Hepatitis - a wide spread ticking time bomb

Compulsory HBV vaccination has been instituted in Malaysia since 1989. Nevertheless, hepatitis B remains an important cause of morbidity and mortality.

Chronic hepatitis B is a worldwide phenomenon, and it is estimated that there are more than 350 million hepatitis B virus (HBV) carriers in the world, with 75% of them living in the Asia Pacific region, where the majority of infections are acquired perinatally (period immediately before and after birth) or in early childhood.

Approximately one million people die from HBV-related liver disease every year. The implementation of effective vaccination programmes in many countries has resulted in a significant decrease in the incidence of acute hepatitis B.

Compulsory HBV vaccination has been instituted in Malaysia since 1989. Nevertheless, hepatitis B remains an important cause of morbidity and mortality, and many individuals who carry the virus (HBsAg-positive) remain undetected and unaware of the infection, and therefore, pose a danger to themselves and others close to them.

Patients with chronic hepatitis B seldom exhibit symptoms apart from fatigue, unless they have complications such as decompensated liver cirrhosis.

Physical examination may be completely normal. Those with end-stage liver disease may have jaundice, big spleen, ascites, leg swelling and encephalopathy.

Routine laboratory tests may be normal. There may be mild to moderate increase in liver enzymes (serum AST and ALT), which can increase dramatically and substantially in patients who develop exacerbations.

Doctors following up patients with apparent “silent” chronic hepatitis B will look for signs of progression to cirrhosis evidenced by hypersplenism (big spleen with decreased white blood cell and platelet counts) or impaired liver synthetic function, such as low serum albumin, prolonged prothrombin time and high serum bilirubin levels.

The natural course of chronic hepatitis B infection is determined by the interplay between virus replication and the host immune response.

Other factors that can influence the progression of HBV-related liver disease include gender, alcohol consumption and concomitant infection with other hepatitis viruses.

The outcome of chronic hepatitis B infection depends on how severe the liver disease is at the time HBV replication is suppressed.

Patients with this infection may be in an inactive carrier state, but can progress to cirrhosis, hepatic decompensation and liver cancer, which may prove fatal.

The prognosis is worse in HBV-infected patients from endemic areas like South-East Asia.

Twelve to 20% of patients with chronic hepatitis B may progress to cirrhosis; 20 to 23% of those with compensated cirrhosis can progress to hepatic decompensation; while 6 to 15% will progress to liver cancer within five years.

Patients with compensated cirrhosis have an 85% survival rate at five years, while those with decompensated cirrhosis have survival rates of 55 to 70% at one year and 14 to 35% at five years.

Presently, doctors may wish to know the viral genotype of their chronic hepatitis B patients. Traditionally, eight genotypes (A to H) have been identified, with genotypes B and C being more prevalent in East Asia and South-East Asia, where perinatal or vertical transmission plays an important role.

Genotype B patients are also associated with spontaneous seroconversion (HBeAg to antiHBe) at a younger age, have less active liver disease, and show slower progression to cirrhosis and less frequent liver cancer than genotype C.

Laboratory tests include a complete blood count, liver enzymes (AST, ALT), total bilirubin, alkaline phosphatase, albumin, prothrombin time and tests for HBV replication (HBeAg, anti-HBe, HBV DNA).

Patients suffering from Hepatitis B, C must take advice before fasting

Health experts believe that the patients with chronic hepatitis B or C must take advice from a qualified physician before going for fasting while patients who have already developed complications of hepatitis C should not fast.

Experts say that the patients suffering from hepatitis C complications including contraction of liver called cirrhosis or ascities (distension of abdomen due to accumulation of water) or liver cancer must avoid fasting as fasting may cause lowering of blood sugar in such patients that can be life threatening.

The experts are of the view that patients of hepatitis B or C who are being administered injections or taking oral medication can fast but they should consult their physicians to get schedule of medicines changed while fasting. Such patients should not discontinue medication including administration of injections. If patients who are fasting feel drowsiness or pain in stomach then they should instead break open fast and consult their physician to avoid complications.

Hepatitis C virus infection is the leading cause of cirrhosis, considered as the end-stage liver disease. Most of the people develop distension of abdomen due to accumulation of water, many present with vomiting of blood as the veins in the food passage rupture due to raised pressure of the portal circulation. Patients with chronic hepatitis B or C or those who are being treated through injections or oral medication, if fast, should not take food containing higher fats. 

