Dr Somnath Chattopadhyay, Consultant and Head of Department, Hepato-Pancreato-Biliary Surgery and Liver Transplant, Kokilaben Dhirubhai Ambani Hospital talks about hepatitis, its diagnosis and available treatments
Viral hepatitis is also known as the ‘silent killer’. According to WHO, about 350 million people around the world are suffering from viral hepatitis and nine out of ten people are unaware of it. The term ‘Hepatitis’ means swelling of the liver. There are many causes of swelling of the liver, but the most common are a group of viruses which cause viral hepatitis.
Viral hepatitis can be divided into Hepatitis A, B, C, D and E. Hepatitis A and E are spread due to contaminated food or water especially in places with poor sewage disposal. Hepatitis B, C and D viruses are blood-borne and can spread from mother to child during childbirth, unsafe sexual practices or sharing of contaminated needles.
Hepatitis A and E
Hepatitis A and E commonly cause acute hepatitis which means that the infection is self-limiting and usually lasts for 2- 6 weeks. The common symptoms include fever, pain in the abdomen, malaise and jaundice. There is no specific treatment required for hepatitis A and E and most patients make a complete recovery. Very rarely, Hepatitis A and E can lead to acute liver failure which is a life-threatening condition and may need an emergency liver transplantation.
Hepatitis B
Hepatitis B is a major cause of liver cirrhosis around the world. In India, an estimated 40 million people are suffering from chronic Hepatitis B and most of them are unaware of their condition. After acute infection, 70% of patients do not have any symptoms which makes it difficult to diagnose or treat. Many patients are diagnosed incidentally during health checkups or while doing blood tests for employment. Transmission of hepatitis B from mother to child can happen and can be prevented by vaccination of the child with the first dose being given less than 24 hours of birth followed by booster doses. Some children may also need antibodies to the hepatitis B virus and mothers can be treated with antiviral drugs during the third trimester depending on the viral level in the mother’s blood.
If a person thinks they have had exposure to the bodily fluids of someone with Hepatitis B, they should seek immediate medical treatment. Getting a vaccine within 24 hours of contracting the virus can stop an infection from developing. Chronic hepatitis B can lead to liver cirrhosis or liver cancer.
Hepatitis C
Hepatitis C is also a major cause of chronic hepatitis around the world. The prevalence of Hepatitis C in India is about 1 per cent of the population. Up to 85 per cent of Hepatitis C patients develop chronic infection and up to 30 per cent develop liver cirrhosis in 20 years. Acute infections with hepatitis C usually go unnoticed and patients come for treatment very late once symptoms of liver cirrhosis arise.
Hepatitis: A silent killer
The liver is a unique organ due to its immense capacity to repair and regenerate itself. When a person undergoes liver surgery or donates a part of the liver, the remaining liver grows back to its normal size in as early as six weeks. Similarly, damage to the liver goes unnoticed in the early period as there are no signs or symptoms and the liver keeps repairing itself. It is only when the capacity to repair itself is overwhelmed that the signs of liver disease manifest. The common signs of liver cirrhosis include jaundice, bleeding and fluid collection in the abdomen known as ascites and swelling in the legs.
Diagnosis
The diagnosis of viral hepatitis can be easily done with widely available blood tests which look for viral antigens in the blood and specific antibodies to the viral structure. Advanced techniques allow the detection of the number of viral particles in the blood. The damage to the liver can be assessed with help of blood tests and imaging techniques like Ultrasound and CT/MRI scan.
Treatment & new drugs
The treatment of Hepatitis B varies if it is an acute or chronic case. In acute cases, the treatment mainly consists of rest, a nutritious diet, and proper hydration. Severe symptoms may need hospitalization. If blood tests show that a person still has the virus 6 months after contracting it, it is a chronic, long-term infection. Chronic Hepatitis B increases the risk of developing liver failure, cirrhosis, liver cancer, and hepatitis-related deaths.
Currently, there are two types of approved therapies – Immune modulator drugs that boost the immune system to help get rid of the hepatitis B virus and antiviral drugs that slow down or prevent the virus from reproducing. There are also more than 30 new drugs currently in development to cure chronic Hepatitis B infection.
Elimination of Hepatitis C is a global goal as it is a major public health threat with around 71 million people living with chronic infection worldwide. This will require universal screening and treatment to find infected individuals. Today, we have direct‐acting antivirals that cure nearly all infected patients. WHO’s goal is to reduce new infections by 90 per cent, treat 80 per cent of chronic infections, and reduce mortality by 65 per cent.[1]
However, a liver transplant is indicated when patients start developing severe symptoms of liver cirrhosis or liver cancer. With improvements in technology and surgery, the results of liver transplant are excellent in experienced hospitals. The transplant patients can go back to their normal lives after the surgery.
To combat the threat of hepatitis, the National Viral Hepatitis Control Program was launched by the Government in 2018. The program covers the entire range from prevention, detection and treatment to mapping treatment outcomes and aims to end Hepatitis C in India by 2030 in line with the Sustainable Development Goal 3.3. It also aims to significantly reduce the complications of cirrhosis and liver cancer in patients with Hepatitis B and C, and reduce the risk, morbidity and mortality from Hepatitis A and E.[2]
Integrated behaviour and medical models of care will benefit by removing barriers to care. Barriers such as access to hepatitis specialists can be overcome by a robust primary care system for initial identification and diagnosis followed by a full-time model for doctors that promotes a multidisciplinary team approach to care and treatment.
Viral hepatitis can be easily detected, prevented and treated. New treatments offer hope to the millions suffering from hepatitis B and C. By creating awareness, this ‘silent killer’ can be prevented from harming more people around the world.
References:
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917266/
[2] National Viral Hepatitis Control Program (NVHCP) | National Health Portal Of India (nhp.gov.in)