A Professor of Clinical Pharmacy, Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Okonta Matthew, talks about hepatitis B and ways to avoid it.

What is hepatitis B?

The liver is a vital organ in the body; it is responsible for the biotransformation of nutrients and chemical substances like drugs and alcohol into acceptable forms the body can utilise or excrete as wastes. The liver can be affected or inflamed by any of these chemical substances, viruses or both at anytime to cause this vital organ to be unable to properly carry out its biotransformation role.

When the liver becomes inflamed, the person is said to suffer hepatitis. Hepatitis B refers to an inflammatory disease of the liver caused by hepatitis-B virus.

Anybody could be at risk of hepatitis B; adult or children. In highly endemic area like Nigeria, risk of hepatitis B infection is increased by somebody having unprotected sex with multiple sex partners such as commercial sex workers, having sex with known hepatitis B infected person(s); scarification with unsterilised sharp blades, needles and knives, such as tattooing, circumcision and piercings of the skin; sharing of blades used for hair cutting, injection needles used by drug addicts, in some health facilities especially the ones operated by quacks; having sexual relationship with men, and people that indulge in oral sex; and somebody receiving blood transfusion especially from an infected source.

The age at which a person is infected with hepatitis B influences the extent to which the disease can become chronic.  Infants who are infected with hepatitis B have higher tendencies of developing the chronic form of the disease than children. Less than five percent of normal adolescents and adults infected with hepatitis B develop the chronic infection.

Are there different types of hepatitis B?

Yes, hepatitis B infection is of two different types -the acute hepatitis B and chronic or long-lived type. Acute hepatitis B symptoms can last for a few days to six months and most of these symptoms are mild. In most people with acute hepatitis, symptoms resolve over weeks to months and they are cured of the infection. Chronic hepatitis B is more severe than the acute hepatitis form. Chronic inflammation of the liver can lead to scarring of liver tissue, liver failure, and liver cancer. Chronic hepatitis B is not curable, but it is treatable. The goal of therapy is to reduce the risk of complications, including premature death.

What are the symptoms of hepatitis B?

Most people that suffer from hepatitis B infection do not know that they have such infection until the symptoms begin to manifest or through general screening during recruitment exercise, before blood donation, or any other circumstances. Before some of the symptoms of the infection are manifested, the liver may have been damaged. This is why it is called silent killer. If somebody is with/without symptoms, such a person can be screened for hepatitis B surface antigen (a protein on the surface of the hepatitis B virus). A positive test means the person has an acute or chronic hepatitis B virus infection and can pass the virus to others; hence such a person needs to be treated. Some common symptoms of hepatitis B are abdominal pain, dark urine, clay-coloured bowel movements, joint pain and jaundice (yellow colour of the skin or the eyes) among others.

Any positively tested person requires the attention of gastroenterologist or an appropriately trained physician to further evaluate and treat them properly.

How is hepatitis B diagnosed? 

Based on patient’s presentation, the difference between hepatitis B and other viral hepatitis may not be too obvious. It is essential that laboratory confirmation is done to differentiate between acute and chronic infections.

It can be diagnosed by detection of hepatitis B surface antigen in the blood sample of the person. The laboratory diagnosis can also be used to differentiate the hepatitis B infection types into acute and chronic infection.

How is it treated?

The treatment of hepatitis B is complex, life-long and expensive once diagnosed. Treatment is based on the type of hepatitis B.

Patient needs to be properly counselled before and during the treatment especially when it is the chronic type. Patients must be fully informed of the possibility of passing on the infection to their loved ones if there is any failure in treatment compliance.

Chronic hepatitis B infection can be treated with anti-viral agents to slow down the disease progression to cirrhosis and reduction of liver cancer incidence and improve patient survival.

The drugs that are needed to manage the disease must be prescribed, administered and monitored by a gastroenterologist or any other trained and certified healthcare professional. A patient with acute hepatitis B infection, most times, requires no specific treatment. The patient must be kept in a comfortable state, reduce liver load such as proteinous meal, maintaining adequate nutritional balance and fluid replacement to cover for fluid lost from vomiting and diarrhoea.

