Written by David Bernstein, MD, FACP, FACG Thursday, 25 June 2009 14:01
The international community recognized the importance of liver disease on May 19, World Hepatitis Day. One in 12 people worldwide have chronic hepatitis, including roughly 350 million with HCV and 170 million with HBV. Morbidity and mortality from these conditions are high with the world’s health authorities estimating that at least one million people die each year of hepatitis, especially in Asia, sub-Saharan Africa and Latin America where it is endemic.
Where do we stand in the war against hepatitis? The battles are being fought on three fronts: screening, treatment and prevention. Screening programs are becoming more widespread and are essential in identifying and tracking sufferers; they are determined by country and governmental priorities. The effectiveness and scope of these programs are directly related to a nation’s economic resources. Progress in treatments over the past decade has been dramatic. Hepatitis B has three highly potent compounds available for treatment: interferon-alpha, entecavir and tenofovir. Prior to 1992, there were none. Several worldwide societies have published cutting edge clinical practice guidelines that are highly innovative in their use of virology orientated endpoints and their recommendations of choice of therapy. Despite this progress, hepatitis B is still a chronic incurable condition.
The treatments available for hepatitis C are not as advanced as those available for hepatitis B. Standard interferon and ribavirin therapy can cure about half of patients. There remains no good treatments for those who fail initial therapy. The good news is that newer agents in combination with standard hepatitis C therapies appear to increase the sustained response rates to more than 75 percent and this should help reshape the course of this disease for the better.
There is no vaccine for hepatitis C while the hepatitis B vaccine has been extremely effective in limiting new infections. If the world were to adopt universal vaccination, it is conceivable that the next generation could expect to be free of hepatitis B altogether.
Hepatitis is only the start of a continuum of diseases that can affect the liver, creating a long-term health concern with huge mortality concerns. Fatty liver caused by either non-alcoholic steatohepatitis secondary to diabetes or obesity, alcoholic liver disease, autoimmune diseases such as primary biliary cirrhosis and hereditary liver diseases continue to pose long-term concerns for the overall health of our populations. Of these conditions, fatty liver is the most common and most concerning as its incidence is rapidly on the rise and it is associated with the metabolic syndrome and is a risk factor for heart disease. All of these conditions can lead to cirrhosis and recent evidence suggests these conditions can directly cause liver cancer. Liver cancer is often the terminal endpoint of the continuum of liver diseases. As we look towards the future, especially in the Western World, even if hepatitis is brought under control, chronic disease will almost certainly progress through cirrhosis to liver cancer, and the current peak in hepatitis cases will see a peak in liver cancer 20 years from now. This relationship has already been seen in Japan.
(Disclaimer: The views and opinions represented are those of the author and meant for informative purposes only. For your specific questions, consult your physician.)