Hepatitis viruses, especially B and C, can cause acute and chronic
infection and inflammation of the liver leading to cirrhosis and liver cancer.
World Hepatitis Day, a
day designated by the World Health Organization (WHO) in 2010 to mark the
importance of viral hepatitis as an important health issue that requires
worldwide attention.
The sanctioning of
World Hepatitis Day is deemed as a highly visible way to raise awareness of
viral hepatitis, and drives forward actions to improve prevention, diagnosis
and treatment of hepatitis B and C.
Hepatitis is a health
condition defined by inflammation of the liver, and is characterised by the
presence of inflammatory cells in the tissues of the organ.Hepatitis A is the least serious of these diseases, and it is an acute condition that is usually self-limiting. Most people get well after an extended period of rest, and the body will be able to totally get rid of the virus.
The greater burden on
the healthcare system would be the hepatitis B (HBV) and C (HCV) as they cause
longstanding or chronic infection (defined as existing for more than six
months).
It is estimated that
more than 500 million people worldwide are living with either chronic hepatitis
B or C, thus representing one of the biggest threats to global health, killing
approximately one million people a year.
However, awareness of
HBV and HCV is comparatively low, a situation made worse by the fact that a
large proportion of those infected do not know that they carry the virus.
According to Prof
Rosmawati Mohamed, consultant hepatologist (liver specialist) at the University
of Malaya Medical Centre (UMMC), awareness about hepatitis here is low. “It is
pretty much limited to the general notion that one can get all forms of
hepatitis from ingesting contaminated food and/or water. For example, there is
the misconception that you get hepatitis from eating cockles or shellfish, but
that is true only for hepatitis A.
“This is not the case
for HBV and HCV, which is spread through contact with infected bodily fluids
such as blood and other secretions.”
Addressing the media
at a press conference recently to announce the observance of World Hepatitis
Day 2012, Prof Rosmawati said that authorities must now put more emphasis on
HBC and HCV as these two diseases are now having a huge impact worldwide,
especially in the Asia Pacific region.
Of particular
importance to specialists like her is HCV. “The emphasis for this year is to
diagnose hepatitis C early and to treat it early, with effective treatment now
available. With chronic HCV, the continuous inflammation damages liver cells –
eventually killing them and leaving behind scar tissue. Scarring makes it
harder for the liver to function and may lead to liver failure over time. And
the liver is an organ people can’t live without, making the disease potentially
fatal.”
Worldwide, it has been
estimated that 170 million people have HCV, while the prevalence in South-East
Asia is about 30 million, or 2.2% of the population. In Malaysia, estimated
prevalence is about 2%.
“HCV screeing has only
been available in most parts of the world since the early 1990s, and Malaysia
implemented HCV screening for donated blood in 1993,” said Prof Rosmawati, who
added that HCV is estimated to kill over 350,000 people annually, while adding
that three to four million new cases occur each year.
“The majority of
patients have no symptoms, but by the time they present themselves to
hospitals, it may already be too late to offer any treatment. The lack of
symptoms contribute to late diagnosis, or underdiagnosis. This has grave
consequences as HCV is an important causal factor in end-stage liver cancer. ”
HCV gives few clues as to how much damage it may be causing as the infected
person may not look or feel sick. If symptoms do develop, they often are
non-specific (like nausea, fatigue, vague abdominal discomfort).
With chronic HCV,
liver damage is unpredictable, advancing slowly in some and quickly in others.
“It can take many years after being exposed to the virus for visible damage to
the liver to be detected,” said Prof Rosmawati.
Studies show that
about 10% to 20% of chronically infected persons progress to cirrhosis (final
stage of chronic liver disease) over an average of 20 years.
Faster rates of
progression (some as early as five years after diagnosis) are seen in persons
who are infected at an older age, or who have contributing risk factors such as
moderate or heavy alcohol consumption, human immunodeficiency virus (HIV), or
other coexisting liver diseases.
It is rare for someone
to be able to completely get rid of the HCV virus on his own without any
medication. Even then, most of the treatment modalities using pegylated
interferons and antivirals like ribavirin out there cannot guarantee total
success even after several courses over several years.
As such, many
individuals carry the HCV virus for life, though several clinical trials are
now in place to come up with more effective combination therapies to combat the
disease (see sidebar, Battling HCV, on a new drug called boceprevir from
Merck).
Those who are most at
risk of contracting HCV are intravenous drug abusers (more than 20% in most
cases), healthcare workers who are exposed to sharps like syringes as well as
blood or blood products, those who obtained tattoos and body piercings, those
undergoing haemodialysis, those with multiple sexual partners, as well as
children born to mothers with the disease.
In Malaysia, another
unique group of high-risk persons are those who had blood transfusions or organ
transplants before 1994 (as screening for HCV in the blood banks started only
in 1993).
The first screening
for HCV in 1993 found that 53 out of 3,540 blood donors were infected with the
disease. Similarly, 162 out of 190 intravenous drug users also have the virus.
There are no vaccines
to prevent hepatitis C infection, but the risk can be reduced by avoiding
unnecessary injections, body piercing with contaminated equipment, sharing of
personal items (like nail clippers, razors, toothbrushes, manicure/pedicure
tools) that may be contaminated with infected blood, and avoiding unprotected
sexual contact, especially with multiple partners.
Aware of the huge
burden of the disease, Prof Rosmawati, who is also an executive member of the
Coalition to Eradicate Viral Hepatitis in Asia Pacific (CEVHAP), and is working
with her fellow professionals to push through initiatives that can lead to a
nationwide screening for HCV in high-risk individuals, especially through this
year’s World Hepatitis Day events.
“People do not
normally associate HCV with liver disease. But one in every five people
infected with the virus will get scarring of the liver that could lead to
cancer. We need to stress that the disease is potentially life-threatening.”
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