Treating hepatitis constrained by lack of awareness of those infected

Although testing and treatment have been made more accessible, hepatitis B and C are still far too prevalent in the Asia-Pacific region, with public health systems often struggling to deal with the disease, not least because those infected tend not to realise the infection’s impact on their liver.

Several medical experts are calling for countries to deal with this infectious disease as the World Health Organisation (WHO)’s data from 187 countries showed that the estimated number of deaths from viral hepatitis increased from 1.1 million in 2019 to 1.3 million in 2022.

“Of these, 83 per cent were caused by hepatitis B, and 17 per cent by hepatitis C,” WHO reported, adding that 3,500 people are dying each day due to hepatitis B and C infections.

Patients with hepatitis B and C could develop symptoms like exhaustion, nausea, night sweats, fever and unexpected weight loss. These symptoms are also often linked to severe disease, including cirrhosis, liver failure and liver cancer.

John Ward, director of the Coalition for Global Hepatitis Elimination in the US, said that lack of awareness of how the hepatitis virus acts in the body poses a threat to global public health.

Hepatitis has been dubbed a ‘silent dragon’ in the US as the virus silently impacts patient’s liver and it is often several years before they realise those impacts, he explained.

“Hepatitis is a huge public health problem in the Asia-Pacific as there were 300 million living with this chronic virulent infection as of 2022 and over 1 million deaths a year,” he said.

He added that 80 per cent of liver cancer deaths in the world were triggered by hepatitis B and C.

Dealing with social stigma

A survey published by multinational healthcare company Roche showed that over 50 per cent of the population in APAC, Africa and Latin America have a basic awareness of hepatitis, but over 30 per cent have not been tested.

Part of the reason for the lack of testing stems from the fact that the disease can be transmitted through contact with infected body fluid and sexual contact, as well as mother to child. HIV patients and people with criminal behaviour, such as drug users and ex-convicts, are also at risk of hepatitis.

“Many are reluctant to get screened for fear of being labelled as someone who deserves it,” the company said. “Societal attitudes and taboos not only discourage individuals from seeking testing, but also perpetuate a harmful culture of silence surrounding the disease.”

Roberta Sarno, director of APAC Liver Disease Alliance, said that much can be done to address this social stigma, including psychological support for patients and families, and education to help people know the reality of the disease.

Collective effort needed

In 2016, WHO released guidelines to eliminate hepatitis by 2030, focusing on a 90-per-cent reduction in incidence and a 65-per-cent reduction in mortality.

Studies have found that an estimated 4.5 million premature deaths could be prevented in low- and middle-income countries by 2030 through a combination of vaccination, diagnostic tests, medicines and education campaigns.

Although countries have adopted the WHO guidelines, implementation lags behind as access to viral hepatitis treatment has not yet shifted to a public health approach, and the availability of affordable and simplified regimens is limited, especially primary healthcare.

“Most countries of the APAC region are currently lacking in their optimum national action plan [on eliminating hepatitis], so their national action plan is not there or not adequate,” Sarno said.

She urged governments and relevant agencies to collaborate on reducing hepatitis mortality and comply with the WHO’s guidelines.

Political commitment is crucial to facilitate people’s access to hepatitis testing and enhance treatment efficiency, she said, adding that artificial intelligence (AI) could help boost the potential of hepatitis diagnosis along with allowing medical staff to get closer to patients.

“This technology is giving us opportunities to actually overcome many of these viruses and bring medical staff closer to patients,” she said.

Thailand’s commitment

In Thailand, 2-3 million people or 3 per cent of total population are living with hepatitis B or C, and one-third of them had died, Tawesak Tanwandee, head of Siriraj Hospital’s Division of Gastroenterology said.

He confirmed that Thailand had improved guidelines for dealing with hepatitis over time by focusing on mitigating risk of infection among people, especially mother-to-child infection which could put them at risk of developing acute symptoms.

The Public Health Ministry kicked off vaccination against hepatitis among children in 1992, resulting in only 0.1 per cent of them being at risk of infection, he explained, adding that medical institutions in the country use disposable syringes to prevent infection from blood.

The ministry also allows people to access testing for hepatitis at a reasonable price, and conducts screening in communities nationwide to deal with social stigma, he added.

“Now we have testing for hepatitis using blood from a patient's finger, which can be conducted at home,” he said. He added that people can access this testing at hospitals near their home, which takes 10-15 minutes for the result.

However, Tawesak said 42 million people who were born before 1992 are at risk of hepatitis infection. He noted that sexual contact between men also causes the risk of the disease spreading to increase.

Even though Thai people can access treatment for hepatitis C and could recover after taking medication for 12 weeks, he said Thailand has a flawed record in tackling hepatitis B and this often leads to up to eight years of medication.

“We are encouraging hepatitis B patients to access long-term treatment under a social security system similar to HIV/Aids,” he said.

Tawesak would also like to see testing for hepatitis conducted for everyone to prevent the risks of developing cirrhosis and liver cancer.

“Mothers should be screened for HIV, hepatitis B and syphilis, so they and their children can receive vaccines if they test positive,” he said, adding that mothers should receive antiviral drugs three months before the delivery.

He said technology could be applied to support physicians’ diagnoses and enable patients to access treatment anytime and anywhere.

“We need technology in case people forget to take their medicine as this could boost their awareness and responsibility for receiving treatment regularly,” he said. He added that patients should be able to receive drugs at medical institutions near their homes.