The liver, which is one of the largest organs in the body, has myriad functions.
These include storage of nutrients; production of bile, which digests fats and removes waste products; removal of waste products and degenerated cells from the blood; filtering and processing of chemicals in food, medicines and alcohol, etc.
Hepatitis is a term for inflammation in the liver.
When the liver is inflamed or damaged, its functions can be impaired.
Having said that, the liver is an organ that has marked powers of regeneration.
Five types of hepatitis
The multiple causes of hepatitis include medical conditions like autoimmune diseases, toxins, certain medicines, heavy alcohol consumption and viral infections.
Viral hepatitis, of which there are five types (A, B, C, D and E), is a significant public health problem globally.
Each type spreads differently.
Hepatitis A and E spreads through contaminated food or water, and hepatitis B, C and D mainly through contact with infected blood or body fluids.
The World Health Organization (WHO) estimates that there are 304 million people worldwide with hepatitis B or C.
The Health Ministry recorded nearly 50,000 cases of hepatitis B and 35,000 cases of hepatitis C between 2013 and 2023 in Malaysia.
Most experts agree that the recorded numbers do not reflect the actual disease burden because of underdiagnosis and limited screening.
Modelling suggests that the prevalence of hepatitis C ranges from 0.3% to 2.5% of the Malaysian population.
This means that between 100,200 to 835,000 of the 2026 population are affected.
It is pertinent to remember that there has been widespread hepatitis B vaccination since 1989, and available treatments that can cure about 95% of hepatitis C since 2017.
Malaysia made a commitment at the WHO World Health Assembly in 2016 to eliminate viral hepatitis as a public health threat by 2030.
Yet, progress demands more than rhetoric.
The Health Ministry’s reports have highlighted three major hurdles: limited public awareness, limited healthcare for the disadvantaged and those living in remote areas, and social stigma that discourages testing.
While most people know about hepatitis A and B, many are unaware about hepatitis C, which is the focus of this column.
Hepatitis C
Hepatitis C (HCV) infection is caused by a virus.
The severity of an acute infection varies from a mild illness with limited or no symptoms, to a serious one requiring hospitalisation.
About 20% of the infected are able to get rid of the virus themselves without treatment within the first six months of infection.
However, the majority, i.e. 80%, develop chronic infection.
The long-term complications are HCV liver disease, liver failure, liver cancer and other liver-related health issues.
HCV is spread by contact with blood or body fluids, i.e. through sharing of needles, syringes or other injection equipment; sexual contact; and mother-to-baby transmission.
HCV and HIV (human immunodeficiency virus) have similar modes of spread.
As such, HCV and HIV co-infections are common.
In such situations, HIV may cause chronic HCV to progress faster.
Whether or not HCV also causes HIV to progress faster is unclear.
The majority of acute HCV patients have no symptoms.
However, when there are symptoms, they include fever, poor appetite, nausea/vomiting, tiredness, abdominal pain, dark-coloured urine, clay-coloured stools, jaundice (yellowing of eyes or skin) and joint pain.
The majority of chronic HCV patients have no symptoms and are often diagnosed following routine blood tests.
Treatment
There were no cost-effective treatments for HCV until 2017 when cheaper generic medicines became available in Malaysia.
These anti-viral medicines target specific steps in the HCV lifecycle, prevent progression of the disease and effectively eliminates the virus from the body.
The cure rates are more than 95%.
The medicines are combinations of anti-virals, which are usually taken orally.
Most treatment regimens take eight to 12 weeks depending on the specific medicines used and the person’s health status.
Some patients may require longer treatment if they have advanced liver disease or specific genotypes of the virus.
There are interactions between certain medicines and HCV treatment, which can affect the latter’s efficacy.
As such, it is vital to inform the attending doctor of all the medicines that one is consuming.
Regular follow-ups are essential to monitor liver health and the response to treatment.
Lifestyle modifications like consuming a healthy diet, exercising regularly, and avoidance of illicit drugs and/or alcohol, are necessary to promote better liver health, and consequently, response to treatment.
Prevention
There are several preventive measures to avoid being infected with HCV.
The best is never to inject illicit drugs.
If one does inject drugs, it is vital to always use new, sterile needles every time a drug is injected.
It is important not to reuse or share needles, syringes or other injection equipment.
One should also not share personal items like toothbrushes, razors etc that may come into contact with another person’s blood or body fluids.
If one gets a body part pierced or have a tattoo done or removed, it is important to ensure that the procedure is done by a competent person with sterile equipment and proper sterilisation methods, and in a clean and hygienic premise.
Everyone who has HIV should first get an HCV antibody test.
A positive test means that there was exposure to HCV previously.
However, it doesn’t necessarily mean that the person has an ongoing HCV infection.
As such, a positive HCV antibody test must always be followed up with a test to check if HCV is present in the person’s blood.
If this second test is positive, then it confirms that the person has an HCV infection.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