Can hepatitis B be cured?

No, but it is treatable. Until this moment, no drug in use has been able to cure patients of hepatitis B but it can be managed. Available medications have only been able to slow down the progression of liver cirrhosis due to chronic hepatitis B infection.

Can one be vaccinated for hepatitis B? 

Yes. It is the major way of preventing hepatitis B infection for a normal or uninfected person that has been proven through negative HBsAg from blood sample screening.   If you are at increased risk for hepatitis B virus infection vaccination is very necessary especially if you belong to any of the categories below: if you are a sex partners of hepatitis B surface antigen -positive persons; if you are sexually active and have had multiple sex partners in the last six months; if you have sexual intercourse with men (gay relationship); if you inject drug and share devices with other users; if you are from susceptible household contacts of HBsAg-positive persons; and if you are a health care and public safety workers at risk of  exposure to blood or blood-contaminated body fluids.

Can hepatitis B cause liver cancer? 

Yes, people with hepatitis B have an increased risk of liver cancer. And these people with hepatitis B are at risk of liver cancer even if they do not have cirrhosis. The most common primary liver cancer in adults is hepatocellular carcinoma called hepatoma. It is caused majorly by hepatitis B worldwide. The common risk factors are chronic hepatitis B infection. Cirrhosis is linked to more than 80 percent of all HCC.

How common is hepatitis B in Nigeria?

Nigeria is an area of high endemicity for HBV with over 70 percent of the population showing evidence of past infection of the virus while average of 13.7 percent still has serological evidence of current infection. Since the current population of Nigeria is about 170 million according to the 2006 national census, the level of current infection is estimated to be 23 million in Nigeria according to current Nigerian treatment guidelines. The ratio of HBV infection in Nigeria is estimated at one in every eight persons. The prevalence of the disease is estimated at three times more than HIV/AIDS according to specialists.

If this disease spread must be arrested and reversed, the following steps may need to be adopted: awareness of the fatality of this HBV infection must be created among Nigerians with every available opportunity, in all institutions, service delivery and gathering points of all sorts; every Nigerian must be encouraged to be screened for HBV at any given opportunity free of charge; all recruitment points must include opportunities to screen for HBV and be willing to do the needful by not discriminating against people who are found to be positive. The government must be able to put up structures such as policies and health facilities to help control and prevent this disease. Thus, vaccine for the immunisation of those infected with HBV albi initio.

Can hepatitis B cause cirrhosis of the liver?

Yes, chronic hepatitis B virus is one of the major causes of liver cirrhosis. It was estimated that more than 200,000 chronic HBV carriers worldwide die of liver cirrhosis annually. Chronic hepatitis B infection contributes to the scarring of the liver tissue and distortion of the liver structure with the associated blood circulatory system leading to liver cirrhosis. These changes develop over time.

Is it true that one can develop cirrhosis even if one doesn’t take alcohol?

Yes, liver cirrhosis is majorly caused by chronic hepatitis B infection, and a greater percentage of hepatitis is caused by viral agents. The majority of the cirrhosis patients that are seen in the hospitals do not consume alcohol yet are cirrhotic. But most of them have HBsAg present in their blood samples, an indication that they have hepatitis B virus infection.

Cirrhosis can also be caused by excessive amount of fat in the liver. Two other common types of liver disease include non-alcoholic fatty liver disease and non-alcoholic steatohepatitis. These are conditions in which the liver contains excessive amounts of fat. People who have non-alcoholic steatohepatitis have excessive amounts of fat in their livers and also have inflammation and scarring of liver tissue. Risk factors of these conditions include: obesity, high blood cholesterol levels, high triglyceride (blood fat) levels and diabetes

Even if excessive alcohol consumption can cause liver cirrhosis, this liver disease can also be developed in non-consumer of alcohol.