Hepatitis B, a silent killer

THE PUNCH Newspaper- Bukola Adebayo

Shola and Mary-Anne Oyedokun got married on January 26, 2009 in Lagos. They were happy at the initial stage, but when a child wasn’t forthcoming 10 months after, anxiety set in.

Mary-Anne noticed that she felt tired most of the time, in addition to experiencing general body weakness, feeling nauseated and vomiting at the sight of food. These are believed to be signs of morning sickness, especially when her mid region began to grow bigger by the day.

Shola was elated that his wife was pregnant at last, and the young family decided to visit the hospital to confirm what they thought was a new addition to their family.

After she was cross examined by the doctor at a private hospital, Mary-Anne was told that she was not pregnant and was immediately referred to the General Hospital at Lagos Island, Lagos, where she was told that she had liver cancer.

Mary-Anne‘s mother died five years earlier from liver cancer, and the medical tests conducted on Mary-Anne showed she had Hepatitis B. One of her siblings also tested positive to the virus.

Hepatitis B is one of the deadly six viruses that cause hepatitis. It has no symptoms and, left untreated, causes liver cancer.

In 2008, the World Health Organisation estimated that about two billion people have been infected with the virus, while 350 million people are living with chronic Hepatitis B viral infection.

In Nigeria, about 20 million people are infected, and five million of this figure are believed to have died due to the consequences of the viral infection.

Experts at a media workshop organised by the Society of Gastroenterologists and Hepatologists of Nigeria, in commemoration of the World Hepatitis Day today, have warned that Nigeria‘s statistics would continue to rise if infected persons are not aware of their status.

A consultant hepatologist with the General Hospital, Lagos Island, Dr. Oluremi Oluyemi, in his presentation said that Hepatitis B virus, which is found in all major body fluids of infected people, including sweat, tears, urine, semen and even saliva, is about 100 times more infectious than the HIV virus.

“The virus can stay on any surface it touches for at least seven days. Even the HIV virus does not stay up to an hour on a surface. It is highly infectious to the extent that it was successfully cultured in Egyptian mummies,” he said.

Oluyemi described the virus as “a silent killer,” as an infected individual could live with the chronic infection for years without any florid symptoms.

He said, “The first symptom that shows that someone has Hepatitis B is clinically late for us. By the time you start getting symptoms like dark coloured urine, abdominal pain in some areas of the body, especially around the liver, and yellowing of the eyes, you already have liver cancer.”

He stated that another peculiarity to the virus is that it does not require any risk factor for it to lead to liver cancer.

“Hepatitis B viruses can single-handedly cause liver cancer. You can have a healthy lifestyle and still have it. You don‘t have to be a smoker or an alcoholic before its infection leads to liver damage,” he said.

He warned that infected persons who do not know their status would continue to transmit it to those that are Hepatitis B naive.

According to a new report by the World Hepatitis Alliance, one in 12 people of the world population is chronically infected with Hepatitis B or C virus.

Oluyemi said “Science is a game of figures. You may think that 12 is quite many, but this statistics is 100 per cent to the family or a person that has liver cancer. What you should ask is, ‘am I number 12?’ How will you know, if you have not been tested?”

According to Oluyemi, who has lost two male patients to Hepatitis B-induced liver cancer this year, schools, hospitals and other organisations should adopt avenues to test people.

“So many people would not have known about their status if not for some hospitals that insist on husbands donating blood if they want to register their pregnant wives in the hospital. Some get to know when they go for pre-employment tests, and some schools insist that their pupils take the test,” he observed.

However, a major drawback to the Hepatitis B test is that it costs about N25,000 per person to have it done.

According to another hepatologist at the workshop, Dr. Oladipupo Hamed, who is in private practice, apart from the high cost of the test, there are just three government hospitals in Nigeria that have the facilities to do an HBV DNA test, which is the most effective test for the virus.

The centres include the National Institute of Medical Research, Yaba, Lagos; University of Jos Teaching Hospital and University College Hospital, Ibadan, Oyo State, as well as two private centres in Nigeria.

Hamed said that long queues, coupled with the long waiting time to get results, could discourage people from getting tested.

“After taking the test, you have to wait for weeks to get your result, and you may have to board a flight to where you were tested. All these hassles have discouraged people from going for the test,” he said.

Fortunately, there has been a vaccine against Hepatitis B since 1982. It was incorporated into the National Immunisation Programme in Nigeria in 2005 for new born babies.

Oluyemi said although the initiative was one to be commended on the part of the Federal Government, the programme started rather late, leaving a lot of Nigerians vulnerable to the infection.

He said, “The immunisation started late; so, anybody born before this time is at a risk of infection. A child born 29 years ago is the workforce of today. We have seen cases where 19- year olds died of liver cancer. Their only crime is that they missed the vaccination.”

He said the importance of HBV testing could not be over- emphasised, as the vaccine is only effective in those who have not been infected.

Hamed noted that many people have not been immunised in the country, calling on the authorities to provide testing facilities in the hospitals at subsidised costs.

This, he said, would ensure that the adult population which missed out on the immunisation programme and are still HBV naive can get vaccinated.

He said that there were treatment options for those with HBV infection when detected and treated early, but added that there is still no treatment for liver cancer in the Nigeria.

He said the treatment options for liver cancer was limited, according to Hamed, a liver transplant costs about $100,000 (N15m) for non-citizens in Cairo, Egypt.

“Even in the best of countries, the success of liver transplantation is not attractive. It is a more difficult surgery than kidney transplant. The best drug against liver cancer costs about five to six million naira, and it only prolongs life for about three months. The only option we have right now is to treat the HBV infection,” he said.

Experts also blamed some HBV-induced liver cancer deaths on some medical practitioners who give wrong medical advice to some of their patients who had HBV infection.

Oluyemi said, “I had a patient who said when he was told he had HBV, he felt sad, but he met a doctor in the corridor who asked him what was wrong, and after explaining to the doctor, the latter said, ‘So, you only have Hepatitis B? Do not worry about it; go home.’ This is very wrong.”

Hamed said the association, on its part, appealed to general practitioners who do not know much about the consequences of the diseases to refer their HBV positive patients to specialists.

However, not all HBV infections would lead to liver cancer, said a consultant gastroenterologist with the Gastroenterology Unit, Lagos University Teaching Hospital, Mrs. Olufunke Adeleye. According to her, like most viral infections, the body‘s immunity can clear the HBV infections naturally.

She said, “If you have the HBV infection, the immune system can clear it in some people; then you can‘t catch it again. It is like measles; once you have it, you cannot catch it again. But if the body does not clear the infection after six months, then it could be chronic and you need to see a specialist for appropriate treatment.”


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