By Dr Lim Su Yin, Dr Yau Weng Keong & Dr Noor Aliza Abd Mutalib

The hepatobiliary clinic at the public hospital is bustling with patients and their caregivers. Some are waiting for their numbers to be called while others are picking up their medications after their consultations. Mr W is patiently waiting to see his doctor for an update on his current medical status. Despite the long wait times for his appointments and medication, he feels grateful for the regular care he receives. Mr W has been living with chronic hepatitis B and has experienced numerous complications over the years. In 2011, he underwent chemotherapy embolisation for liver lesions, followed by alcohol injection in 2014 and another chemotherapy embolisation in 2022. He is being closely monitored and has remained stable since. His uncle was not as fortunate and passed away at the age of 55 due to late detection of his hepatitis B infection and liver lesions. A few of Mr W's siblings also have hepatitis B, and a cousin was identified as a carrier after donating blood for the second time.

The case scenario above exemplifies the typical journey of an individual diagnosed and treated for viral hepatitis.

Over the last decade, deaths and complications from viral hepatitis have improved worldwide due to advancements in diagnosis, treatment and public health initiatives.

Case in point is the advancements in medical research that have enabled new treatments for hepatitis C, curing over 95 per cent of cases, while vaccination programmes and effective antiviral treatments have also greatly reduced deaths from hepatitis B.

Of the five main strains of the hepatitis virus (A to E), hepatitis B and C can lead to chronic debilitating disease, where they are the most common causes of liver cirrhosis, liver cancer and hepatitis-related deaths.

Early detection of the virus helps prevent its spread, allows timely treatment and avoids severe liver problems.

However, major challenges remain. Most symptoms of hepatitis only appear once the disease has advanced, resulting in many undiagnosed people living with protracted hepatitis.

In Malaysia, hepatitis B-related deaths have steadily increased over the years, with 9.6 deaths per 100,000 population in 2019. Hepatitis B and C are the leading causes of liver cancer which is one of the five most common cancers diagnosed locally.

Many hepatitis infections remain silent, and liver health awareness is very low in our country.

Even when hepatitis is diagnosed, the number of people who go on to receive treatment is incredibly low. This could be due to lack of awareness on the catastrophic complications of viral hepatitis and the public's stigmatisation towards people living with hepatitis.

Most importantly, accessibility to treatment remains limited and centralised, and many affected populations still face out-of-pocket expenses for viral hepatitis services.

For those receiving free hepatitis treatment in government facilities, they may have to wait long for their first gastroenterology clinic appointment.

Moving Forward

Decentralising access to rapid testing for everyone and making treatment available at primary care level are some ways forward. Simplifying treatment criteria for hepatitis B and C, strengthening healthcare infrastructure with more diagnostics testing, training healthcare workers so that many more can treat hepatitis, and ensuring adequate resources are vital.

In Malaysia, universal hepatitis B vaccination of all newborn infants has been implemented since 1989. Hepatitis B vaccination for adults born before 1989 should be offered at a very low cost at least.

Public health campaigns are crucial to increase awareness about this silent killer. Multimedia social platforms, schools, workplaces and community organisations can play vital roles in disseminating information to inform people about hepatitis transmission, prevention and the importance of early diagnosis and treatment.

Regular screening is essential for high-risk groups such as those in endemic regions of Asia, infants born to infected mothers, sexual partners of individuals with hepatitis, people with human immunodeficiency virus (HIV), blood transfusion recipients, those who inject drugs, individuals with multiple sexual partners, healthcare workers and men who have sex with men.

Initiatives to reduce the stigma associated with hepatitis are needed, as fear and misunderstanding often deter individuals from seeking diagnosis and treatment.

The high cost of antiviral medications, particularly the newer antivirals for hepatitis C, poses a financial barrier to treatment for many patients worldwide.

Nevertheless, in Malaysia, innovative strategies involving the navigation of international drug patent laws and collaboration between non-profit organisations and local pharmaceutical manufacturers have made the treatment more affordable, making us an exemplary model for other low and middle-income countries.

Acknowledging the various challenges that remain, the global community has rallied under the powerful call to action, "Integrate, Accelerate, Eliminate" for this year's World Hepatitis Day.

Increasing awareness, improving access to early diagnosis, and ensuring that more individuals receive effective vaccines and treatments are essential in continuing to reduce the burden of viral hepatitis worldwide.

Hence, it is hoped that World Health Organisation’s global hepatitis elimination goals to significantly reduce the incidence of viral hepatitis will be achieved.

-- BERNAMA

Dr Lim Su Yin is a senior lecturer in Internal Medicine, and both Dr Lim and Assoc Prof Dr Yau Weng Keong are faculty members at the School of Medicine, Taylor's University.

Dr Noor Aliza Abd Mutalib is a Consultant Gastroenterologist and Hepatologist at SALAM Shah Alam Specialist Hospital.