Shahid Akhter, editor, ETHealthworld spoke to Prof. Anil Arora, Chairman, Institute of Gastroenterology, Hepatology and Pancreatobiliary Sciences, Sir Ganga Ram Hospital, New Delhi to know about the challenges associated with the management of Hepatitis B in India.
According to the latest estimates there are 40 million people chronically infected with hepatitis B in India. What is the reason for this high disease burden?
Hepatitis B, unlike hepatitis C, is not a curable disease. Once you get hepatitis B, in adults there is a good chance that you spontaneously clear the virus and in acute phase, but unfortunately in 5% of the adults and 90% of the children if the virus gets stuck up in the body for longer than six months then that is called chronic carrier state. Unlike other viruses, hepatitis B virus continues to get integrated into the human genome and hence it is very difficult to get rid of it. There are very good drugs, which are available now for suppressing the virus, but since the virus get into the body’s own cell and the nucleus and the DNA, hence it is not easy to get rid of it. So, there is perpetuation of infection, that is on reason, from mother to the child and secondly because of the indiscriminate use of disposable needle and syringes if there is an infected person, especially in IV drug abusers and if there is no good screening of the blood. These are the major reasons why in spite of vaccination, which is available for a long period of time, the virus continues to cause major havoc even today.
According to the WHO, 95% of those infected with viral hepatitis are unaware of their infection. The reason for this is given as lack of disease awareness and lack of access to testing services. What is your view on this?
I think it is a combination of the both. Whenever the patient has hepatitis B, unfortunately the patient does not have much symptoms and even if the symptoms are there, they are totally nonspecific in the form of fatigue, weakness and generalized irritability, but that does not point out to the hepatitis B as the cause of the symptoms and unfortunately by the time symptoms related to hepatitis B pop up in the body in the form of jaundice, swelling in the feet or tumor in the liver then the disease is too advanced. So, it is very important that there should be general screening for everybody for hepatitis B. If the person is not infected with hepatitis B, there is a very good, effective, cheap, safe and efficacious vaccine, which is available, which gives you almost 100% protection and if you are infected and if we can treat you at a stage when the disease is not symptomatic and when it has not produced substantial damage to the liver including cirrhosis and hepato-cellular carcinoma, the results are much better than treating it in the advanced stage.
Apart from awareness, what else should both doctors and patients do to bring down the hepatitis B burden?
Most important part on the patient or the general public should be — there should be awareness of hepatitis B. Everybody in the family, every household, every single Indian, everybody on the earth should get screened for hepatitis B for two reasons. First is that if you are already infected and the rate of prevalence of infection varies from country to country. In India, the general prevalence is anywhere from 1 to 4% in the general population. If you are already infected with hepatitis B, if we treat you at a stage where you are still having an early disease without substantial damage to the liver, so we have good drugs, which can take care of your liver as well as the virus. From doctor’s point of view, I think we should have more CMEs, continuing medical education program, we should have health awareness program, we should conduct more camps to increase the awareness in the public by not only providing the free kits for early testing, but there are now good drugs available because of the availability of the generic drugs in Indian scenario by good Indian pharmaceutical industry, we should be able to provide them good, cheap and effective medicine for hepatitis B provided we catch them early, provided we catch them at a stage prior to development of advanced liver disease and liver cancer.