READ: [Your Health]...Hepatitis diagnosis and management (3)

 The diagnosis of hepatitis B Virus is a major issue, as it has an impact on every part of life for the person who receives the diagnosis. It is a potentially chronic and life-limiting illness, associated with considerable social stigma, effects on quality of life, and consequences for decisions about work, relationships and having children.

Diagnosis of hepatitis B Virus is the first step in an effective treatment pathway for those with HBV. After diagnosis is treatment, but most of those infected stop at this first step partly due to reassurance by the health workers that there is no imminent danger, thereby postponing the evil day.

Hepatitis B Virus can be acute or chronic. Acute HBV infection is usually asymptomatic but when symptomatic, it is characterised by a flu-like syndrome, with anorexia (an eating disorder), nausea, jaundice, and right abdominal pain. Symptoms usually disappear after one or three months.

Chronic hepatitis B Virus happens if the hepatitis test (HBsAg) is repeated in six months from the time the test was first done and it came out as positive. It is said to be chronic HBV.

Hepatitis profile/viral markers

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There are six parameters used in the management of HBV.

HBsAg — This is a marker of current infection or recent vaccine. Positive result means that the person is either infected or recently immunised. This is the first test and the beginning of the management. Every patient with positive result must be tested for the remaining HBV markers.

Anti-HBs — This is the marker of immunity from resolved infection or vaccine. Any patient with this is fully immunized either from the Hepatitis B vaccine or from total recovery from virus. This category of people don’t require treatment

Anti-HBc — This is a marker of current or past infection .It will show those that are recently infected (acute HBV) or those infected in the past (chronic carrier).

HBeAg — This is a marker of viral replication and infectivity. Any patient with a positive result is highly infected and may need adequate treatment.

Anti-HBe — This is a marker of the immune control in chronic hepatitis B

HBV DNA — This is a marker of viral replication commonly called viral load. Any patient with high viral load result is highly infected and will need adequate treatment. It is also used to monitor the progress with treatment.

ALT — This is a marker of liver inflammation, not a viral marker but a liver function test. When it is high, it shows the liver is undergoing inflammation.

Treatment

The treatments for acute and chronic infection are considered separately. The majority of hepatitis B Virus encountered in Nigeria is due to chronic infections. Treatment of acute hepatitis B Virus is supportive in most cases, consisting of bed rest, nutritional support and symptomatic management such as simple analgesia and anti-nausea medications.

The treatment of chronic HBV can be life-long and it is explained below:

General (lifestyle modification): Alcohol consumption should be ceased, cigarette smokers should be advised to quit, weight reduction with sound nutritional advice is ideal. Eat plenty of vegetables, legumes and fruits. Eat plenty of cereals, preferably whole grain, lean meat, fish, poultry, milk, yoghurt, cheese and regularly drinking water.

Vaccination: The diagnosis of hepatitis B is also an opportunity to prevent its spread through vaccination. The standard regime is at three doses at between zero and six months respectively. Post-vaccine laboratory test is required to be sure the person is fully immune.

For the person who has already acquired hepatitis B, it is too late to vaccinate against HBV, but further liver injury by another virus — hepatitis A — can be prevented.

Hepatitis B immune globulin is indicated as a post exposure prophylaxis for people at risk of developing hepatitis B because they have been recently exposed to body fluids of individuals who have hepatitis B.

Newborn treatment: Up to 90 per cent of infants born to HBeAg-positive mothers acquire the infection if untreated. The concurrent administration of two injectables Hepatitis B immunoglobulin and the Hepatitis B vaccine to the newborn immediately after birth is effective in preventing vertical transmission of the virus.

If the neonate has taken the two injectables, the mother with HBV infection can breastfeed the neonate safely because there is no increased risk of transmission. Children born to HBV-positive mothers should be assessed for their hepatitis B status after the completion of the course of vaccination.

Sexual partners of HBV positive persons should be counselled to protect themselves from sexual exposure to infectious body fluids such as semen and vaginal secretions, by using condoms; or by receiving full immunisation against hepatitis B virus.

Medication: The treatment may be appropriate in some patients. It is very rare that anti-viral drug treatment will lead to a cure for HBV infection. The long-term aim of treatment is to arrest or reverse the progression of liver damage, with the ultimate goal of preventing cirrhosis, cancer of the liver and liver failure.

Concluded.

-Rotimi Adesanya (roayad@yahoo.com)/Punch 

Read all here: Hepatitis diagnosis and management (1) & Hepatitis diagnosis and management (2)

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