Hepatitis infects more, kills faster than HIV

Hepatitis, a viral infection which causes infection and inflammation of the liver, kills over 1.5 million people annually on a global scale, and in Nigeria, plagues the health of over 20 million people.

The World Health organisation says; around the world 400 million people are infected with hepatitis B and C, more than 10 times the number of people living with HIV. An estimated 1.45 million people died of the disease in 2013 – up from less than a million in 1990.

“One can only laugh when so much noise is made about HIV prevention and abstinence (not that it’s not important) but it can be managed,” Oretayo Oni, a medical doctor in Lagos, tells BusinessDay

“Hepatitis is several times more infectious and virulent than the HIV virus. Hepatitis A and E are self limiting and transferred via faeco-oral route, but the real killers are the hepatitis B and C viruses with the main hope being vaccination,” Oni adds. “The world has ignored hepatitis at its peril,” said Margaret Chan, WHO Director-General. “It is time to mobilize a global response to hepatitis on the scale similar to that generated to fight other communicable diseases like HIV/AIDS and tuberculosis.”

Emphasising the highly infectious nature of Hepatitis, Oni says, “If an HIV infected person’s blood were to spill onto a surface and you wipe off with bleach, the surface becomes virus free. However if the person were hepatitis positive, the surface could still infect another person 6 months later; that is if the person has an open wound or something.”

Uchenna Ijeoma, a Gastroenterologist at the University of Nigeria Teaching Hospital (UNTH), Enugu, further explains that the hepatitis B virus is particularly strong, compared to HIV which is unable to replicate outside a living tissue.

Hepatitis is itself an inflammation of the liver. The condition can be self-limiting or can progress to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis viruses are the most common cause of hepatitis in the world but other infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune diseases can also cause hepatitis.

A staggering 95% of people infected with hepatitis B or C around the world do not know they are infected, says the WHO. One reason for this is that people can live without symptoms for many years. When they find out they have hepatitis, it is often too late for treatment to be fully effective. As a result, liver damage becomes cirrhosis or liver cancer.

The Society for Gastroenterology and Hepatology in Nigeria (SOGHIN), an umbrella organisation consisting of doctors and other allied professionals interested in the study and management of disease of the gastrointestinal tract and ancillary organs including the liver remains at the fore front of the campaign to increase knowledge and awareness of viral hepatitis in Nigeria.

According to SOGHIN, the knowledge of this endemic disease is sparse, therefore multitude of patients are not being properly identified, not referred early enough and in most cases poorly managed.

Studies done in Nigeria indicate an average prevalence of 11% to 14% for hepatitis B infection suggesting that about 17 to 22 million Nigerians may be affected by hepatitis B virus alone. The implication is that at least 1 of every 10 Nigerian is chronically infected by hepatitis B and not only at risk of liver diseases and death but also at risk of transmitting it to others. About 5 million die annually due to the consequences of this disease.

The WHO has urged countries to take rapid action to improve knowledge about the disease, and to increase access to testing and treatment services. Today, only 1 in 20 people with viral hepatitis know they have it. And just 1 in 100 with the disease is being treated.

In May 2016, at the World Health Assembly, 194 governments adopted the first-ever Global Health Sector Strategy on viral hepatitis and agreed to the first-ever global targets. The strategy includes a target to treat 8 million people for hepatitis B or C by 2020. The longer term aim is to reduce new viral hepatitis infections by 90% and to reduce the number of deaths due to viral hepatitis by 65% by 2030 from 2016 figures.

The strategy is ambitious, but the tools to achieve the targets are already in hand. An effective vaccine and treatment for hepatitis B exists. There is no vaccine for hepatitis C but there has been dramatic progress on treatment for the disease in the past few years. The introduction of oral medicines, called direct-acting antivirals, has made it possible to potentially cure more than 90% of patients within 2–3 months. But in many countries, current policies, regulations and medicine prices put the cure out of most people’s reach.

“We need to act now to stop people from dying needlessly from hepatitis,” said Gottfried Hirnschall, WHO’s Director of the HIV/AIDS Department and Global Hepatitis Programme. “This requires a rapid acceleration of access to services and medicines for all people in need,” Hirnschall added.

Literature by the WHO shows that scientists have identified 5 unique hepatitis viruses, identified by the letters A, B, C, D, and E. While all cause liver disease, they vary in important ways.

Hepatitis A virus (HAV) is present in the faeces of infected persons and is most often transmitted through consumption of contaminated water or food. Certain sex practices can also spread HAV. Infections are in many cases mild, with most people making a full recovery and remaining immune from further HAV infections. Hepatitis B virus (HBV) is transmitted through exposure to infective blood, semen, and other body fluids. HBV can be transmitted from infected mothers to infants at the time of birth or from family member to infant in early childhood. Hepatitis C virus (HCV) is mostly transmitted through exposure to infective blood. This may happen through transfusions of HCV-contaminated blood and blood products, contaminated injections during medical procedures, and through injection drug use. Sexual transmission is also possible, but is much less common. There is no vaccine for HCV.

Hepatitis D virus (HDV) infections occur only in those who are infected with HBV. The dual infection of HDV and HBV can result in a more serious disease and worse outcome. Hepatitis B vaccines provide protection from HDV infection.

Hepatitis E virus (HEV) is mostly transmitted through consumption of contaminated water or food. HEV is a common cause of hepatitis outbreaks in developing parts of the world and is increasingly recognized as an important cause of disease in developed countries.

Caleb Ojewale

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