There is so much awareness on HIV/AIDS, but very little is known about Hepatitis B, which is similarly deadly
• A black couple kissing. Having multiple sex partners increases the risk of Hepatitis
Three years ago, Mr. Oluyinka Opadotun, a 50-year-old teacher, experienced a protracted bout of fever. This coincided with the marking of scripts for the West African Examinations Council senior secondary school examinations. As a result, he abandoned the scripts and asked that a senior colleague continue the marking. He rushed home, where his wife, a nurse, gave him some drugs. The drugs brought no respite, as he vomited profusely. He also noticed blood clots in the vomit and realised that his affliction was not just a fever. His wife rushed him to the hospital, where a series of tests was carried out on him.
The tests revealed that he had liver cirrhosis which was the result of chronic hepatitis B. At the hospital, he was asked about his medical history. He told the doctor that he had jaundice about 30 years ago. Jaundice is one of the symptoms of hepatitis.
Today, Opadotun has accepted his fate. Every three weeks, he goes for medical check-up and he has been placed on drugs that he has to take for the rest of his life. The drugs are quite expensive, thereby stretching his financial resources. He was also told to stay off alcohol. The alternative to this treatment regime is a liver transplant. Unfortunately, that is not available in Nigeria. “It is a real burden for me. The drugs are quite expensive, yet I have to take them for the rest of my life,’’ Opadotun, who is a civil servant told TheNEWS.
Hepatitis virus infections continue to be a major disease burden worldwide. The World Health Organisation, WHO, estimate, based on weighted average for regions rather than individual (because of lack of data in developing countries), revealed that Hepatitis C Virus, HCV, accounts for 20 per cent of cases of acute hepatitis, 70 per cent of cases of chronic hepatitis, 40 per cent of cases of end-stage cirrhosis, 60 per cent of cases of hepatocellular carcinoma, HCC, and 30 per cent of liver transplants. An estimated 27 per cent of cirrhosis and 25 per cent of HCC worldwide occur in HCV-infected people
According to Dr. Olufunmilayo Lesi, consultant physician and gastro-enterologist at the Lagos University Teaching Hospital, LUTH, Nigeria belongs to the group of countries with a high rate of hepatitis virus infection. Its prevalence is about 10-20 per cent based on the extrapolation of 90 million Nigerians. But awareness of its deadliness is extremely low. It is a disease that attacks the largest organ in the body – the liver. “A long-term damage restrains the liver, which performs numerous functions like conversion of glucose to glycogen, filteration of harmful substances from the blood, conversion of toxic products into non-toxic ones, storage of glycogen, vitamins A, D, B12 and tracing elements among others,” said Lesi.
She described hepatitis as a condition that involves the inflammation or swelling of the liver, a condition that can be caused by viral infections A-E, bacteria, drugs, alcohol, certain medications, chemicals and poisons or by other diseases.
The commonest causes, she explained, are viruses. “These are types A, B, C, D and E. But the most prevalent of these viral infections is Type B, with a prevalence of 10-20 per cent,” she explained.
Lesi explained that these viral infections manifest in acute and chronic stages, depending on the spectrum of the infection. Hepatitis A, also known as oro-faecal, is of the acute variety. It is spread through contaminated food and water. It can cause acute hepatitis in young people. But it is curable within six months of treatment. Unfortunately, Lesi warned, it can also persist for years.
Hepatitis B can be acute and chronic. In chronic inactive Hepatitis B, the virus does not multiply and it is less likely to lead to liver damage. Lesi advised that a patient with chronic inactive hepatitis requires monitoring because about 60-70 per cent of the virus could become active.
Hepatitis B is not contracted through food and drink, but through contact with blood or body fluid, or sharing of contaminated needles among intravenous drug users. It is transmitted through blood transfusion with an infected blood or blood products, hemodialysis or organ transplants from infected donor and is the most dangerous of the species. Transplants, however, are no longer a common mode of transmission as they once were. Lesi added that blood and blood products are now tested to ensure that they are not contaminated. As a result, cases of Hepatitis B related to transfusion, hemodialysis, or transplantation have dropped to almost zero. She advised that blood collected for the purpose of transfusion undergoes tests recommended by the World Health Organisation. The tests are hepatitis B, surface antigen, antibody to hepatitis C, antibody to HIV, usually sub-types 1 and 2, as well as serologic test for syphilis.
Certain traditional practices have also been found to play some role in hepatitis B virus transmission. These include scarification marks, sharing of body-piercing objects, sharing of toothbrushes, and instruments for native uvulectomy (excision of the uvaula). Uvulectomy is practised in Nigeria as treatment for sore throat. It is usually carried out by local healers in very unhygienic environments. The procedure carries other risks like bleeding, anaemia, sepsis and transmission of other pathogens, including HIV and HBV.
Other causes are mother-child transmission, child-child transmission and through sexual intercourse with an infected person. Dr. Lesi warned that having multiple sex partners and engaging in a deep kiss with an infected person who has an ulcer or sores on the gum, mouth or on the tongue is a risk factor in the transmission of hepatitis B.
Dr. Oladipupo Hammed, a consultant physician and gastro-enterologist at Subol Hospital Group, Lagos, explained that in mother-child transmission, the virus is transmitted during childbirth. “It happens that a child who has picked it up during delivery grows up with it for so many years. In the absence of screening to detect the presence of the virus, it would have become chronic hepatitis B infection,” he said.
Child-child transmission occurs when an infected child plays with other children. While playing, some children bite one another. It can also be transmitted through the use of towels previously used by an infected child who has a bruise. A child does not manifest the symptoms until it is too late. The commonest manifestations of a symptomic period of chronic hepatitis B are fever and body pains. Some, however, show no symptoms for between 15 and 30 years. During this period, an infected person experiences mild symptoms while the liver gets progressively damaged. If this continues, the liver becomes scarred, hardened and then starts to fail. This may also result in liver cancer.
Hammed pointed out that many people present themselves at the end stage when it is too late. “The problem is that most people do not screen for hepatitis B virus. The screening costs between N500 and N1,000. The health care provider interviews you about your illness or medical history. The patient will be asked about symptoms and any exposure to hepatitis viruses. Then the blood will be drawn and tested in the laboratory to determine whether the patient has been exposed to hepatitis. And for those found to be positive, further investigations are carried out to determine if it is acute or the chronic type,’’ he explained.
The most widely used method detects antibodies to these viruses. Tests are also available to identify which of the six known strains of the virus is causing the infection. This can help determine the best treatment plan. Other tests will be done to check the effects of the infection on other organs of the body.
The treatment plan depends on the severity of infection. For hepatitis B, the treatment is for life. This ensures that the liver continues to work well.
“The drugs for treatment are expensive. There are different brands coming in from different places. A reliable brand costs about N15,000 per month. Patients will have to undergo investigation between the third and sixth month, possibly for a minimum of five years, depending on the response. They may have to do this for as long as possible,” he stressed.
Liver transplant as an alternative for treatment of liver cirrhosis, said Hammed, is not available in Nigeria. According to him, South Africa and Egypt are the only African countries where liver transplants are carried out.
Hepatitis C has a prevalence of about five per cent of the population. It can be acute and chronic, while Hepatitis E is only acute.
Professor Innocent Ujah of the Nigerian Institute of Medical Research, NIMR, said the awareness campaign on HIV/AIDS has lowered the rate of infection through contaminated blood to between four and five per cent.
Lesi explained that there is a need for more awareness on hepatitis, test for hepatitis and the treatment available.
The prevalence of HIV in Nigeria is put at about 4 per cent, while that of Hepatitis B is thought to be 15 per cent.
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