Hepatitis B

By Flavia Nassaka

Doctors say is ten times more deadly than HIV

Kenneth Kabagambe, a university graduate, only got to learn about hepatitis B, when a colleague succumbed to the infection.  “The way he was buried scared me. They didn’t allow anybody to get close to the body just as they do when one succumbs to Ebola.” Kabagambe’s awe is not misplaced as hepatitis B, like Ebola and HIV, is a viral infection that spreads through blood and other body fluids. But hepatitis B attacks the liver and kills faster than HIV.

But it was too late for Kabagambe. He was already infected. Soon after testing positive for it, Kabagambe also learnt that there is a vaccine for it.  But unfortunately, he was told, only people who are not infected could be vaccinated. When he asked about treatment, the health worker who conducted the test was unhelpful.

In desperation, Kabagambe did another three tests at a bigger hospital. Here he was immediately initiated him on HIV Anti-Retroviral (ARV) drugs, although he had tested negative for HIV.

“The doctor assured me that if I took ARVs for a month. I would be completely cured,” he recalls.  But he says when he told another doctor about it, he was told that HIV drugs cannot treat hepatitis B.  The doctor also told him that his viral load was also too low to require any kind of treatment – not even the real antivirals recommended for hepatitis B patients. In reality, Hepatitis B is incurable. Kabagambe’s story shows the ignorance around the disease – even among health workers.

Part of the reason for this is mainly because the disease has not been given the attention it warrants.  Although about 3.5 million Ugandans are at risk – more than doubling the 1.4 million living with HIV, the government is only now starting to pay attention and allocating money to fight it.

Dr. Jacinto Amandua, the Commissioner Clinical Services at the Ministry of Health, says Shs10 billion has been allocated to managing the increasing hepatitis B.

Amandua said the disease is ten times more deadly than HIV/AIDS and that Uganda is one of the countries with the highest prevalence in the world. The highest rates of infection are in Karamoja region (23.9%), Northern Uganda (20%), West Nile (18.5%) and western region (10%).

Perhaps it’s not just Uganda that has ignored hepatitis B. Health care providers all over the world have not had uniform guidelines for treatment until March when the World Health Organisation (WHO) released the first ever set of guidelines.

Statistics from WHO indicate that 240 million people suffer from the disease and an estimated 780,000 succumb every year. Most of them are from low income countries where the disease is more prevalent.

Amandua  says  about Shs7.5 billion will be spent on vaccination in 30 most at risk districts of northern Uganda and the rest of the money is being used to purchase reagents for testing and drugs.

“The good thing the anti viral drugs are made here. We have already done quality tests on them. Very soon they will be available,” he said adding that two clinics have also been opened at Mulago National Referral Hospital and Arua in the West Nile for capacity development and training because there’s generally lack of awareness about the silent killer.

But how does the disease manifest itself?

Kabagambe told The Independent that by the time he tested positive, he did not feel pain or any other symptoms. Doctors say that many people who suffer from chronic hepatitis B will not have any symptom.

“You may get infected without knowing it because the disease can be transmitted as children run around playing. Actually some people never know they have hepatitis B until a doctor finds that they have cirrhosis or liver cancer,” says Amandua.

At the Uganda Cancer Institute, hepatitis B is responsible for 80% of the liver cancers.

Though many never show any symptoms until the disease advances, some may experience constant discomfort on the right side of the belly, yellowing of the skin, fatigue, and dark urine among others.

Prevention techniques

Amandua says just as HIV, your risk of acquiring the disease increases when you have unprotected sex with a person with the disease or with multiple partners. He encourages people to use condoms.

According to the doctor, the deadly virus lasts longer than HIV outside the body. The upside is that it can be vaccinated against. Recently the government made it compulsory for children and health workers to be vaccinated. The vaccine is given in three intervals. The second is given a month after the initial one and then the final one after six months.

He also encourages routine testing explaining that people with chronic infections may feel fine for a long time, even as the virus is causing damage and by the time symptoms appear, the liver damage may be advanced.  To him, everyone should be tested. Hepatitis B becomes chronic when it lasts more than six months. Although infections can persist in adults, most chronic cases occur in people who are infected in childhood. At the Ministry, Amandua said they have programmes focused on prevention of mother to child transmission of the disease since many contract the disease at birth.  Acute infections occur in those who have been infected recently. Blood tests can tell doctors whether the infection is acute or chronic and whether the virus is actively multiplying.  Important tests to consider according to Amandua after testing positive include the liver function which is meant to determine whether it’s functioning normally, the hepatitis antigen, which shows whether one has a dormant or active virus and the viral load that determines the amount of virus in the blood.

However, WHO recommends that to cut the numbers of those succumbing to hepatitis B, governments and health workers should use two medicines tenofovir or entecavir for treatment in addition to using simple tests for early detection of liver cancer to assess whether treatment is working or if treatment can be stopped.