HEALTH: Yes, hepatitis b can be treated!

Infection of hepatitis B affects one-third of the world’s population. In the Philippines, one out of ten harbors the disease. This makes the country as having one of the world’s highest carriers of the virus.

And despite several educational campaigns conducted by government health agencies and various organizations, a lot of Filipinos still don’t know that there are now available treatments for the chronic disease.

“I would hear patients telling me that they were told that there is no medicine for hepatitis B and that it is a deadly disease,” recalled Dr. Jane D. Ricaforte-Campos, a liver and gastrointestinal disease specialist at the Medical Center Manila. “Since 1997, a lot of oral anti-viral medicines and a more potent anti-viral with immune-modulatory effects have become available to patients who have met the criteria for treatment.”

Dr. Ricaforte-Campos shared the information of her three male patients who lost the virus completely after completing a year of treatment. “One of these patients was a seafarer and was able to return to board the ship after a year of therapy,” she said.

It must be recalled that 50 out of the 142 overseas Filipino workers who were deported from the Middle East last year were found to be carriers of the hepatitis B virus (HBV), according to a Saudi-based medical association.

“I remember vividly the facial expression of my patients having been denied the opportunity to work abroad simply because they are carriers,” Dr. Ricaforte-Campos wrote in Vital Signs. “Although this may sound disappointing, I always emphasize to them that they should not lose hope because the chance to get hired will depend on the phase of infection.”

A recent survey conducted in various countries in Asia showed that ignorance is fueling the spread of HBV in the region. “Ignorance helps the transmission of the disease and the survey finds this ignorance results in people giving up on the chance of proper treatment,” said Dr. Nancy Leung, an expert on the disease and associate professor at the Chinese University of Hong Kong’s department of medicine and therapeutics. “They don’t think it’s important to be treated because they don’t have symptoms.”

HBV carriers are at risk of developing liver cirrhosis and liver cancer if they are not vaccinated or given the proper treatment.

In 1998, Senator Rene Cayetano was diagnosed of carrying the hepatitis B virus (HBV). But it was not four years later that alarming symptoms started to appear. The lawmaker would feel tired despite having enough sleep and his skin gradually turning yellow.

As the disease threatened to develop into cancer, friends, family, and even members of the senator’s staff volunteered to donate part of their livers to save his life. In 2003, the entire family went to the United States, where the senator underwent a successful liver transplant operation at the University of Southern California University Hospital.

But in June 24, 2003, Cayetano passed away, succumbing to abdominal cancer, which was diagnosed by doctors three months after his successful liver operation. Doctors diagnosed the cancer as having come from his previous liver.

The word hepatitis simply means “inflammation of the liver”. Oftentimes, doctors use it to refer to the diseases caused by hepatitis viruses. If a physician tells a patient, “You have hepatitis,” he means that the person has a viral disease caused by a virus that attacks the liver, and not necessarily that he has an inflamed liver.

So far, medical scientists have discovered six different kinds of hepatitis: A, B, C, D, E, and G. A different virus causes each of these. Five types cause disease in the liver while one (hepatitis G) lives in the blood without causing any apparent illness. All five disease-carrying viruses are responsible for more than 98 percent cases of viral hepatitis.

Unknowingly, “hepatitis viruses cannot live outside a cell,” points out Professor John S. Tam, of the Department of Microbiology at the Chinese University of Hong Kong. “They only come alive when they are given the right conditions such as the necessary nutrients from inside a cell. At room temperature, they do not last very long – maybe 10 minutes. Once the blood dries, infectivity decreases.”

Like most hepatitis viruses, HBV is all too easy to catch. It is more common than the human immunodeficiency virus (HIV) and far more infectious: HBV is 50-100 times more infectious than HIV.

But hepatitis B is not transmitted casually. The virus cannot be spread through sneezing, coughing, hugging or eating food prepared by someone who is infected with HBV, according to the World Health Organization (WHO). Also, you cannot get HBV from mosquitoes. Prof. Tam explains: “All viruses which are transmitted by a mosquito must go through a replication before sufficient viruses is available for infection. HBV do not grow in mosquitoes.”

Ninety percent of the people who get hepatitis B recover spontaneously with their body’s defenses. “The remaining 10 percent who maintain the infection for six months or longer and who do not produce an effective antibody response are considered chronic carriers,” explains Dr. Ernesto Domingo, a national scientist who is a liver specialist.

Hepatitis can be acute (short-lived) or chronic (lasting at least six months). “Acute hepatitis can produce anything from a flu-like illness to fatal liver failure,” explains The Merck Manual of Medical Information. “Hepatitis A and C often produce very mild symptoms or none at all, and may go unnoticed, whereas B and E are more likely to produce severe symptoms. Co-infection of hepatitis B and hepatitis D may make the symptoms even more severe.”

Though much less common than acute hepatitis, chronic hepatitis can persist for years, even decades. “In most people, it is quite mild and does not cause significant liver damage,” the Merck manual informs. “In some people, though, continued inflammation slowly damages the liver, eventually producing cirrhosis (severe scarring of the liver), liver failure, and sometimes liver cancer.”

“Hepatitis B virus is the most common cause of liver cancer around the world,” says Professor Mei-Hwei Chang, chairman of the Department of Pediatrics at the National Taiwan University Hospital in Taipei. “Although hepatitis C virus is the most prevalent cause of liver cancer in some countries where HBV infection is not prevalent, HBV is still the most prevalent cause worldwide.”

The HBV may be found in blood, semen, vaginal fluids, tears, and saliva. It is transmitted the same way as HIV. That is, through sexual intercourse (vaginal, oral, or anal), use of contaminated needles, unsafe blood transfusion, and from mother to child.

Most people who get HBV fight off the infection by themselves, but the HBV antibodies “will be present in their blood for the rest of their lives,” writes Dr. Alan Berkman, author of Hepatitis A to G: The Facts You Need to Know About All The Forms of This Dangerous Disease.

Most people who are infected with HBV don’t show any symptoms of the disease, so “many people are surprised when they go to donate blood to learn that at one time in the past they had the virus.”

“Only a blood test can confirm for sure if a person has hepatitis B or not,” wrote Dr. Philip S. Chua in his newspaper column. “After a person is exposed to the HBV, it takes about 4 weeks (range: 1-9 weeks) for the blood test to show if a person has acquired the HBV infection or not.”

After exposure to HBV, the symptoms, if they occur, will manifest on the average of 12 weeks (9 to 21 week range). “Only 70 percent of patients will have symptoms, the 30% will be symptom-free although infected,” Dr. Chua said. “Adults are more likely to show clinical symptoms than children.”

What are the signs? “Sometimes, people infected with HBV have what looks like the flu, with symptoms including loss of appetite, nausea and vomiting, fever, and weakness,” Dr. Berkman writes. “They may also develop symptoms more directly related to their livers: abdominal pain, dark urine, jaundice.” Jaundice is the yellow discoloration of the skin and the whites of the eyes.

As there are several stages of hepatitis B, there are also several treatments. “Oral anti-virals are good in suppressing the virus with insignificant side effects, but has to be taken daily for an indefinite period of time,” Dr. Ricaforte-Campos said. “Long-term treatment can result to the development of resistance to the initial drug requiring addition of another oral anti-viral or shifting to a more potent drug with low resistance rate but obviously at a higher cost.”

Interferon-alpha is an example of a potent anti-viral with immune-modulatory effects. An injectable, it is “given once weekly for one year” and “is a suitable option particularly for patients who are in the reproductive age group and wanting to undergo treatment for a finite duration.” This treatment has “systemic side effects which are tolerable and manageable.”