Baby boomers in Canada should test themselves for hepatitis C

Many people in Canada undertake preventive tests to make sure they stay healthy. For most people, the tests that come to mind may be a colonoscopy to screen for colon cancer, or a cholesterol test to screen for heart disease. Liver cancer is generally not on their radar, but it is one of the few cancers in Canada that is increasing. The most common condition leading to liver cancer is a long-standing infection with a virus called hepatitis C.

So what does this have to do with you? Nearly two-thirds of hepatitis C infection in Canada occurs in people born between 1945 and 1965, but most don’t know they have the disease. People can remain symptomless for decades, while hepatitis C infection quietly destroys the liver. This can lead to cirrhosis, liver cancer or liver failure, ultimately requiring a liver transplant. In fact, hepatitis C is the No. 1 reason for liver transplants in Canada.

Hepatitis C can also burden your partner or family. Left untreated, you may transmit the virus to your loved ones, through simple things like sharing a razor or toothbrush. It can also contribute to financial stress. One Canadian study noted that, on average, the cost per patient was over $2,000 per year (above insurance coverage), plus an additional $1,300 in out-of-pocket costs for caregivers. Moreover, expenses for the Canadian health-care system may be as high as $240 million annually by the year 2020 if current trends continue.

However, thanks to new and alternative medicine therapies, hepatitis C is curable. If started early, treatment is more likely to be successful (up to 75 per cent of people can be cured!) and can often reverse liver damage, preventing complications like cancer and restoring quality of life. Successful treatment is a true cure.

So why aren’t Baby Boomers getting tested?

Hepatitis C is often a stigmatized disease, only associated with high-risk populations, such as injection drug users. However, there are many other ways to get hepatitis C, including previous blood transfusions, tattooing, and even one-time recreational cocaine use. What’s more is that up to 30 per cent of individuals have no identifiable risk factor for hepatitis C, and many are Baby Boomers. They are the group with the highest rate of hepatitis C in Canada and the group least likely to be tested for it. Primary health-care providers currently do not routinely screen for hepatitis C virus and thus it is up to you to advocate for yourself to get tested. For most Baby Boomers, with all of the other things in life to remember, hepatitis C screening simply may not be a priority.

So, here’s the challenge Baby Boomers:

Make an appointment to get tested by World Hepatitis Day, July 28.

Liver cancer caused by hepatitis C is straightforward; we know exactly what causes it, and how to prevent it. Screening involves a simple, one-time blood test that can literally save your life!

Many world celebrities suffering from Hepatitis C

Hepatitis C is a liver disorder which is caused by many ways such as blood transfusion, using infected needle, etc. It is transmitted by blood-to-blood contact, or by exposure to another person's infected blood. Hepatitis C can later on lead to many other liver problem such as cirrhosis or even liver cancer.

Many of the world celebrities from different walks of life are known to have Hepatitis C. Pamela Anderson is believed to have gotten Hepatitis C through the use of an infected needle. Brooke Ashley has gotten infected with Hepatitis and HIV during the making of a movie.

Christopher Kennedy Lawford is the nephew of President John F. Kennedy. Lawford grew up with U.S. presidents and movie stars as close relatives and personal friends. He is believed to have contracted it in his early years but it wasn’t until 2001 that Lawford was diagnosed with HCV.

Anita Pallenberg is an Italian-born actress, model, and fashion designer. She was the romantic partner of Rolling Stones multi-instrumentalist and guitarist Brian Jones and later the partner of Keith Richards, the guitarist of the same band. She is also known to have been infected with Hepatitis C.

Anita Roddick, founder of Body Shop chain of stores, and Rocky Aoki, the successful Japanese businessmen, contracted hepatitis C due to blood transfusion.

Many other celebrities such as Natalie Cole, David Crosby, Steven Tyler, Dharmachari Aryadaka and many more been diagnosed with Hepatitis C.

Hepatitis C does have any vaccine at this time and it is the leading cause of liver transplant in the United States. Thousands of people die each year from the disease. The symptoms of infection can be medically managed when the disease is diagnosed early, and a proportion of patients can be cleared of the virus by a course of anti-viral medicines. Like other liver disorders (such as cirrhosis, fatty liver, ascites), Hepatitis does not have proper treatment in allopathic medicine. In the alternative medicine world there are herbal or ayurvedic products which are proven to be effective in the treatment of hepatitis and treatment of liver disorders.