It may have been easy to miss due to all the hubbub surrounding the start of the Olympics but Saturday was World Hepatitis Day. So for Testing Tuesday this week, we have teamed up with Waverley Care - a fantastic organisation which has been supporting people with HIV and Hepatitis in Scotland for 21 years - in order to provide some information on hepatitis testing and the different varieties of the disease.
Hepatitis is an inflammation of the liver. It can be viral or caused by toxins such as alcohol or medication. It can also be either short-term (acute), becoming severe very quickly but like-wise detected and often treated quickly, or it can be long-term (chronic), often remaining symptomless for a long time but inflicting damage over a long period of time.
Unfortunately, chronic hepatitis (often hepatitis C) is a good example of how much damage can be caused by late diagnosis. Many suffering from chronic varieties of hepatitis do not display any symptoms until the disease has progressed so far that the effects of treatment will be limited.
The issue is a global one, with viral forms of the disease being particularly common in areas such as Asia Pacific. The Guardian reported last Friday that approximately 340 million people in this area live with chronic hepatitis B or hepatitis C. This is almost eight times the number of people in the region infected with HIV, tuberculosis or malaria (42 million). In 2011, the World Health Organisation's south-east Asia office reported there are 120,000 deaths annually related to hepatitis C and 300,000 related to hepatitis B.
The issue of late diagnosis was a priority for World Hepatitis Day 2012. Also, raising awareness of symptoms among those at risk and increasing access to screening and vaccines still remain priorties for the World Hepatitis Alliance. Therefore, two UK patient groups, Addaction and Hepatitis C Trust have identified this challange and united to raise awareness and improve care pathways from diagnosis up to treatment.
Addaction have taken on a secondee from the Hepatitis C Trust and, through their network of services across England and Scotland, are delivering a national training programme to more than 600 medical staff. An estimated 2,000 people at risk of viral hepatitus will be screened and those testing positive will be referred to specialist secondary care. We look forward to hearing their success stories on World Hepatitis Day 2013!
Below, with the help of Waverley Care, I have mapped out some of the basics of hepatitis but do follow us @BIVDA on Tuesday 31st July to get a clearer picture of the vast array of tests involved in testing and monitoring all three varieties of hepatitus.
What are the different types of hepatitis?
Infection with hepatitis A virus can cause an unpleasant illness, but most people fully recover. Symptoms include flu-like symptoms and jaundice which then gradually clear without treatment. Serious problems are rare. Good personal hygiene (in particular, washing hands after going to the toilet) helps to prevent spreading the virus to others as the virus is passed out in the faeces.
Hepatitis A has become uncommon in parts of the world where sanitation is generally good, such as the UK. Most cases of hepatitis A infection in the UK are diagnosed in people returning home after travelling to a country where sanitation is poor and risk of hepatitis A infection is higher.
The hepatitis B virus can cause an acute infection, which may or may not cause symptoms. Following an acute infection, a minority of infected adults develop a chronic hepatitis B. Many people with chronic hepatitis B remain well, but can still pass on the virus to others. Some develop serious liver problems. The virus is mainly passed on by sexual contact, sharing needles to inject drugs, and from mother to baby.
The exact number of people infected is not known. In the UK around 1 person in 350 is thought to have chronic (persistent) hepatitis B infection. Worldwide, it is much more common and hepatitis B is the most common cause of hepatitis. For example, in parts of Asia and Africa more than 1 person in 10 has chronic hepatitis B infection. Hepatitis B is thought to be 50 to 100 times for infectious than HIV.
Like hepatitis B, hepatitis C is blood borne and is often passed via sharing needles used for tattooing or sharing drugs. There is a small risk associated with sexual contact or the virus being passed from mother to baby. Hepatitis C was only discovered in the 1980s so it is still a relatively new disease; some aspects of this disease are still not completely understood. Hepatitis C is a virus which is carried in the bloodstream to the liver. It can then affect and damage your liver. However, this virus can also affect other parts of the body, including the digestive system, the immune system and the brain.
The exact number of people infected is not known because it is thought that many people have it and area not aware of it. This is because it can be symptomless until very advanced stages. There are around 216,000 people chronically infected with hepatitis C in the UK. Worldwide, over 180 million people are infected.
The number of people infected with hepatitis C is increasing. In 2020, it has been estimated that around 15,840 people in England will be living with either hepatitis C related cirrhosis or liver cancer caused by hepatitis C. Most cases are in people who inject illegal drugs. It is estimated that up to half of injecting drug users become infected with hepatitis C.
You can read what it is like to live with hepatitis in Waverley Care's blog post, featuring an account of life with hepatitis by a man named Martin.
Testing for Hepatitis
There are many tests which can be used to check the status of the liver or the effectiveness of treatment. For instance there are seven individual tests which, when undertaken together, are referred to as liver function tests.
To detect the presence of hepatitis A, B or C there are a plethora of other potential tests. Some of the tests detect antibodies produced in response to hepatitus infection; some detect antigens produced by the virus, and others detect viral DNA.
There are two antibody tests for hepatitis A diagnosis, seven tests (inc. antibody, antigen and DNA) for hepatitis B diagnosis and five tests (involving all three types, like hepatitis B) for hepatitis C.
Click the links or follow our tweets to find out more about these tests.
A, B, C
Symptoms to look out for are:
• Flu-like symptoms
• Fatigue & Nausea
• Jaundice (yellowing of the skin)
• Stomach ache
• Diarrhoea/dark urine/bright stools
• Aching joints
• Anxiety and depression
• Poor concentration
• Loss of appetite
If you think you have been at risk of exposure to hepatitis then contact your doctor to arrange a test. To help you work out whether you are risk, NHS Choices has put together this useful questionnaire.
Many thanks to Waverley Care for providing us with information on hepatitis this week. If you would like to know more about #TestingTuesday, or if you are an interested patient group, please contact Gemma Scotcher on firstname.lastname@example.org or follow us @bivda.
Waverley Care: http://www.waverleycare.org
World Hepatitus Alliance: http://worldhepatitisalliance.org/Home.aspx
Addaction UK: http://www.addaction.org.uk/
Hepatitus C Trust: http://www.hepctrust.org.uk/
The British Liver Trust: http://www.britishlivertrust.org.uk/home.aspx
If there is a link that should be added to the list, please let us know.