Hepatitis: Infections that drive liver disease

The Star

4 days ago

The liver is a vital organ that plays a central role in key bodily functions, including metabolism, immunity, digestion and detoxification.
When the liver becomes inflamed or swollen – a condition known as hepatitis – these functions can be disrupted, potentially leading to health complications ranging from mild discomfort to severe liver damage.
The most common cause of hepatitis is viral infection.
It is classified based on the specific virus involved, i.e. hepatitis A, B, C, D or E.
Hepatitis A and E are typically transmitted through contaminated food or water, while hepatitis B, C and D are more commonly spread through contact with infected blood or bodily fluids.
Aside from viral infections, other causes of hepatitis include excessive alcohol consumption, exposure to toxins, or certain autoimmune diseases.
Several groups face a higher risk of contracting hepatitis, such as healthcare workers, people who use injectable drugs, individuals with multiple sexual partners, and babies born to mothers who are infected with hepatitis.
Hepatitis can be classified as either acute or chronic.
Acute hepatitis refers to short-term inflammation of the liver, which may resolve on its own without long-term effects.
However, in some cases, it can progress into chronic hepatitis.
This condition lasts for more than six months and may lead to serious complications, such as cirrhosis, liver failure or liver cancer.
In many instances, people with hepatitis do not show any noticeable symptoms during the early stages of infection.
As the disease progresses, however, several common symptoms may appear, including: Yellowing of the skin and eyes (jaundice)
Dark-coloured urine
Fatigue
Loss of appetite
Nausea
Vomiting, or
Abdominal pain.
In Malaysia
Hepatitis infections remain a significant public health challenge in Malaysia.
The two most common types are hepatitis B and C, both of which contribute heavily to the national burden of liver-related diseases.
Several factors drive the continued spread of these infections, including limited public awareness, restricted access to healthcare in rural areas, and high-risk behaviours.
According to Health Ministry statistics, between 2013 and 2023, there were 49,992 reported cases of hepatitis B and 34,573 cases of hepatitis C.
In 2016 at the 69th World Health Assembly, Malaysia pledged its commitment to eliminate viral hepatitis as a public health threat by 2030.
In line with this goal, the Health Ministry has adopted a multisectoral approach in addressing hepatitis B and C.
Collaboration among government agencies, the private sector and non-governmental organisations includes screening efforts, provision of treatment and immunisation services, as well as advocacy and public education initiatives.
Public health strategies in the country focus primarily on hepatitis B and C because these types are the main causes of chronic liver disease and liver cancer.
In contrast, hepatitis A and E are usually self-limiting and do not require long term treatment, while hepatitis D is rare and only occurs alongside hepatitis B infection.
As hepatitis B and C pose a greater burden on the healthcare system, they are prioritised in screening, treatment and prevention efforts.
Prevention and treatment
One of the key strategies to prevent the spread of hepatitis is immunisation.
In Malaysia, vaccines are available for hepatitis A and hepatitis B.
Specifically, the hepatitis B vaccine is included in the National Immunisation Programme (NIP) and is routinely administered to newborns.
Furthermore, for pregnant mothers who are diagnosed with hepatitis B, antiviral prophylaxis is given to reduce the risk of transmitting the virus to the unborn baby.
Apart from immunisation, routine screening for hepatitis is equally important.
In particular, it should be prioritised among high risk groups, blood donors and foreign workers.
Early detection not only allows for prompt initiation of treatment, but also helps reduce transmission within the community.
While prevention remains a crucial aspect in combating hepatitis, effective treatment is equally important in managing the disease.
Treatment for viral hepatitis plays a vital role in improving long-term survival.
However, not all individuals with hepatitis require treatment.
In certain cases, the immune system is capable of limiting the virus from replicating without medical intervention.
Therefore, the decision to begin treatment depends on several factors, including liver function, viral load and other co-existing health conditions.
For chronic hepatitis B, treatment involves the use of antiviral medications that work by inhibiting viral replication.
These include nucleoside analogues such as entecavir, and nucleotide analogues such as tenofovir.
These oral medications do not cure hepatitis B, but they help to reduce the risk of serious complications and improve long-term survival.
Most patients need to take these medications for life.
Another treatment option for hepatitis B is peginterferon alpha injection, which is an immunomodulator that boosts immunity against infection.
In Malaysia, this treatment is usually reserved for patients who do not respond to, or cannot tolerate, oral antiviral medications.
It is not recommended for pregnant or breastfeeding mothers.
On the other hand, hepatitis C is treated with direct-acting antiviral medicines such as sofosbuvir, daclatasvir, ribavirin and ravidasvir.
These medications have been shown to cure more than 95% of hepatitis C cases, with shorter treatment duration and fewer side effects.
They act by disrupting the virus replication cycle.
Before starting this treatment, healthcare providers will explain how to take the medication properly, the importance of not sharing it with others, and the need to avoid any medication that might interact with the treatment.
This is to ensure the success of the hepatitis C treatment.
Although antiviral medications for hepatitis B and hepatitis C are generally safe and well tolerated, some patients may experience side effects such as headache, nausea, fatigue or skin rashes.
If any of these symptoms occur or if there are concerns about starting treatment, it is important to consult a doctor for further advice.
Advice for patients
In addition to taking prescribed medications, hepatitis patients are advised to maintain a healthy lifestyle.
This includes eating a well-balanced diet, engaging in regular physical activity, getting tested for HIV (human immunodeficiency virus), limiting alcohol intake, and getting vaccinated against hepatitis B if they have hepatitis C.
Similarly, those with hepatitis B are advised to get tested for hepatitis C.
Patients should also consult their healthcare providers before starting any new medications, supplements or traditional products.
Moreover, hepatitis patients should avoid behaviours that can lead to transmission of the virus.
These include sharing personal items such as toothbrushes, razors or nail clippers, donating blood, and having unprotected sexual intercourse.
In conclusion, a better understanding of the many aspects of hepatitis empowers individuals and communities to take proactive steps to prevent infection, seek timely diagnosis and access appropriate treatment.
As part of global efforts to raise awareness, World Hepatitis Day is observed annually on July 28.
This year's theme 'Let's break it down' underscores the need to overcome barriers in understanding hepatitis so that it can be effectively managed, treated, and ultimately, eliminated.
For any inquiries about medicines, please call the National Pharmacy Call Centre (NPCC) at the toll-free number 1-800-88-6722 during weekdays from 8am to 5pm, except on public holidays.
Umi Kalthum Mohd Isa is a pharmacist at Hospital Sultan Idris Shah in Serdang, Selangor. This article is courtesy of the Health Ministry's Pharmacy Practice and Development Division. For more information, email [e-mail]. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.