Treatment and prevention of Hepatitis B and C

Hepatitis virus infection is a major health problem, especially Hepatitis ‘B and C’.  These types of Hepatitis can lead to cirrhosis and liver cancer.  Hepatitis B accounts for 5 percent of the world’s population or 3.5 million people infected with Hepatitis ‘B’ (HBV). There are more than 370 million who have died from Hepatitis infection and 70 percent of Hepatitis B carriers are Asian. Thailand is one of the main centers of HBV in the world. There is 5-10 percent of the population (or 5-6 million people) who are HBV carriers that can cause flare-ups of HBV, and while HBV was a serious problem in the past in Thailand, following HBV vaccine has been providing immunity to newborn babies, the numbers are decreasing.

How are Hepatitis B and C transmitted?

According to the recent research, the transmission of Hepatitis C, B and HIV are the same. Formerly, it was transmitted via blood or blood product. These days, Hepatitis transmission via blood (blood donation) is very rare due to blood screening of all donated blood for infective agents. They can be transmitted from unprotected sex with a Hepatitis carrier or mother to baby either during giving birth or breastfeeding. Receiving virus from mothers is the most concern in Thailand because some Hepatitis patients may believe they cannot get the virus as they have never received a blood transfusion. They can find out when they have an annual health check-up or donate blood. The patients might be unaware of getting infected from contacting with blood, body fluids or Hepatitis B and C contacts from a minor cut or scratch due to blood, fluid and secretion from patients and Hepatitis carriers. For example, breastfeeding, saliva, semen, re-using disposable syringes, razor, ear piercing, non-sterile tattoo needle or sharing toothbrush with carrier allows transmission of virus.

What are the symptoms of Hepatitis B and C? Is there complete recovery? If not, what will happen?

Incubation of Hepatitis B and C takes about 6-8 weeks. Most hardly show symptoms though occasionally there can be lethargy, nausea, vomiting or pain in the liver. Some patient may present with acute liver failure. Normally there will not be serious symptoms during the incubation period and they will recover in 2 weeks and fully recover within 2-3 months. It is only a small group that go on to become fatal.

Unfortunately, 5-10 percent of Hepatitis B patients do not fully go on to chronic Hepatitis. If there is continuous inflammation from Hepatitis B after 10-20 years, it can lead to liver cancer. The chance of cirrhosis and liver cancer differs between each patient. Some might not be harmful but some will cause cirrhosis and liver cancer, mostly found in men with a family history of liver cancer in the immediate family.

One difference between Hepatitis B and C is that only 10-20 percent of Hepatitis C patients fully recover. The virus still exists and can cause cirrhosis and liver cancer.

How to know if it is Cirrhosis?

The usual causes of cirrhosis in Thais are from chronic Hepatitis B and C (more than 10 years) and in patients who suffer from alcoholism. Patients will not notice the difference between Cirrhosis and common diseases as the symptoms are indigestion, jaundice, swollen in stomach and legs areas etc. It is recommended to be alert about Cirrhosis when noticing symptoms such as feeling tired, weakness, bleeding disorder etc. and the patients will need to consult a doctor.

How to find if it is Hepatitis B or C?

Blood tests not only find Hepatitis B Surface Antigens (HBsAg) but also Hepatitis B e Antigen (HbeAg). During the incubation period, the carriers can transmit the disease to others. For that reason, blood tests are to diagnose Hepatitis B and C, and find viral HBV-DNA.

Do Hepatitis B and C patients require treatment and care?

Acute Hepatitis B and C patients will gradually recover in 2-3 weeks after the initial symptoms and will get back in shape in 1-3 months. If the patients are in good health, they can have treatment at home with regular follow-ups.

Treatment and Care

• Having enough rest to maintain good health. Resting does not mean being in bed at all times but having a light workouts such as walking, reading or playing music are good options.
• Having good nutrition with low fat helps in fast digestion and reduce gastric acid. High in energy food is good. Have enough protein like meat, fish, eggs, tofu etc. and avoid all syrups and sweet drinks. Recommended food for patients are steamed fish, pork or prawn and avoid high fats like fatty meats, coconut milk or fried food.
• Avoid alcohol.
• Avoid medicine that can harm the liver, and always inform or consult with the doctor when requiring medicine.
• Get specific treatment for Hepatitis B and C.
• Immediate consult with the doctor if the symptoms worsen. Major importance are jaundice, bleeding and bruisung.
• Understand the disease and know how to prevent the transmission to family and communities.

