Hepatitis B and C in the Philippines

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by Dr. Janus P. Ong, The Medical City |

Viral hepatitis, a major public health problem worldwide, is believed to account for about 1.45 million deaths, more than the number of deaths from HIV, tuberculosis, malaria, or diabetes mellitus. Most of the deaths are caused by Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infection. The reason is that both HBV and HCV can lead to cirrhosis, liver failure, and liver cancer.

What is HBV and HCV infection?

Hepatitis B affects more than 7 million adult Filipinos while Hepatitis C is estimated to affect about half a million Filipinos. Both HBV and HCV are transmitted through contact with contaminated blood and body fluids. In the Philippines, the most common way that persons with HBV acquired the infection is through mother to child transmission at the time of childbirth. That is the reason why it is not uncommon to find several members within a family who have HBV infection. Hepatitis C,on the hand, is usually acquired through blood transfusion, the sharing of contaminated paraphernalia among persons who inject drugs, or the use of unsafe injection and health care practices. Both HBV and HCV can also be transmitted sexually.

Both HBV and HCV cause chronic infection which means that the infection lasts longer than six months. They can lead to chronic liver disease and eventually liver failure and liver cancer in up to 1/3 of those who are infected. However, many persons with HBV and HCV are not aware that they are infected because majority do not have symptoms until they have developed cirrhosis or liver cancer. This is the reason why it is important to screen those who are at risk of HBV and HCV so that they can be diagnosed early and given timely and appropriate interventions. Screening for HBV and HCV is recommended for: people who inject drugs or use intranasal drugs, recipients of blood products before 1994, children born to mothers infected with HBV or HCV, people with sexual partners who are HBV- or HCV-infected, close personal and household contacts of persons with HBV or HCV, persons with abnormal liver tests, people with HIV infection, prisoners or previously incarcerated persons, andpeople who have had tattoos or piercings.

Can HBV or HCV be prevented?

Hepatitis B is a vaccine-preventable infection. The vaccine is given in three to four doses. In the Philippines, the law requires that a timely birth dose of HBV vaccine be given to all infants. This should be given within 24 hours of birth. The vaccine is also recommended to anyone who is not infected and does not have antibodies to HBV. There is currently no vaccine for HCV. For both HBV and HCV, other ways to prevent infection include screening of blood supply, avoiding sharing of personal items such as razors, promotion of safe sex practices, providing comprehensive harm reduction services to persons who inject drugs, appropriate use of health care practices, and proper handling and disposal of sharps and waste.

How is HBV and HCV diagnosed?

Both HBV and HCV infection can be diagnosed with a simple blood test. In fact, there are rapid test kits available that only require a small drop of blood for testing. Once someone screens positive for HBV or HCV, they will need confirmatory testing. It is advised that confirmatory testing be done in consultation with a healthcare professional so that proper interpretation of test results is made. An important aspect of the care of a person who has HBV or HCV is the determination of the presence of liver disease. This can be done by way of blood tests, medical devices, or liver biopsy. Most doctors and patients prefer blood tests or medical devices over liver biopsy because a liver biopsy is invasive and is expensive. The AST-to-platelet ratio index or APRI is a simple way to diagnose cirrhosis by using the results of two blood tests – the AST level and the platelet count. An alternative is transient elastography or FibroscanR, which determines the presence or absence of cirrhosis using ultrasound.

Are there treatments for HBV and HCV infection?

In 2017, there are very effective and safe medications for HBV and HCV infection. For HBV infection, the antiviral treatments can lead to control of HBV. Cure of HBV is not yet possible at this time but very active research is ongoing in search of a cure for HBV. There are oral and injectable medications that can be given for HBV. The World Health Organization (WHO) recommends the use of Entecavir or Tenofovir, both of which are oral medications. At this time, oral antiviral treatment must be given long-term.

The situation is very different for HCV infection. Antiviral treatment that can lead to a cure is available for HCV. Since 2016, highly effective and safe combinations of oral antiviral drugs,that can lead to a cure in >95% of treated patients with HCV,have been available in the Philippines. These combination regimens are easy to use either as a single fixed-dose combination pill (Sofosbuvir and Ledipasvir) or as atwo pill combination regimen (Sofosbuvir and Daclatasvir). Moreover, these drugs have the advantage of having few side effects and much shorter duration of treatment than older drug regimens.

Can I lead a normal life if I have HBV or HCV?

Absolutely! With proper diagnosis and follow-up, persons with HBV and HCV can lead healthy and normal lives. In fact, there are many prominent and successful individuals who have either HBV or HCV. Singer Naomi Judd has HCV and helps raise funds for HCV research. Bollywood superstar Amitabh Bachtan has Hepatitis B and was recently appointed WHO Goodwill Ambassador for Hepatitis. Both are active in fighting to eradicate stigma and discrimination against HBV and HCV. Everyone should be involved in this fight as well.

July 28, 2017 is World Hepatitis Day. Join the Medical City and the world in the campaign to eliminate Hepatitis B and C.

For more information on hepatitis and other liver diseases, screening and treatment, please call the Center for Liver Disease Management and Transplantation at 9881000 ext. 6506.

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