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    Monday, March 31, 2014

    Hepatitis B deadlier than HIV -- Expert

    In this interview with ARUKAINO UMUKORO, Dr. Joseph Onigbinde, an infectious disease specialist and professor of Public Health, New York University, who is also the Managing Director of Ropheka Medical and Dental Hospital, speaks on the link between Hepatitis B and HIV/AIDS

     What is Hepatitis B?

    Hepatitis simply means an inflammation of the liver as a result of an infection or virus. Hepatitis is a broad nomenclature. There are different types, Hepatitis A, B, C, D and E. A tends to be 'fecco-oral' mode of transmission. B and C are similar to HIV mode of transmission. D is a parasite, it infects only those that have B, and E is similar to A. In my organisation, we are interested in Hepatitis B, which is about the most dangerous among the types. Hepatitis B, when fully blown, is dangerous because most of the time, the infection is not known until one is screened. Hepatitis B causes terminal diseases such as cancer of the liver, liver cirrhosis and liver failure.

    How prevalent is Hepatitis B in Nigeria?

    Many studies have been done in Nigeria by local scientists. In the last two years, the Centre for Disease Control in Atlanta, USA sent out some researchers who have been doing research in the country. They came out last year to say the prevalence rate of Hepatitis B in Nigeria was as high as 11 per cent. That means if you extrapolate that with the population of the country, close to 20 million Nigerians have it. There has been an increase over the years. The survey was presented to the Federal Government in December last year. In advanced countries, the prevalence rate is hardly higher than two per cent. The vaccine had long been developed as far back as 1982.  There are 280 million people in the world who are chronic carriers of Hepatitis B virus in their liver. About two million of the carriers die every year from liver cancer and liver cirrhosis.

    What is the mode of transmission?

    One can get infected with Hepatitis B the same way one can be infected with HIV/AIDS; that includes through sex, blood transfusion, body fluids and many others way by which HIV/AIDS is transmitted. When fully blown, Hepatitis B is more dangerous than HIV. This is because none of the complications of chronic Hepatitis B infection can be managed conservatively, but HIV/AIDS can be. Although HIV still has no cure, if one uses the drugs effectively, it could help the infected person live a prolonged life. But chronic Hepatitis B is always catastrophic, either as cancer of the liver or liver cirrhosis. However, if Hepatitis B is detected early, there are drugs that can be used to manage it, but they are very expensive.

    How can Hepatitis B be prevented or managed?

    Prevention is through vaccination. Like I said earlier, the vaccine has been available since 1982. It has been incorporated into the immunisation scheme of the US. As a professor of public health and director of Hepatitis programme at New York University, I led a team of medical researchers to investigate the prevalence of Hepatitis B among New York residents. To my amazement, among over 20,000 people, only five persons were positive. And four out of five of them, or 80 per cent of them, were Nigerians. The fifth person was Togolese. So, it was an all-African affair.

    What is the relationship between Hepatitis B and HIV/AIDS?

    They are just like co-travellers because their mode of transmission is similar.

    Can someone contract Hepatitis B and HIV at the same time?

    Absolutely.

    How can such cases be managed?

    HIV and Hepatitis B can be managed separately. But where there is co-infection, such people have to be treated more seriously. But it's not everyone with Hepatitis B that needs treatment. There has to be a series of medical tests to determine if the virus is actually active in the body. The case has to be investigated further before the person is subjected to treatment. As per HIV, tests include determining the blood count, viral load and CD4 counts. If the viral load is so heavy and the CD4 counts are very low, treatment should be introduced immediately, especially when the person has already shown signs of AIDS.

    Would you say Nigeria is winning the war against HIV and Hepatitis B?

    With due respect, I think Hepatitis B, and generally Hepatitis infections, have been neglected by the government and many non-governmental organisations. Everybody seems to have focused more on HIV. I have been involved in HIV/AIDS control programme since 1992, and in 2003 I travelled to the US for the International Visitors Programme on HIV/AIDS and infectious diseases. The programme was sponsored by the US. To be fair to Nigeria, the prevalence rate of HIV is declining, that means we are winning the war. This is because people are now more aware about HIV/AIDS than Hepatitis B. It is now that people are getting to know about Hepatitis B. A year ago, when I asked 10 persons whether they knew anything about Hepatitis B, nine of them knew nothing about it. But now, more people are more aware. That is the thrust of our organisation; to create awareness and help reduce the prevalence rate in the population, and how people can protect themselves against it, as well as screening themselves for it.

    What should people know about Hepatitis B?

    Like I said, there should be more enlightenment programmes to let people know that Hepatitis B is very deadly. One wouldn't know one has the infection without undergoing thorough screening and tests. That is what we are doing. There should be more vaccination also, especially in rural areas. Seventy per cent of people who give birth are in the rural areas which lack such healthcare. Since our primary healthcare is in rural areas, if they incorporate the Hepatitis B vaccination into their healthcare programmes, it will reduce the prevalence rate in the country.

    What further advice would you give to government and health authorities to effectively contain Hepatitis B?

    I would advise that more awareness should be created through community-based and faith-based organisations, as well as the use of the print and electronic media to campaign about it. It is time we stepped up intervention strategies.

    Is there a particular age range that is more prone to Hepatitis B?

    Yes. People between 30 and 60 have a lot of prevalence because they would have been carrying the virus from an earlier age. And it begins to manifest at this prime of their lives.

    What are the signs and symptoms of Hepatitis B?

    The signs and symptoms include weakness, it may look like malaria and typhoid cases. Sometimes, it doesn't show any sign, especially when it is in the early stages. Later, it becomes too late. The complications arising from chronic infection of Hepatitis B can be serious. And in many cases, one may not know one is infected until he or she is tested. That is why having a test is very important.

    What is the most effective way to curb it?

    Vaccination for children is the best way to prevent it. But every age group can be at risk and can be vaccinated to prevent Hepatitis B infection.

    What are the challenges your organisation is facing in creating awareness?

    One of the challenges is lack of partners to work with us. I would say that the concept of NGO has been abused in this country. Currently, we do not have partners and it is difficult to move our workers from one community to the other. We need more partners to do the work and see the importance of what we are pioneering.


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