World Hepatitis Day: Are Hepatitis B And C Curable? An Overview- Dr Seyitan
Are Hepatitis B and C curable? Hepatitis is simply put, inflammation of the liver, that is, the body’s response to an insult to the liver. Several agents can “insult” the liver, from toxins to chemicals (alcohol) to infectious agents like viruses and parasites. However, the focus of this article is on hepatitis caused by viruses. Of the various hepatotripic (liver-loving) viruses, hepatitis B virus and hepatitis C virus stand out, because of the ability of these viruses to persist in the liver for long periods of time, causing long term damage and deterioration to the liver over many years. This often leads to liver failure or liver cancer (hepatocelluar carcinoma). These viruses are transmitted via blood (sharing or sharps, accidental needle stick injuries, transfusion of unscreened blood etc.) and body fluids like vaginal secretions and semen. Infected persons can present acutely with anorexia, nausea, vomiting, body aches, low-grade fever before developing yellowish discoloration of their sclerae (white part of the eyes), skin and mucous membranes. In the late stages, patients could develop signs of chronic liver disease such as abdominal swelling with fluid (ascites), swelling of the feet (pedal edema), muscle wasting, redness of the palms (palmar erythema), enlargement of the liver and spleen etc. It could also be asymptomatic, leaving the sufferer unaware of the infection, often for many years before they are discovered incidentally by screening. Any individual experiencing any of these symptoms, or who is at risk of exposure to these viruses can walk into a health centre and have some screening tests done i.e. Hepatitis B surface antigen (HBSAg), Hepatitis C virus antibody (anti-HCV) and other ancillary tests like the liver function test and abdominal ultrasound (more useful for those with the infection). Anyone with a positive HBSAg test would be required to do a full Hepatitis B panel (Hepatitis B surface antigen, Hepatitis B e antigen, Hepatitis B core antibody IgM and IgG, Hepatitis B e antibody, Hepatitis B Virus DNA), which would determine the phase of infection and guide treatment. On the other hand, those who test positive to Hepatitis C would proceed to quantify the virus by doing a viral load which would also guide treatment. Most interestingly, the treatment of these viral hepatitides (plural for hepatitis) are experiencing major breakthroughs, with new drugs being discovered and cures being achieved. Hepatitis B remains yet uncurable, but all hope is not lost. New antiviral agents are being discovered and current ones are able to suppress viral load to the barest minimum… enough to prevent progression of the disease to end stage/ end game. It however gives me great pleasure to write that Hepatitis C CAN and has been CURED in many individuals. Initially, for many decades only medications like ribavirin and interferon were available, with disappointing cure rates and side effects that made “the cure of the disease more grievous than the endurance of the same.” The newer drugs and drug combinations are however doing the trick more conveniently (oral administration), cheaper (than prolonged suffering and death), with much less side effects and for only about 8-12 weeks. These wonder combos include Ledispasvir/sofosbuvir (Harvoni), Elbasvir/grazoprevir (Zepatier), Ombitasvir/paritaprevir/Ritonavir/Dasabuvir (Viekira Pak), Ombitasvir/paritaprevir/Ritonavir (Technivie) and Sofosbuvir/velpatasvir (Epclusa). Combination therapy is much more efficacious than monotherapy. Like the adage goes, prevention is indeed better than cure and this holds true for hepatitis B and C virus infection. Hepatitis B vaccine should be given to new borns and immunoglobulins added for babies born to infected mothers. Hepatitis B vaccine for adults are also available, some of which last for life. Other preventive strategies generally involve having respect for our bodies and treating our livers nicely, by avoiding alcohol (especially the excess of it), self medication, sharing of sharps (like razors, nail cutters, hair clippers, ear rings etc), adequate protection during sexual intercourse (especially for an unmarried couple where their statuses are not known), and avoiding illicit (intravenous) drug use. Also, blood for transfusion should be well screened and health workers should be extra careful to avoid unprecedented needle stick injuries and avoid unnecessary contact with blood and body fluids of patients. On a final note, when has routine health checks ever harmed anybody? Do well to get yourself screened. Better safe than sorry.