Why miss out on a test? World Hepatitis day seeks a global solution

Australia is well placed to eliminate viral hepatitis by 2030 yet many people continue to miss out on treatment.

According to Hepatitis Australia, thousands have yet to be tested and are unaware they have hepatitis B or hepatitis C.

“Many who may have been diagnosed years ago are not accessing their doctor to monitor how hepatitis B is affecting their liver health and many are unaware they could be cured of hepatitis C,” according to a Hepatitis Australia spokesperson.

So far, 60,000 Australians have been cured of hepatitis C, yet 170,000 haven’t accessed the breakthrough treatment.

And when it comes to hepatitis B, 40,000 Australians are receiving care, but 200,000 are missing out.

Professor Jacob George, Head of Department, Gastroenterology and Hepatology, at Westmead Hospital, wants to turn those figures around.

“Australia is now moving towards eliminating hepatitis C from our population, which means that we are hoping that by the middle of the 2020s, we won’t have hepatitis C as being a problem at all in Australia,” Professor George said.

“If you don’t get on to effective therapies in time just remember that the liver is slowly getting damaged over time and eventually you may develop one of the complications such as liver failure or liver cancer.

“We can today cure hepatitis C in more than 95 per cent of people and we’ve got such effective cures for hepatitis C, it’s just one tablet a day, for about three months – 84 days – and you’re cured of the virus,” he said.

Hepatitis means inflammation of the liver.

There is viral hepatitis, as well as a type caused by alcoholism and another caused by having a fatty liver.

“Once we find inflammation, we then try and work out what the cause is, is it a virus, is it alcohol, is it something else,” Professor George said.

Hepatitis A and E are transmitted by the hands, via the ingestion of fecal matter found in contaminated water, or from food such as shellfish.

Hepatitis B is spread through sexual contact, while hepatitis C is spread through blood-to-blood contact.

Hepatitis B, C and D cause chronic inflammation of the liver, which over decades leads to severe scarring of the organ (sclerosis of the liver).

“The body has got a lot of excess capacity with liver function, so for most of the time that you have chronic hepatitis B or C, you have absolutely no symptoms,” Professor George said.

“When you get sclerosis, you develop symptoms, including swelling of your legs, swelling of your abdomen, or tummy – you can vomit blood and you can get infections in your belly.

“They happen at the end stage when (hepatitis has) destroyed 80 to 90 per cent of the liver.

“But for that first 80 to 90 per cent of destruction, which can take decades, patients have no symptoms whatsover.”

And that is why it is important to get tested early.

In Australia, one in six people do not know they have the hepatitis C virus, while for hepatitis B, it is one in three.

“On the other hand, with hepatitis A and E, usually people get yellow, they get sick, they go to the GP saying ‘I’m yellow’, my urine’s got dark in colour, and usually with hepatitis A and E you recover… and there’s no chronic disease, whereas hepatitis B and C you can have chronic long-lasting disease that the body can’t eradicate,” Professor George said.

Hepatitis B, C and D are killers, because over time a person can develop liver failure or liver cancer.

Fortunately, there are very effective treatments for hepatitis B and C.

A vaccine has been developed for hepatitis B, while hepatitis C is now curable in most cases.

The tests for hepatitis B and C are cheap and readily available.

But getting people to have these checks is still quite a challenge for health care providers.

“The vast majority of people with hepatitis, whether it’s B or C, live out in the community and they don’t particularly like coming to hospitals to get treatment,” Professor George said.

“If you ask people about their risk factors, they may become very self-conscious, and they may not come back to you again,” he said.

So the Western Sydney Local Health District (WSLHD) is focusing on getting people tested by their local GP or at a community clinic first.

“If they want us from the hospital, nurses or doctors, to come to them and assess the patient for treatment and give the patient treatment in the community, we’re very happy to do that, and already we’ve linked up with several general practices out in the community to provide such a service,” Professor George said.

Patients born outside of Australia face a higher risk of having hepatitis B.

In Australia, 90 per cent of hepatitis B transmission is from mother to baby.

“Now we’ve got very effective vaccination strategies, and Australia has a universal policy of testing all mums for hepatitis B and all babies get vaccinated for hepatitis B.”

There is no vaccine for hepatitis C, and if the mother has hepatitis C the baby has a one in 20 chance of getting it.

The WSLHD will soon purchase a van to allow doctors and nurses to travel into the community to test those who are at high risk of having hepatitis.

“It’s all about reaching out to the people that don’t like to come into hospital but they have a health issue, and it is important for us as physicians and doctors to be able to treat them,” Professor George said.

World Hepatitis Day is on July 28.