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Hepatitis, As Explained By A Doctor

The term Hepatitis comes from the Latin for word liver – ‘Hepar’, and the suffix ‘-itis’ which means inflammation. The combination of these two creates the medical term Hepatitis which translates to inflammation of the liver. There are many insults that can lead to Hepatitis, the most common cause in Malaysia being the various viruses (such as Hepatitis A, B, C, and dengue virus), medication, alcohol, and not forgetting, fatty liver.

The difference between the 5 main types of Hepatitis? (Hepatitis A-E)
The main difference between the types of viral Hepatitis is that Hepatitis A & E causes short episodes of infection. Whereas Hepatitis B & C can turn into a chronic (long-term) infection after the initial episode in the patient. The chronic infection and inflammation can lead to scarring as well as hardening of the liver, and in the worst case, liver cancer. Hepatitis D is a special virus that only infects a patient who already has Hepatitis B. It may lead to more severe forms of liver insults and will require additional treatments, aside from the Hepatitis B treatment. Out of all the different types mentioned above, Hepatitis A, B, and C, are the most common viral hepatitis.

How Hepatitis is contracted
Hepatitis A & E is often contracted from unsterile food and water that has already been contaminated by the virus. Hepatitis B & C are essentially blood borne viruses. For example, a mother who already has Hepatitis B can pass it to her newborn during pregnancy and delivery (this is known as ‘vertical transmission’). This virus can also be transmitted during sexual intercourse, sharing of needles during recreational drug use, and receiving already infected blood during transfusion. However, Malaysia has very stringent screenings processes when accepting blood donations which has helped to minimise the infection rate from transfusions.

Symptoms to watch out for
There are two forms of Hepatitis: acute (sudden) and chronic (long term) Hepatitis. Acute Hepatitis is often symptomatic as patients may develop a fever, jaundice (the white part of a patient’s eye turning yellow and producing deep-yellow coloured urine), nausea, vomiting, and abnormal liver (blood) test results. In the case of Hepatitis B or C, some of the acute viral infections may be followed by the chronic form, meaning the virus will stay with the patient for life.

More often than not, patients may have no symptoms other than a mild to moderate abnormal liver test results that is detected during blood tests. Infrequently, some patients develop non-specific symptoms such as tiredness and body aches. The virus can remain active in a relatively well patient but will slowly damage the liver over the next 10 to 15 years without them knowing.

A more worrisome symptom would be liver diseases such as an enlarging tummy that is caused by water accumulation in it (ascites) and vomiting blood (hematemesis). These are complications of the scarring and hardening of the liver (cirrhosis) due to years of liver damage, which are potentially lethal. The last unwanted manifestation would be the feeling of a growth in the liver and extreme weight loss, which may point to the diagnosis of liver cancer.

How is Hepatitis treated?
An acute infection of Hepatitis A often only requires symptomatic and supportive care. The infection will resolve itself with the response of the body’s immune system. In very severe cases of liver injury that leads to liver failure, the patient may require a liver transplant.

For Hepatitis B, not all patients will need treatment. It is important to recognise that there are different states of infection for Hepatitis B, depending on the interplay between the immune system and the virus. For example, a Hepatitis B ‘carrier’ with no abnormal liver test results will need no treatment and are only required to have regular blood tests as well as liver scans to monitor it. On the other hand, a patient that has persistent abnormal liver tests will need further workups and take oral medication.

While it is difficult to completely cure Hepatitis B among patients, Tenofovir and Entacavir are two commonly used oral medications that are very effective in suppressing the virus. When patients are put on these medications, the virus count is lowered to negligible levels with minimal side effects.

Hepatitis C patients will be happy to hear that in this decade, scientists have developed a very effective medication as a “cure”. This is called ‘sustained viral response’ in medical terms. Most patients only need one course of the oral antiviral tablet (known as DDA – Direct Antiviral Agent) treatment for 3 to 6 months to achieve a sustain viral response. It is worth noting that the medication has minimal adverse or side effects and most patients, if not all, are able to complete the course of treatment without major issues. In fact, the World Health Organisation have set an attainable goal of eradicating Hepatitis C from the population by the year 2030.

Are there any ways to prevent or reduce the risk of getting viral Hepatitis?
Yes! There is an available vaccine for Hepatitis B, and Malaysia’s national vaccination program has significantly reduced this Hepatitis’s infection rate in our country. There is a vaccine for Hepatitis as well, but it is not part of this vaccination program.

The other significant method to reduce the risk is to perform a blood test on pregnant mothers for Hepatitis B, and administer Tenofovir if needed, to prevent transmission to the newborn. Telbivudine is another medication which is deemed safe to use during pregnancy. It is also advised to avoid risk factors such as sharing unsterile needles and practicing safe sex to prevent contracting Hepatitis B & C. In terms of preventing Hepatitis A & E, ensure you eat properly cooked food and only drink clean water!

Dr Gew Lai Teck
Consultant Gastroenterologist and Hepatologist,
Sri Kota Specialist Medical Centre

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