Hepatitis B: Silent virus that ravages the liver

Ruth Juma* was diagnosed with hepatitis B after being ill for some time. Although she was devastated by the news, she felt relieved that she had finally found out what was ailing her.

“I had visited many hospitals. None of them could treat me or even identify whatever I was suffering from,” says Ruth. “The hepatitis B tests were around Sh50,000 and I could not afford it. I tried appealing to my family members and former schoolmates through WhatsApp, but no one was willing to assist me,” Ruth says.  

Her friend told her about Kemri, and she visited the Comprehensive Care Centre (CCC) clinic for Hepatitis B tests and treatment.

“I tried to go to a public health facility and realised they wanted me to pay for the blood counselling and other charges. I explained to them that I do not have enough cash but they were not willing to listen to me,” she says.

Before Ruth knew she had hepatitis B, she tested negative for HIV. However, everyone that knew about her illness kept urging her to recheck her HIV status because of the erratic symptoms that she did not understand.

“I even had an ultrasound because my stomach was distended and it kept growing bigger. I now understand that it was hepatitis B affecting the liver, plus my eyes also had jaundice,” says Ruth who is in her 50s.

No cure

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“Some of the physical symptoms I got were dark blotches on my skin and blood while brushing,” says Ruth. 

Ruth says hepatitis B is manageable even though she has learnt that it is not treatable once it becomes chronic.

She confesses that there are fellow patients with a low viral load who do not feel they need the treatment because of the stigma of taking ARVs.

“Sometimes I must drag myself to work although I feel exhausted because I must take care of my bills. I wish the international community would support us through powerful campaigns like malaria and HIV assistance programmes,” Ruth says. 

According to Dr Missiani Ochwoto, a senior researcher and scientist at Kemri, hepatitis B is a viral liver infection caused by the hepatitis B (HBV) virus.

“There is no cure for Hepatitis B and people who suffer from acute infections are given fluid replacement and symptom management to relieve pain,” he says. Doctors then wait for six months before testing if the patient qualifies for further treatment as only patients with chronic hepatitis B receive lifelong treatment.

“Most people who are infected remain at the acute stage, and they recover after six months. Those who recover develop lifelong immunity to the virus. Therefore, they will never be infected again. However, the others become chronic,” he says.

The researcher says the disease is a silent killer because it slowly multiplies in the liver cells, and leads to liver cirrhosis, fluid in the abdomen(ascites), liver cancer, liver failure, and death. 

He discloses that the tests are expensive, yet very few hospitals offer them, and doctors require them before treatment. They are histologic (liver biopsy), virologic (viral load), and biochemical (liver function tests). 

According to Dr Ochwoto, other signs of the virus include fever, abdominal pain in the upper right, nausea, vomiting, loss of appetite, itching and hives, flu-like symptoms, dark urine, and stool.  

As for how the disease spreads, Dr Ochwoto reveals that studies in Nigeria have found the active hepatitis B virus in bed linen.

“In Uganda, people who were sharing a cup contracted the virus. You can easily contract hepatitis B from people with jaundice because at that time, the virus is high and replicating in their bodies. In South Africa, the virus was found in barbershops. In our country, pedicure, manicure, massage and tattooing areas are not regulated, yet the virus can easily be transmitted in those premises,” reveals the researcher. 

The researcher explains that barbershops and salons use small towels, which they share among all clients. Even though the staff might wash the towels properly, there is no requirement that they must sterilise them. He proposes that the businesses should be regulated and be made to follow a health code of conduct. 

He adds that 90 per cent of hepatitis B mother-to-child transmission occurs during delivery. The World Health Organisation (WHO) recommends that every mother who comes to the ante-natal clinic (ANC) must be tested for hepatitis B, HIV, and syphilis.

“However, in Kenya, pregnant women are not tested for the virus, and this creates a gap. We are not certain how many pregnant women are affected by the virus,” says Dr Ochwoto who further says that a Prevention of Mother-to-Child Transmission (PMTCT) programme would reduce childhood cancers and prevent the infection from spreading to children.

He recommends that children born to hepatitis B positive mothers are given a dose of medication 24 hours after birth, which prevents mother to child transmission and horizontal transmission within the house because of bodily fluids. Dr Ochwoto also recommends that hepatitis B testing should be tied to HIV.

He adds that human milk banks should have proper screening for the hepatitis B  to prevent exposure to the virus. 

“If referral hospitals can access these tests from Kemsa, it will be easier. Studies in Baringo show the virus is prevalent there. Positive residents sell their land and animals to access treatment. There is also occult hepatitis or undetectable hepatitis B antigen in the population. People in Eldoret are forced to come to Nairobi to do the test,” says the doctor.

 Studies have shown that 78 per cent of people who die from liver cancer developed it from hepatitis B. Liver cancer is among the top eight cancers in the world.

“In 2018, during World Hepatitis Day, Kemri held a clinic in Nairobi town, and residents were tested and vaccinated for the virus. Most people who tested positive did not know they were infected, and only a third of the people who started on the vaccination completed it. Yet most of them were medics who understand its importance,” reveals Dr Ochwoto.  

“Therefore, Kenyans still need a lot of Hepatitis B awareness. There should also be follow-ups for vaccines so that everyone who begins the dose completes it. Many hospitals also lack immunoglobins, which is a risk for doctors who handle bodily fluids. Counseling should also be done professionally before testing,” concludes the researcher.