Deadlier Than HIV/AIDS

BY Chukwudi OHIRI

For more than one thousand years, there was no cure for malaria. It was then seen as very lethal and incurable before 1631 when a Jesuit brother and an apothecarist in Peru—Agostino Salumbrino discovered what was then referred to in the ancient church parlance as ‘a new miracle’. The ‘miraculous’ panacea was quinine. Ever since, malaria seized to be seen as so lethal and incurable anymore. Part of the reason why it took so long to proffer a solution to the menace at that time was lack of knowledge. Today, the level of awareness has tremendously increased and though still a silent killer disease, the scourge is not as severe as it was in colonial and pre-colonial times. And now, another plague came—the HIV/AIDS scourge. At the moment, there is no known cure for this ailment but it can be managed.

The level of awareness for this ailment is so high that there is virtually no one that does not know or have not heard about the virus (HIV) and how deadly it can be once contracted. There are lots of seminars, adverts, public enlightenment programmes as well as materials available to the public concerning this disease. Although these efforts have not led to the discovery of a permanent cure for the virus, the information disseminated has helped in no small way in curbing the spread of the virus significantly unlike when little or nothing was known about it. Yet, more deadly than HIV/AIDS is an ailment that most people know little or nothing about called Hepatitis B.

It has been proven by medical experts that the Hepatitis B virus is even more contagious than the HIV virus. According to research findings by the World Health Organization (WHO), it is 50 to 100 times more infectious than HIV. This is because the Hepatitis B virus is known to have the capability of surviving even outside the body for at least seven days unlike HIV/AIDS and can equally infect another person with equal magnitude. Again, its transmission mode is just similar to that of HIV/AIDS but can also be contracted through other means order than infected blood and sex. Such other means include saliva, sweat, breast milk, tears, urine of chronic carriers as well as other forms of body secretions unlike the HIV. However, the most common way of contracting this virus is by having unprotected sex with an already infected person. Another way of getting an infection is by taking hard drugs using contaminated or unsterilized needles. Working in a healthcare setting, transfusions, and dialysis, acupuncture, tattooing can also lead to infection. Infected mothers, it has been discovered can also transmit the virus to their babies. The good news in all these is that like the HIV, Hepatitis B viruses cannot be spread by casual contact such as holding hands, sleeping together, sharing plates, spoons or cups, drinking glasses, hugging, coughing, or sneezing.

Hepatitis B is a potentially life-threatening ailment that affects mostly the liver. Chronic hepatitis B may eventually lead to cirrhosis and liver cancer—a disease with poor response to all but a few current therapies. It is caused by the hepatitis B virus and it is presently a major global health challenge and the most serious type of viral hepatitis. It can cause chronic liver disease and put people at high risk of death from cirrhosis of the liver and the liver cancer. Globally, WHO estimates that about two billion people have been infected with the hepatitis B virus (HBV), and more than 350 million have chronic (long-term) liver infections. Also, an estimated 620,000 persons are said to die each year due to the acute or chronic consequences of hepatitis B. Most unfortunately, some of these people die without actually diagnosing the real source of their ailment at least to serve as source of awareness for potential carriers.

The diagnosis of hepatitis B can be made only with specific hepatitis B virus blood tests. The tests, called assays, for detection of hepatitis B virus infection involve serum or blood tests that detect either viral antigens (proteins produced by the virus) or antibodies produced by the host. Interpretation of these assays is complex. These tests are known as hepatitis ‘markers’ or ‘serology’. A liver biopsy is a test for liver damage which is also used to check for Hepatitis B.

Medical research revealed that Hepatitis B virus can be either acute or chronic and the general symptoms include acute illness with symptoms that last several weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, nausea, vomiting and abdominal pain. People can take several months if not year to recover from the symptoms.

Children, especially infants, are more likely to get chronic hepatitis B, which usually has no symptoms until signs of liver damage appear. Without treatment, chronic hepatitis B can cause scarring of the liver, called cirrhosis; liver cancer; and liver failure. Symptoms of cirrhosis include yellowish eyes and skin, called jaundice; a longer than usual amount of time for bleeding to stop; swollen stomach or ankles; tiredness; nausea; weakness; loss of appetite; weight loss and spiderlike blood vessels, called spider angiomas that develop on the skin.

It is not enough to talk about an ailment as deadly as this without discussing its cure or treatment. Unfortunately, Hepatitis B usually is not treated unless it becomes chronic. Mrs. Chukwurah Nkanu, the medical Director of Balm of Gilead Hospital, Abakaliki Ebonyi State lamented that “at the moment, there are no known effective treatment for Hepatitis B. However, it can be prevented or at least managed”. “In the worst case scenario” she said, “a liver transplant can be carried out where the liver is badly non-functional”. Chronic hepatitis B is treated with drugs that slow or stop the virus from damaging the liver. Proper nutritional balance, including replacement of fluids that are lost from vomiting and diarrhea can be adopted until the virus clears off by itself in case of acute Hepatitis B. Experts advise that it is best to prevent hepatitis B using vaccines and precautionary measures than thinking of treatment. Where treatment is applicable, cost of such drugs is usually beyond the reach of ordinary individuals and the treatment may take varied length of time, depending on extent of damage. Early diagnosis and treatment can help prevent liver damage.

Several vaccines have been developed for the prevention of hepatitis B virus infection. These rely on the use of one of the viral envelope proteins (hepatitis B surface antigen or HBsAg). The vaccine was originally prepared from plasma obtained from people who had long-standing hepatitis B virus infection. However, currently, it is made using a synthetic recombinant DNA technology that does not contain blood products. One cannot be infected with hepatitis B from this vaccine.

 The risk of transmission from mother to newborn can be reduced from 20–90% to 5–10% by administering to the newborn hepatitis B vaccine (HBV 1) and hepatitis B immune globulin (HBIG) within 12 hours of birth, followed by a second dose of hepatitis B vaccine (HBV 2) at 1–2 months and a third dose at and no earlier than 6 months (24 weeks). Since 2% of infants vaccinated will not develop immunity after the first three dose series, infants born to hepatitis B-positive mothers are tested at 9 months for hepatitis B surface antigen (HBsAg) and the antibody to the hepatitis B surface antigen (anti-HBs). If post-vaccination test results indicate that the child is still susceptible, a second three dose series at (0, 1 and 6 months) is administered. If the child is still susceptible after the second series, a third series is not recommended.

Following vaccination, hepatitis B surface antigen may be detected in serum for several days; this is known as vaccine antigenaemia. The vaccine is administered in either two-, three-, or four-dose schedules into infants and adults, which provides protection for 85–90% of individuals. Protection has been observed to last 12 years in individuals who show adequate initial response to the primary course of vaccinations, and that immunity is predicted to last at least 25 years. Besides the WHO-recommended joint immunoprophylaxis starting from the newborn, multiple injections of small doses of hepatitis B immune globulin, or oral lamivudine in HBV carrier mothers with a high degree of infectiousness (>10⁶ copies/ml) in late pregnancy (the last three months of pregnancy effectively and safely prevent HBV intrauterine transmission, which provide new insight into prevention of HBV at the earliest stage.

Several people in developing nations are still in the dark about this lethal ailment that kills softly and slowly. What is generally known is the HIV/AIDS and a lot of awareness campaigns are ongoing globally concerning it. But this one ailment that is even more deadly and more easily contracted seem to be ignored in this part of the world today. It is therefore recommended that hospitals, medical experts, NGOs, WHO, the media and other people in good stead of enlightening the public on this subject should do so as a matter of urgency to ameliorate the scourge. On the part of the individual, a regular test and medical checkup may just be the best way of ensuring prevention.