Shedding light on hepatitis B

The Gastroenterology Unit team at Tygerberg Hospital.

A killer disease described as the “forgotten cousin of HIV/Aids” infects 4 million South Africans, but many have never heard of it or don’t know they have it.

According to the City of Cape Town about 6.7% of South Africans are infected with hepatitis B, but many don’t know their status. Hepatitis is a viral infection that targets the cells of the liver and causes inflammation. It has several strains, the most common being hepatitis A, B and C. The B and C strains can lead to serious liver disease.

According to the paper, Hepatitis B in sub-Saharan Africa: Strategies to achieve the 2030 elimination targets, published by Lancet journals in December last year, recent estimates from the Global Burden of Disease study and the World Health Organisation indicate that viral hepatitis kills 1.34 million people in sub-Saharan Africa annually – more than the 1.3 million annual deaths from HIV/Aids.

More awareness is needed to fight hepatitis and encourage the public to get vaccinated, according to Tygerberg Hospital gastroenterologist Dr Khalid Coovadia, speaking ahead of World Hepatitis Day on July 28.

The Western Cape Health Department offers vaccinations for hepatitis B and other infectious diseases. And it encourages parents to vaccinate their children from birth until the age of 12.

“Viral hepatitis is endemic in our population,” said Dr Coovadia. “We live in a country that has a very high prevalence of hepatitis compared to the rest of the world.”

Informing the public about hepatitis was key to fighting the spread of the disease, he said.

“They need to know how one gets it, what treatment options are available and whether screening is available.”

Dr Coovadia said Europe’s campaigns against hepatitis were similar to South Africa’s HIV/Aids campaigns.

“If you speak to people in South Africa everybody knows about HIV/Aids and they know how to go for testing and how to access anti-retroviral treatment.”

But hepatitis B, he said, was the “forgotten cousin” of HIV/Aids in terms of awareness and screening.

“Many people are not aware of it, and hence there is not a lot of information and support structures in place to help them,” Dr Coovadia said.

A 28-year-old woman who wanted to remain anonymous, said she was not aware that she had hepatitis B until she decided to donate blood at her previous job.

“I had never heard about hepatitis before, but they said there was something wrong with my blood and that I could not be a donor because of it,” she said.

Reacting to her diagnosis, she said: “I feel very disappointed in myself for contracting the disease because I had a boyfriend who was using drugs and that is one way I could have contracted it because we were having unprotected sex,” she said.

After donating blood, in 2016, she was asked whether she had received a letter from the blood transfusion services. “I waited for the letter, and after receiving, it called Tygerberg Hospital in 2017 to make an appointment.

“The first time I came here they drew blood and the doctors told me my diagnosis,” she said.

She was prescribed anti-viral medication to reduce her viral load which is the concentration of the virus per unit of blood.

“By taking the drug, we are able to reduce a patient’s viral load significantly, resulting in fewer complications.

“We aim for our patients who have lower than detectable viral loads. When someone is newly diagnosed, they can have very high viral loads, and when we initiate therapy.

“We aim for lower than detectable loads so that when we test them the illness is undetectable,” he said.

Dr Coovadia said to the best of his knowledge the Western Cape did not have a database detailing the number of patients who have hepatitis B.

“Some of the population are co-infected with hepatitis B and HIV/Aids. HIV/Aids clinics test patients for hepatitis B and if they are positive, they are managed by those clinics predominantly. We tend to look after patients with hepatitis B who don’t have HIV/Aids.

“The infectious diseases unit looks after HIV/Aids and hepatitis B co-infected patients,” he said.

He said the Gastroenterology Unit at Tygerberg Hospital looked after patients who had complications with HIV.

“So for those patients with HIV/Aids and hepatitis B and who experience complications, we would look after them or someone who is HIV negative with hepatitis B.

“We would also see to their needs and that is the reason why we don’t have clear statistics,” he said.

Dr Coovadia said many people with hepitatis B don’t know it because they could be asymptomatic.

“The idea is that we want patients to be screened earlier so that we can prevent complications down the line.

“The complications of that is cirrhosis of the liver; liver cancer. And that is what we ultimately want to prevent.

“If patients are tested earlier, we can put things in place to decrease the progression of the disease,” he said.

Intravenous drug users who share needles and people having unprotected sex are particularly at risk of contracting hepatitis B.

“In the 1980s, patients who received blood transfusions were at risk but medical technology has evolved to a point where that no longer happens,” Dr Coovadia said.

“Mother-to-child transmissions is also another way the illness can be spread.

“Also, people who use drugs like dagga and tik would engage in anti-social behaviour which would leave them vulnerable to contracting the illness,” he said.

Mayco member for safety and security and social services JP Smith said hepatitis B could be prevented through routine vaccinations.

“All parents should take their children for their routine vaccination, which is free of charge at any City Health facility.

“Until recently, hepatitis C was an untreatable chronic disease. With the development of new antiviral drugs, hepatitis C can now be treated effectively.

“This means that all forms of the disease can be treated and help should be sought at selected clinics,” he said.

Additional information from: https://www.thelancet.com/journals/langas/article/PIIS2468-1253(17)30295-9/fulltext and the Western Cape Health Department.