What you may not know about hepatitis B; the good, the bad and the ugly



The good

· An effective vaccine exists to prevent hepatitis B infection

· Hepatitis B does not affect everyone equally

· When spilled on a concrete surface, hepatitis B virus-infected blood can be easily killed by dilute bleach (mix 1 part of bleach to 9 parts of water)

· Hepatitis B virus can be controlled by the immune system of the body in most adults, whose immune systems are healthy

· Hepatitis B is not transmittable via breast-feeding, kissing, hugging, sleeping in the same bed and or eating from the same plate

· Hepatitis B does not always cause an overt illness

· Over 90% of those affected by hepatitis B for the first time in adulthood will recover and develop immunity to the virus (able to protect them from a second infection by the virus)

· Hepatitis B can be effectively treated by oral medicines that are within reach of many

· Hepatitis B diagnosis is not a death sentence

· There are specialists that can monitor and treat hepatitis B infection

· There exists an effective vaccine against infection by hepatitis B virus, and which have also been shown to reduce the rates of liver cancer

· Most cases of chronic hepatitis B do not need treatment by medicines – all they would require is to monitor their disease (known as chronic carriers)


The bad

· Hepatitis B disproportionately affects people in developing countries, with rates that can be as high as 20% in some populations



· Even among people living in developed western countries, blacks, Asians & minority ethnic groups (BAME) are worst affected by hepatitis B and its consequences

· Most cases of hepatitis B infection among patients in developing countries occur in childhood and or via mother to child (during pregnancy and or delivery)

· Infection by hepatitis B virus in childhood is associated with low clearance of the virus from the body – meaning that the chance of developing long term complications of liver damage is extremely high in these populations

· Acute hepatitis B infection can be complicated by liver failure and death

· The complications of hepatitis B infection includes cirrhosis, end stage liver disease and liver cancer

· More than 9 out of 10 persons that have hepatitis B infection do not know that they have the infection

· In developing countries, most patients only get to know their hepatitis B status when they present to hospital with severe complications of the infection, when not much can be done

· When the hepatitis B virus gets into the body of an individual, it integrates itself into the factory (nucleus) of the cells of the individual, thereby using the resources of the cells to multiply itself and cause errors in the process

· The damage that accompanies infection is the response of the body’s immune cells to the infection – the implication of this is that an over-zealous robust immune system can rapidly engulf the liver organ and thus lead to death

The ugly

· Many self-acclaimed “curers of hepatitis B” have worsened the dynamics of those who suffer from hepatitis B, by enriching themselves at the detriment of their patients

· Many patients who should not take medicines are on “treatment” for hepatitis B, depriving them of their hard-earned resources that could be channeled elsewhere

· Several patients are taking unorthodox medications, which effect has worsened their conditions


· The hepatitis B virus can manipulate the liver cell to become cancerous without first causing cirrhosis

· Some pharmaceutical representatives are selling food supplements with false claims of apparent “cure” for hepatitis B

· Some patients with hepatitis B are not disclosing their status to their partners – which has stalled prevention efforts

· Despite proven benefit, the uptake of hepatitis B vaccine has been poor among at-risk populations

· The healthcare seeking behaviour of patients in affected communities is not great, and which promotes the high death rates among affected individuals

· West Africa continues to remain the hot-bed for liver cancer, on account of a high rate of hepatitis B, despite effective management for this virus




Suggestions:

Know thy enemy

Hepatitis B is a disease, predominantly of the liver, caused by a very tiny germ (called hepatitis B virus). This virus is transmitted from an infected individual to another via blood & blood-products as well as via sexual fluids. When the hepatitis virus gains access to a susceptible person, it integrates itself in the liver cells of the person. The cells then present some proteins from this virus onto the surface of the liver cells. This action of presenting some viral components then triggers the soldiers of the body (immune system) to come and save the liver. The interaction of the immune system and the infected liver cells then triggers the overall process of inflammation of the liver, known as hepatitis. In most individuals that do not have an abnormal immune system (not affected by other diseases), the result is a controlled removal of the infected liver cells and which are damaged in the process. The process yields a transient abnormality in the liver enzymes, which recovers in a matter of weeks.



