Hepatitis B feared, but is curable
Hepatitis B feared, but is curable
The World Health Organization estimates that 2 billion people are infected by Hepatitis B virus (HBV) and of that amount 400 million chronically infected, which left untreated could develop into cirrhosis or liver cancer.
George K.K. Lau from the Hong Kong University said that 75 percent of the people with HBV were from the Asia-Pacific region.
Indonesia ranks third after China and India. Hepatitis B causes extensive liver damage and is often transmitted through maternal-infant vertical transmission.
"It is very important to disseminate the information about this disease because it slowly transgresses, so many people will not able to detect it until it reaches an advanced stage. At around 40 to 60 years, if left untreated, people will already have liver cancer or cirrhosis," he said.
Indonesia with an estimated 11.6 million people with HVB, he said, was only one tenth of the number that China dealt with, which saw 120 million people.
But Indonesia has the same problem as other countries in Asia where many patients are left untreated, he added. It is necessary to reduce the risk of getting liver cancer if not Indonesia, for example, faces the death of 50,000 people every year from this disease," Lau said.
Stemming from this concern, Lau, who is a physician at the Queen Mary Hospital in Hong Kong, conducted a study on the treatment of Hepatitis B along with a number of specialists from throughout the world. His study was published in the June edition of The New England Journal of Medicine.
The study itself was initiated in 1998 and was completed last year, involving 841 patients.
"Treatments for chronic hepatitis B are suboptimal. In the search for improved therapies, we compared the efficacy and safety of pegylated interferon alfa or Pegasys plus lamivudine, pegylated interferon alfa without lamivudine and lamivudine alone for the treatment of hepatitis B e antigen (HBeAg) -- positive chronic hepatitis B.
Peginterferon alfa-2a or Pegasys works in two ways: stimulating the immune system and inhibiting viral replication. It is taken once a week for 48 weeks.
Lamivudine is an oral medicine that is taken once a day to treat chronic hepatitis B. The drug belongs to a class of medicine called "nucleoside analogs." Patients typically have to keep taking this medicine indefinitely. In addition, long-term treatment may also result in drug resistance and as a consequence there will be progression of liver disease and liver damage.
Current consensus guidelines from Asia, Europe and the United States recommend lamivudine, adevoir or conventional interferon alfa for the treatment of chronic hepatitis B. Pegasys however, had been widely used in the treatment of hepatitis C.
During the 48-week observation period, many patients tolerated Pegasys very well, Lau said, adding that there were expected side effects like fatigue, headaches, myalgia and pyrexia.
"The number of those who got minor side effects is insignificant," he said.
What is the clinical implication of Lau's study then?
It was found that peginterferon alfa-2a alone or in combination with lamivudine resulted in higher rates of sustained HBeAg HBsAg, virologic and biochemical response among patients with HBeAg-positive chronic hepatitis B than did lamivudine alone.
One example, he said, was a 44-year-old patient. This unidentified patient was diagnosed with hepatitis B after his brother died of liver cancer. Amazingly, Lau said, this man could achieve Seroconversion without a dose reduction in his 44-week long treatment using this new combination of Pegasys.
Manufactured by Roche, Pegasys was already approved by Indonesian's Food and Drug Agency (BPOM) last month, nine months earlier than expected.
In terms of cost, Lau said it would save much of the expenses because of the finite treatment duration. -- Emmy Fitri