What self-care should Hepatitis B and C sufferers do?

When the patients find they are harboring the virus, they should have a blood test to examine liver function. If ALT enzyme level is high, and the period of time is longer than 6 months it indicates Chronic Hepatitis. The patients will need to follow-up every six months or year as well as take antivirus medication. Strict follow-up is very important to get early treatment before the disease produces liver cancer. If the ALT enzyme is at normal level, it indicates the patient find low-risk of liver cancer.

What self-care should Chronic Hepatitis B and C and carriers do?

• Maintain good health, avoid heavy physical work or lack of sleep.
• Avoid drinking alcohol.
• Exercise regularly but not within easy limits.
• Nutrition eat well and not skip meals.
• Do not smoke cigarettes.
• Consult with doctor before buying over the counter medicines.
• Immediate consult with the doctor if the symptoms worsen.
• Pregnant carriers need special treatment and vaccines to prevent transmission of the disease to the unborn baby.
• Jaundice may be caused by acute liver infection and the causes of acute infection are too much consumption of alcohol, lack of sleep or allergy to some medicine.

Can Chronic Hepatitis be treated?

Some patients respond to treatment, but some cannot and they need to continue taking antivirus medication. Before treatment, the doctor will carefully estimate liver function and look for virus in blood and cellular pathology in the liver to find viral strains.

Chronic Hepatitis medications

There are two types of delivery of medications, injection and oral. Interferon injection, Lamivudine and Adefovir medicine are often used. The purpose of these medications is to eliminate HBV virus and lessen inflammation and possible transmission.

Interferon has been used for over 20 years. As the patients do not have enough Interferon to kill the virus, injecting Interferon for 4-6 months helps reducing the virus in the liver and strengthen the immune system. However, it can be used only for HBV inflammation and HBV carriers but not for use for seriously ill Hepatitis patients.

Lamivudine is used to stop the virus multiplying and strengthen the immune system. Even patients with Chronic Hepatitis and Cirrhosis need to take medication daily but with less side-effects. However, patients may need to take medication for at least one year.

Adefovir is also used to stop the HBV virus multiplying. It is widely used and accepted internationally by the Food and Drug Administration (USA) in 2002 as well as Interferon and Lamivudine that have been used in Thailand since 2004. It works effectively on Chronic Hepatitis and Cirrhosis patients. It is necessary to follow-up the condition.

Hepatitis C medications

Treatment with Interferon injection used to require administration 3 times a week for 6-12 months but the treatment was successful only 6-25 percent. Currently Interferon is developed to PEG-Interferon which is more effective when used with Ribavirin.

PEG-Interferon combines Polyethylene Glycol with Interferon to kill the virus. Patients receive injections only once a week.

Ribavirin is more effective when used with Interferon or PEG-Interferon. The quantity of medication will depend upon the type of virus. Type-1 will use Ribavirin with PEG-Interferon alfa-2a from 1,000-1,200 milligrams a day for 48 weeks, with Type-3 800 milligrams a day for 24 weeks. The side-effects are Anemia, rash and feeling dizzy. In pregnant women, it will cause deformation in the fetus. Chronic Hepatitis patients must to consider the side-effect and the cost of treatment carefully. Some medications have less side-effects than injection as well as the individual successful outcome for each patient. The treatment period is long and cost of treatment is high and patients must consult with a specialist to get the right treatment.

How to prevent the transmission of Hepatitis B and C

Hepatitis B and C are mainly transmitted via blood. The prevention is to avoid to contact with blood, body fluids and secretions. Hepatitis B and C virus are very resistant and difficult to cure. Hepatitis B vaccine is now widely used. Patients will get three doses, the protection will last at least 5-10 years. World Health Organization advises Hepatitis vaccination for newborn babies to prevent the transmission and infection.

Currently Hepatitis C vaccine is not yet available so avoiding direct contact with the virus is important.

How to prevent transmission when already Hep B or Hep C positive

• Do not donate blood or organs.
• Do not share personal items with others such as toothbrush or razor. Sharing curlery is not dangerous.
• Inform doctor and dentist about your condition.
• Suggest family to have blood tests to ensure no disease has already been transmitted.
• Always have protected sex.