THE ABCS OF VIRAL HEPATITIS
A COMMON misconception people have about hepatitis is that once they are given this label, they think that’s it, they’re doomed, they’re dying as the liver is now failing, according to a specialist.
“Hepatitis does not necessarily mean liver failure. Liver failure means the liver is losing or has lost all its function,” say hepatologist Dr Prabhjot Singh Sidhu.
“So what’s hepatitis? Hepatitis really just means ‘inflamed liver’. It doesn’t specify any further. Causes are many. It could be from viruses, trauma, genetic issues, blood pressure changes, medication, fatty liver, alcohol and so many more.”
As the second largest organ after your skin, the liver plays a vital role in the body’s immune function by detoxifying chemicals and metabolising drugs.
Although hepatitis has multiple causes and is broadly defined, the main types of hepatitis generally known to the public are Hepatitis A, B, and C.
“These belong to the viral hepatitis group of causes of the disease,” he says.
Dr Prabhjot comments that the level of awareness regarding all hepatitis and their effects remains a global problem, particularly as it is often asymptomatic.
“Although some panic on hearing the word, a large number of people who know they have hepatitis do little or nothing about it unless instructed by their doctors. Let’s also not forget the existing lack of urgency to consult doctors in the first place on said hepatitis, of which it’s worth mentioning again that its asymptomatic nature in the beginning is partly to blame.
“The other part would often be due to poor understanding of the immediate and long term effects of having hepatitis.
“There is also another group of people worth highlighting and it’s those who decide to take un-vetted medication in hopes to selftreat their hepatitis. This is very dangerous behaviour and could even worsen their existing liver disease,” warns Dr Prabhjot.
In comparison, the heart, with all of its symptoms, public awareness campaigns and general public fear of dying of a heart attack has led to early and better screening programmes which then translates to better prevention, early detection and early treatment.
Your body recovers naturally
“As not all hepatitis are the same, so it must be reflected in its management. This is true even within the realm of viral hepatitis,” Dr Prabhjot shares.
For example, in adults, Hepatitis A and acute Hepatitis B infections are mostly self-limiting. Given enough time, the majority (not all) of patients will recover naturally without medical intervention. If medication is needed, it is only as a supportive measure to manage the symptoms.
Chronic Hepatitis B, on the other hand, may require medication to control the virus and its corresponding inflammation if specific criteria are met.
Why only if criteria are met?
“In very simple terms, the body keeps the Hepatitis B virus ‘in check’ and only when control is lost (leading to liver injury) or if significant liver damage exists do people need treatment,” Dr Prabhjot explains.
“As it is the most common cause of liver cancers (lifetime risk is 25%-40%), keeping Hepatitis B ‘in check’ is very important.
“Why ‘in check’ rather than cure? That’s because once chronically infected, the virus cannot be completely removed from infected cells. The goal is to prevent liver damage by keeping the virus ‘in check’ and by that, keeping liver cancer at bay.
“As control of the virus can be lost at any time, often with other illnesses or if immunosuppressed, but also often with no warning at all, continuous follow up sessions with a hepatologist even when all is well is warranted.
“You are also more likely to develop chronic Hepatitis B if infected early in life versus as an adult – up to 95% chance of chronic infection in newborns vs 5% as healthy adults,” he continues.
He adds that Hepatitis B patients who live with other diseases (co-infections) such as Hepatitis C and HIV also have a higher likelihood of getting liver cancer.
“Hepatitis C sits on the other side of things with very effective treatment already available and being delivered. It can and should be treated if found.”
Consulting a hepatologist
“Anybody living with hepatitis would benefit with a review from a hepatologist, but with reference to the ABCS of (viral) hepatitis, there is no better time than now. If there is concern, get a review. Often, only a simple blood test is needed,” says Dr Prabhjot.
Examples for a need of a review in this context would be:
> A family history of Hepatitis B or C.
> A family history of liver disease/cancer. > If a patient is known to have a viral hepatitis of any type even with normal liver function test (LFTS).
> Risky behaviour in the past (for example, tattoos or intravenous drug use).
> Having abnormal liver function and unknown viral hepatitis status.
> Other liver disease already present. “We would rather review the patient early and initiate the appropriate steps early than tell them they should have come to us a long time ago,” says Dr Prabhjot.