According to Prof Dr Rosmawati Mohamed of University Malaya Medical Centre, in Malaysia, five per cent of the population, or 1.4 million people, suffer from chronic hepatitis B. In fact, over 350 million people in Asia are living with either chronic hepatitis B or C. Don’t you think it’s frightening that the hepatitis virus can live in your body for decades without showing any symptom?
In general terms, hepatitis simply refers to an inflammation of the liver. The cause of the inflammation may be viral infection, toxins, attack by one’s own immune system, alcohol abuse or physical injury to the liver. Five types of hepatitis virus have been identified: A, B, C, D and E. However, the more common are the Hepatitis A Virus (HAV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV).
Types of Hepatitis
Dubbed infectious hepatitis, Hepatitis A Virus (HAV) is found in the stools of infected persons. It is common in children with unhygienic habits or living in unsanitary conditions. Homosexuals who practise sodomy are also at a high risk of contracting the HAV. So are customers patronizing dirty restaurants and workers in child-care centres. Consuming shell fish caught from viral-contaminated waters is also a source of infection. As Hepatitis A is a mild infection, some victims are unaware they have the disease.
Also referred to as serum hepatitis, Hepatitis B is caused by the Hepatitis B Virus (HBV) that results in swelling of the liver. Depending on its severity, the disease can cause general malaise to chronic liver disease and even liver cancer. Sources of infection are blood, saliva, semen, vaginal fluids, urine, contaminated blood transfusions (rare in Malaysia), sharing of needles for injecting drugs, intimate sexual contact with an HBV-infected person, and transmission from HBV-infected mothers to babies in the womb. Strangely, the HBV does not attack the liver per se but triggers an immune response from the body, resulting in inflammation to the liver. The disease can cause life-long infection and ultimate death.
The Hepatitis C Virus (HCV) is usually spread by shared needles among drug abusers, blood transfusion, hemodialysis, and getting a tattoo or body piercing with unsterilized tools. Transmission of the virus by sexual contact has been reported, but is uncommon. Sharing of razors and toothbrushes is also a possible source of infection.
The time it takes for a person to become infected after being exposed to the hepatitis virus varies. For Hepatitis A, the incubation period is 2 to 6 weeks; hepatitis B, between 4 and 20 weeks; Hepatitis C, 2 to 26 weeks. HAV is usually active for a short period of time and once a person recovers, he or she can no longer pass the virus to other people. People infected with hepatitis A but have been successfully treated will completely recover from their illness in a few weeks or months without long-term complications. With hepatitis B, about 90% of patients recover from their illness completely within 6 months, without long-term effects. However, around 80% of those who are afflicted with hepatitis C do not recover completely and are at risk of carrying a long-term infection. People who don’t completely recover from hepatitis B or hepatitis C can go on to develop cirrhosis of the liver.
People suffering from hepatitis often exhibit flu-like symptoms at the initial onset of the disease. They include malaise, fever, body aches, loss of appetite, nausea, vomiting and diarrhea. However, some people may not display any initial symptoms at all. As the disease advances, other specific tell-tale signs appear such as jaundice (which is a yellowing of the skin and whites of the eyes), foul breath, a bitter taste in the mouth, dark-colored” urine, and light-coloured stools. Pain in the area where the liver is located may also manifest. Remember that the liver is located on the right side of the abdominal cavity beneath the diaphragm.
Hepatitis A, hepatitis B, and hepatitis C are all contagious. Therefore, in general, to prevent viral hepatitis you should:
(a) Practise good hygiene and avoid unsanitary living conditions.
(b) Avoid drinking tap water or swimming in rivers in undeveloped countries where
sanitation is poor.
(c) Wash your hands thoroughly after using the toilet and before eating.
(d) Thoroughly clean all toilets or bedpan used by someone in the family who
is suffering from hepatitis.
(e) Strictly follow safety procedures if you work in a hospital, laboratory or nursing
home, and need to handle blood or body fluids.
(f) Avoid drug abuse and sharing needles, and practise safe sex – even French-
kissing a sex worker can infect you with Hepatitis B!
(g) Have hepatitis immunizations if you are travelling to certain countries.
(Unfortunately, there’s no vaccine for hepatitis C.)
Don’t play doctor by assuming that jaundice always indicates hepatitis. A blood test is the only conclusive way to know if a person is suffering from hepatitis. A doctor will usually conduct one of three types of tests for confirming hepatitis: (a) liver enzymes, (b) antibodies to the hepatitis viruses, and (c ) viral proteins or genetic material (viral DNA or RNA).
When the liver suffers damage due to viral attack, it secretes enzymes in the blood; therefore, their presence signals liver injury. (For the technical-minded reader, the chemical names of these enzymes are aspartate aminotransferase and alanine aminotransferase).
Detecting for the presence of antibodies against the hepatitis A, B, and C viruses is another vital clue for the medical sleuth. In acute viral hepatitis, antibodies not only kill the virus, but they also protect the patient from future infections by the same virus; in other words, the patient develops immunity. In chronic hepatitis, however, the antibodies are powerless to decimate the attacking virus. As a result, the viruses proliferate and are released from the liver cells into the blood. Their presence can be ascertained by measuring the viral proteins and genetic material. Therefore, in chronic hepatitis, both antibodies to the viruses and viral proteins and genetic material can be detected in the blood.
Apart from blood tests, ultrasound imaging of the liver can indicate whether it is swollen. A swollen liver is definitely a bad sign.
There is no single medication to treat hepatitis. The drug prescribed is specific, based on the doctor’s diagnostic findings. In the case of viral hepatitis, antiviral treatment is the usual avenue. In certain acute cases, no drug is needed. For example, hepatitis A is a self-limited disease which means the body’s immune system will eventually be able to destroy the viruses. Children with hepatitis A may be treated at home. “Rest, rest, rest” is the golden rule in treatment: they should rest in bed until the fever and jaundice are gone and their appetite is normal. If they lack appetite, feed them more frequently with smaller meals, coupled with fluids that are high in calories.
A common viral hepatitis drug prescribed by doctors is Interferon which is marketed under various names such as Intron, Roferon and Infergen. Interferon treatment may often be combined with other antiviral drugs like Lamivudine in the case of hepatitis B or Ribavirin for patients with hepatitis C infection.
Can herbal products be used to treat hepatitis? So far, no research findings have proved that herbal treatments can cure hepatitis. However, certain herbs can support liver function and should complement rather than replace conventional treatments. Among them are milk thistle, thymus extract, ginseng and licorice root. Be warned that long-term consumption of certain herbs such as kava kava and comfrey have side effects, causing damage to the liver instead. If you suspect your liver is not healthy, always check with your pharmacist or herbalist before taking any herbal supplement.
This is a form of hepatitis caused by excessive drinking and not by virus. When the liver breaks down ethanol in alcohol, toxic chemicals are produced that destroys liver cells. Over time, scarred tissues are formed that interfere with the liver’s functions. Surprisingly, women are at a higher risk of developing alcoholic hepatitis than men because of the different ways alcohol is broken down.
Symptoms of alcoholic hepatitis are:
- Abdominal swelling due to fluid accumulation
- Bloody vomit
- Forgetfulness and mental confusion
- Fatigue and nausea
- Unexplained loss of body weight
Solution: Stop drinking and seek medical treatment. If you are already dependent on alcohol, you can join a support group such as Alcoholics Anonymous Malaysia (telephone no. 03-20780564 or 017-2540116.).