiction or someone has
engaged in alcoholism, we wouldsay alcohol use disorder again,
To take away that stigma ofputting almost the blame on the
(24:23):
person and recognizing that is adisorder that resulted in that,
just as any other disorder canreally result in disease.
Nancy Barrow (24:34):
Connecticut Paid Leave helps offer up to 12 weeks
of income replacement while youtake time away from work to tend
to your own serious healthcondition or that of a loved
one. So you can take time awayfrom work and get income
replacement to diagnose or treathepatitis and if it's a chronic
health condition, like you hadmentioned, you can take those 12
weeks year after year if thereare flare ups. How does a
(24:57):
program like Connecticut paidleave help your patients and
their caregivers?
Dr. Banini (25:02):
Yeah. I mean, it is very challenging at times to
take care of someone who has achronic liver disease when the
disease is in advanced stages orwhen it's very severe and
individuals need to get a livertransplant. For instance, it
would require the primarycaregiver to take time off to
(25:25):
care for their loved ones,because really they need almost
20 or seven care and attentionin that setting. So that
Connecticut paid leave wouldgive patients and also their
caregivers the peace of mindthat they can take the time off
that is necessary to care fortheir loved ones, but still be
(25:47):
able to pay their bills evenwhile they do that.
Nancy Barrow (25:53):
Yeah, I know I stress during that time is not
good for you either. So, so Ithink connected leave is sort of
like a stress reliever in thefact that you don't have to
worry about paying your bills.
Dr. Banini (26:02):
Absolutely that really, I mean, with everything
that's going through, takingaway that stress that comes with
financial strain is a big help.
Nancy Barrow (26:17):
Do you encourage people to seek mental health
care when they have a diagnosisof hepatitis?
Dr. Banini (26:22):
Yes, I think it can be very mentally and
psychologically challenging. Noteverybody, necessarily may need
mental health support, but thereare some individuals, especially
those that may have had thedisease for several years and
ended up having complicationsfrom those conditions. Might be
(26:49):
my benefit from speaking to amental health provider to get
the support that is necessary. Iencourage my patients that as
much as they are providers thatare trained to care for their
body. They are also providersare trained to care for their
mind, and so patients should alltheir caregivers should not have
(27:11):
hesitation about asking forsupport for for their mind,
because we know that the mindreally works very closely with
the body, and supporting both ofthose components is essential.
Nancy Barrow (27:22):
What would you like to see happen duringWorld
Hepatitis Day on July 28th?
Dr. Banini (27:27):
I think this is a great avenue for people to learn
about hepatitis, learn aboutviral hepatitis, learn about
other types of chronic liverdiseases and build awareness. We
know that more than half ofpeople who have chronic liver
(27:50):
disease, including hepatitis, donot know, and that's why the
transmission rate can also behigh, because without knowing,
they don't take the necessaryprecaution to prevent
transmitting it to other people.
And so I think this is really agreat avenue for education for
all parties involved, to try andmove forward knowledge about the
(28:14):
liver, and also try and moveforward knowledge about how to
care for those with chronicliver disease, I do want to put
a plug in that, as much as weare celebrating World Hepatitis
Day on July 28 the state ofConnecticut also in recognition
especially of the fact thatmetabolic dysfunction associated
(28:35):
liver disease is causing a highprevalence of chronic liver
disease in Connecticut and otherparts of the US came up, put
together a working group forwhich I was fortunate to co
chair last year and earlier thisyear, and we put forward a set
(28:58):
of 20 recommendations to thestate as to how we can increase
awareness of chronic liverdisease. And Connecticut is
going to have its firstConnecticut liver health day
next April. April 19, 2026, soI'm excited about that. So I
(29:18):
think these really are avenuesto increase awareness about
chronic liver disease.
Nancy Barrow (29:25):
I want to thank my incredible guest and brilliant
guest, Dr Bubu Banini from theYale School of Medicine, for
joining me on the paid leavepodcast. Thank you so much for
taking time out of your verybusy schedule to join us. I know
you're really busy!
Dr. Banini (29:39):
Thank you so very much. Nancy, it's been a
pleasure!
Nancy Barrow (29:42):
For more information or to apply for
benefits, please go toctpaidleave.org. This has been
another edition of The PaidLeave Podcast. Please like and
subscribe, so you'll be notifiedabout new podcasts that become
available. Connecticut PaidLeave is a public act with a
personal purpose. I'm NancyBarrow, and thanks for
(30:03):
listening.
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