Unfortunately, the inflammatory response to infection by hepatitis B virus does not always end with elimination of the virus from the body. The process may continue to smoulder and which then leads to healing by fibrosis and or scarring of the liver (cirrhosis). The erstwhile soft liver is thereby made hard by this process and which then changes the dynamics of blood flow through the liver to the heart and elsewhere. A hypertension of the portal venous system then results, yielding a back pressure with accompanying anatomic as well as physiologic alterations. The overall damages are further complicated by unrelenting accumulation of fluids in the abdomen and legs, engorgement of blood vessels in the digestive system with potential to bleed easily, disorientation of the brain function (hepatic encephalopathy), and in some instances, liver cancer.

Symptoms and signs

Hepatitis B does not always present with symptoms. When they occur, they are those of damage to the liver, in the acute phase (infection lasting less than 6 months). Chronic infection (lasting beyond 6 months) is often asymptomatic and only discovered on routine blood testing. If symptoms develop in a patient with chronic hepatitis B infection, they are those of the complications.

Some of the symptoms that are commonly reported include:

· Fever

· Headaches

· Nausea and vomiting

· Loss of energy and appetite

· Abdominal pain

· Jaundice – yellowing of the eyes and skin (in fair-skinned individuals)

Treatments

The treatment of hepatitis B is guided by the laboratory and imaging outcomes of the patient. In other words, it is not a one-size-fit-all situation.

Acute hepatitis B is self-limiting in most adults. But for those that go on to deteriorate and are at risk of liver failure, trials of antiviral agents have been made. However, none of the results has demonstrated superior benefit compared to conservative symptomatic treatment.




For those with chronic infection, a few of the adults will require treatment, using antiviral agents and or immunomodulatory agent (injection – known as interferon).

Hepatitis B can be treated within a controlled environment, by specialists. As at this moment, no cure for hepatitis B has been found. Records of treatments that lead to clearance of HBsAg have been documented. However, the aim of treatment for hepatitis B is to ensure an undetectable viral load (HBV DNA) and reduce the chance of progressive damage of the liver.

When a patient presents with complication of hepatitis B infection, then the management strategy at that point is to attend to the complications and then face viral elimination later, if appropriate.

The specific treatment strategies for hepatitis B is beyond the scope of this write up, as it is often managed within national and international guidelines, based on robust data and research outcomes.

It is important at this point to state that all patients that are diagnosed with chronic hepatitis B will need to be monitored to determine when and or if they will benefit from treatment. The antiviral agents work by interrupting the enzyme that promotes the replication (multiplication) of the virus in the body. If the virus is not actively multiplying (evidenced by a high viral load), then it would be a waste of resources to take medications at that stage of infection. This is the basis for non-prescription of medications for most of the patients.

A third of chronic carriers do become active and will need treatment. This can be monitored according to national or international protocol.

Prevention methods

Hepatitis B is a preventable disease.

Avoidance of the infection source and promotion of the immune system to resist an infection are the strategies. To reduce community transmission, there is need to identify and treat those that fulfil the criteria for treatment. The following are effective preventive methods against hepatitis B:


· Vaccinate infants, as well as sexual partners, family and close household members living with a chronically infected persons (after testing them)

· Clean up blood spills with a fresh diluted bleach solution (bleached water can kill the virus easily. Mix 1 part of bleach to 9 parts of water)

· Cover all cuts carefully – to prevent you from inadvertent exposure to infected blood

· Avoid sharing sharp items such as razors, nail clippers, toothbrushes, and earrings or body rings – most “unknown” infection sources may have happened via these routes

· Avoid illegal street drugs (injecting, inhaling, snorting, or popping pills)

· Make sure new, sterile needles are used for ear or body piercing, tattoos, and acupuncture

· Wash your hands thoroughly with soap and water after any potential exposure to blood – this can denaturalise the virus

· Use condoms with sexual partners – as the virus is transmissible via sexual fluids

· Avoid direct contact with blood and bodily fluids – if you are to receive blood products, make sure that hospital policy ensures that only screened bloods are transfused to patients


Resources

Here are a few resources that you may find helpful regarding hepatitis B care.

They are android apps, available to you, free from google play store:

Liver Health App: https://play.google.com/store/apps/details?id=com.worthyworks.liverhealthapp

Liver Nutrition:https://play.google.com/store/apps/details?id=com.worthyworks.livernutrition


HepB Combo tool: https://play.google.com/store/apps/details?id=com.hepatitisnigerianetwork.yourhepatitisbstatus


Hepatitis B Interactive: https://play.google.com/store/apps/details?id=com.andromo.dev802431.app918190


Hepatitis B Serology: https://play.google.com/store/apps/details?id=com.worthyworks.hepatitisbserology


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