Management of Viral Hepatitis (2)

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Published July 23, 2019. 

Rotimi Adesanya

Child and Public Health Physician

roayad @ yahoo . com 08037202050

 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 .

Hepatitis profile / viral markers : There are six parameters used in the diagnosis 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 immunised 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 .

Other tests are complete blood count , fasting blood sugar , lipid profile , alfa fetoprotein and abdominal scan, liverscan or fibroscan

Treatment

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 .

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 , legume , fruits , cereals , preferably whole grain , lean meat , fish , poultry, milk, yoghurt, cheese and regularly drinking water. Groundnuts NOT properly preserved contain toxins ( aflatoxin) that are poisonous to the liver .

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 .

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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 . Sexual partners of HBV positive persons should be counseled 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 : There are effective drug therapies that can control and even stop the hepatitis B virus from further damaging a liver . There are also promising new drugs in the research pipeline that could provide a cure in the very near future. 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.

Schedule regular visits every six months ( or at least every year ) to a liver specialist or a health care provider knowledgeable in hepatitis B so they can monitor your liver . Get screened for liver cancer during regular visits since early detection equals more treatment options and a longer life. Avoid or limit alcohol and smoking since both cause a lot of stress to your liver ; Eat a healthy diet with lots of vegetables .

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