Hepatitis. Prevention, Diagnosis and Management

I read the pathetic story of a concerned citizen entitled, Hepatitis management in Nigeria: A red alert, published in the newspaper.
The writer said, “I find it compelling to call attention to the dangerous state of medical knowledge in Nigeria, as experienced in the last three years of my battling a chronic disease called Hepatitis B. Without prejudice to my respect for professionals in Nigeria, I owe it a duty as a concerned Nigerian to raise a red flag on this.”
The patient raised many issues: how the medical experts were unable to help him out of his dilemma; how he was able to join an hepatitis online community group abroad where he got the up-to-date information about the management of hepatitis; how he has been able to stay alive several years after the diagnosis; and how he lost a friend to the complications of hepatitis B Virus due to inadequate management.
There is also the issue of not knowing what to do, where to go for treatment and who to see when it comes to hepatitis.
While working at a National Paediatric Hospital, I had several encounters with many young men who are willing to donate blood to save the life of sick children, but most of them failed to meet the requirements, as they were infected with either Hepatitis B or C.
Also, women attending antenatal clinics were screened, and a few of them had the virus. Such women were counseled on the risk to the pregnancy, the possible effects on the unborn babies as well as on their partners.
Hepatitis is an inflammation/infection of the liver and can result in liver cell damage and destruction. Many people mistakenly think that hepatitis means viral hepatitis, and that all forms of hepatitis are contagious. Actually, the word ‘hepatitis’ just refers to any inflammation of the liver; or the irritation or swelling of liver cells from any cause.
Causes of hepatitis
Toxic hepatitis: This form can occur if someone drinks a lot of alcohol, takes certain illegal drugs or medications, or is exposed to poisons.
Viral hepatitis: There are lots of hepatitis viruses: from Hepatitis A virus to Hepatitis G virus. Though the viruses differ, they have one thing in common: They cause infection and inflammation that are harmful to liver cells.
Non viral infective hepatitis: Malaria Hepatitis and also autoimmune liver disease
The biggest obstacle confronting hepatitis treatment in Nigeria is not necessarily the deadly nature of the virus or even the spread of the disease, but a lack of awareness among Nigerians about the importance of discovering their hepatitis status.
Hepatitis B affects people of all ages. Most adults who become infected with Hepatitis B get rid of the virus within six months. This type of short infection is known as an acute case of Hepatitis B. About 10 per cent of adults infected with the Hepatitis B virus develop a chronic, life-long infection.
People with chronic infection may or may not have symptoms. Those who do not develop symptoms are referred to as carriers. Hepatitis B is acquired through contact with infected blood and body fluids. These viruses are usually transmitted by contaminated needles (in the case of intravenous drug users). Having unprotected sex with someone who is infected can also pass on the Hepatitis B virus. Having chronic Hepatitis B may lead to permanent liver damage, including liver cirrhosis and cancer.
The diagnosis of hepatitis B Virus is a major issue, as it has an impact on every part of life for the person who receives the diagnosis. It is a potentially chronic and life-limiting illness, associated with considerable social stigma, effects on quality of life, and consequences for decisions about work, relationships and having children.
Diagnosis of hepatitis B Virus is the first step in an effective treatment pathway for those with HBV. After diagnosis is treatment, but most of those infected stop at this first step partly due to reassurance by the health workers that there is no imminent danger, thereby postponing the evil day.
Chronic hepatitis B Virus happens if the hepatitis test (HBsAg) is repeated in six months from the time the test was first done and it came out as positive. It is said to be chronic HBV.
Hepatitis profile/viral markers :There are six parameters used in the management of HBV.
HBsAg — This is a marker of current infection or recent vaccine. Positive result means that the person is either infected or recently immunised. This is the first test and the beginning of the management. Every patient with positive result must be tested for the remaining HBV markers.
Anti-HBs — This is the marker of immunity from resolved infection or vaccine. Any patient with this is fully immunized either from the Hepatitis B vaccine or from total recovery from virus. This category of people don’t require treatment
Anti-HBc — This is a marker of current or past infection .It will show those that are recently infected (acute HBV) or those infected in the past (chronic carrier).
HBeAg — This is a marker of viral replication and infectivity. Any patient with a positive result is highly infected and may need adequate treatment.
Anti-HBe — This is a marker of the immune control in chronic hepatitis B
HBV DNA — This is a marker of viral replication commonly called viral load. Any patient with high viral load result is highly infected and will need adequate treatment. It is also used to monitor the progress with treatment.
ALT — This is a marker of liver inflammation, not a viral marker but a liver function test. When it is high, it shows the liver is undergoing inflammation.
Treatment
The treatments for acute and chronic infection are considered separately. The majority of hepatitis B Virus encountered in Nigeria is due to chronic infections. Treatment of acute hepatitis B Virus is supportive in most cases, consisting of bed rest, nutritional support and symptomatic management such as simple analgesia and anti-nausea medications.
The treatment of chronic HBV can be life-long and it is explained below:
General (lifestyle modification): Alcohol consumption should be ceased, cigarette smokers should be advised to quit, weight reduction with sound nutritional advice is ideal. Eat plenty of vegetables, legumes and fruits. Eat plenty of cereals, preferably whole grain, lean meat, fish, poultry, milk, yoghurt, cheese and regularly drinking water. AVOID SPOILT GROUNDNUTS/PEANUTS! Poorly preserved groundnuts contain toxins (aflatoxin)that are poisonous to the liver.
Vaccination: The diagnosis of hepatitis B is also an opportunity to prevent its spread through vaccination. The standard regime is at three doses at between zero and six months respectively. Post-vaccine laboratory test is required to be sure the person is fully immune.
For the person who has already acquired hepatitis B, it is too late to vaccinate against HBV, but further liver injury by another virus — hepatitis A — can be prevented.
Hepatitis B immune globulin is indicated as a post exposure prophylaxis for people at risk of developing hepatitis B because they have been recently exposed to body fluids of individuals who have hepatitis B.
Newborn treatment: Up to 90 per cent of infants born to HBeAg-positive mothers acquire the infection if untreated. The concurrent administration of two injectables Hepatitis B immunoglobulin and the Hepatitis B vaccine to the newborn immediately after birth is effective in preventing vertical transmission of the virus.
If the neonate has taken the two injectables, the mother with HBV infection can breastfeed the neonate safely because there is no increased risk of transmission. Children born to HBV-positive mothers should be assessed for their hepatitis B status after the completion of the course of vaccination.
Sexual partners of HBV positive persons should be counselled to protect themselves from sexual exposure to infectious body fluids such as semen and vaginal secretions, by using condoms; or by receiving full immunisation against hepatitis B virus.
Medication: The treatment may be appropriate in some patients. It is very rare that anti-viral drug treatment will lead to a cure for HBV infection.i.e.it is treatable but not curable. The long-term aim of treatment is to arrest or reverse the progression of liver damage, with the ultimate goal of preventing cirrhosis, cancer of the liver and liver failure.
Dr Adesanya has several certifications on Hepatitis management from western Australian government sponsored e-learning programme.