The curious incidence of HBV

MANILA, Philippines — There’s one out of 12 in the world. In the Philippines, there’s one of 10. That’s the number of people who carry hepatitis B surface antigen (HBsAg), a potentially life-threatening liver infection hyperendemic in the country. The sad part is, despite the figures, it’s not as “popular” as say HIV or AIDS when it has actually been the third leading cause of death in the country since 2010.

Shedding light about the curious case of Hepatitis B in the Philippines is Dr. Judy Lao-Tan from the Hepatology Society of the Philippines (HSP) formerly known as the Council on Liver Diseases under the Philippine Society of Gastrointerology (PSG). The organization has seen the growing rate of the disease in the country since its inception in 2006.

“There are actually two billion people with hepatitis B virus infection. Almost 350 million are carriers of chronic hepatitis B and three quarters of them are living in the Asian region. Of the three quarters, half a million will eventually die of hepatitis B related diseases every year,” says Dr. Tan.

Liver Inflammation

The infection has two possible phases: acute and chronic. “Acute hepatitis B refers to newly acquired infections where affected individuals notice symptoms approximately one to four months after exposure to the virus. In most people with acute hepatitis, symptoms resolve over weeks to months and they are cured of the infection. “Half of all people infected with the hepatitis B virus have no symptoms and may never realize that they have been infected,” warns Dr. Tan.

On the other hand, Chronic hepatitis B is an infection with HBV that lasts longer than six months. Once the infection becomes chronic, it may never go away completely.

According to Dr. Tan, the transmission of hepatitis B varies in geographic areas. “Majority route of the infection is from an infected mother to a newborn child which occurs during or shortly after birth. It can also be transmitted from one person to another via blood or fluids contaminated with blood.”

People who are at an increased risk of being infected with the virus are healthcare workers, commercial sex workers, households with contact with person/s with hepatitis B surface antigen virus, people who undergo multiple blood transfusions, people who are HIV and STD positive, and men who have sex with men.

“It is also a sexually transmitted disease,” says Dr. Tan while advocating the ABCs of safe sex which are abstinence, be faithful or monogamy, and use of condom with a caveat on the latter’s uncertainty.

Hepatitis B is diagnosed with blood tests of which the World Health Organizaiton aims to achieve for everybody. “That is WHO’s goal. If you are tested and are found negative, get vaccinated. If you are tested positive, get treated,” says Dr. Tan

Eradicating the stigma

However, the stigma attached to being diagnosed with Hepatitis B is undeniably present in the country. It is for this reason that the society has undertaken initiatives such as the “Guidelines for the Implementation of the Workplace Policy and Program for Hepatitis B” by Department of Labor and Employment Secretary Rosalinda Baldoz. It advocates for no discrimination in the workplace for patients with Hepatitis B.

According to HSP founding president Dr. Erlinda Valdellon, “Many job applicants who are hepatitis B surface antigen positive are declared unfit to work without appropriate medical evaluation and counseling. These individuals are otherwise healthy and can be gainfully employed. Because the workpace is part of the larger community of Filipinos fighting the Hepatitis B epidemic, strategies need to be implemented to reduce the risk of transmission of the disease in the workplace and eliminate discrimination against hepatitis B positive workers.”

Meanwhile, the fight against discrimination and the stigma associated with the disease is also shared by a duly registered organization aptly called the Yellow Warriors Society of the Philippines (YWSP) who made a public debut in connection with the celebration of the first World Hepatitis Day slated on July 28.

“I speak for the many unnamed faces who may not even known that they have the virus today,” says Pamela Chan, YWSP spokesperson while adding, “The WHO described the diseases as 50 to 100 times more infectious than HIV… We implore for the support of our government to push for programs such as hepatitis B detecting to be more accessible to many regardless of social status, religion, gender and other biases.”

Come August 27, YWSP together with HSP is organizing a fun run in commemoration of the World Hepatitis Day celebration. Venue is yet to be announced.

HSP current president Dr. Marilyn Arguillas gives more details on the activities prior to the fun run. “In answer to our mission and vision in providing comprehensive and continuous medical education, we have a medical caravan going around the country to educate the doctors and the public, as well as the and the baranggay health workers. We also conduct lay forums with the students to aid awareness and correct information.”

Hepatitis Treatment Access Program

Also in time for the World Hepatitis Day celebration, HSP, in patnership with Roche officialy launched the PEGASSIST Easy Access Plan for patients with hepatitis B. This is an innovative first-of-its-kind treatment access program that aims to provide Hepatitis B patients with the means to finance the medication and treatment they need to combat the disease.

Through the program, patients with hepatitis B can have access to the peg-interferon alfa-2a hepatitis treatment medication with discounts up to as much as 50 percent. “It socializes the medication discount system. This means, patients who truly cannot afford the medication will get a higher discount accordingly,” says Dr. Dennis Dioko, Roche specialty business unit director.

“For patients who are interested to see if they qualify for discounts through the PEGASSIST Easy Access Plan, there are several ways to find out. First, if they are seeing a gastroenterologist, their doctor can refer them to the Hepatitis Hotline (718-7620).”

In addition to providing discounts for the medication, patients will also be provided with free selected laboratory tests that would havev otherwise been very expensive. Tests such as HBV DNA Testing and S-quantification are samples of laboratory tests patients can have access to.

“The program hopes to be able to make treatment and care available to a wider range of hepatitis B patients and given them the opportunity to get the medication they need. In addition to discounted medication and discounted laboratory tests, the hotline will also provide a nurse assistance program that will continue follow-ups on patients throughout the course of treatment. And for patients who wish to pay through credit card, they can opt to pay via staggered payments to make the payments even easier on their budgets,” says Dr. Dioko. –ROWENA BAUTISTA-ALCARAZ, Manila Bulletin